Acute Allergic Conjunctivitis Research Articles

Results of Observational Study and Integration of Epinastine 0,05% in Treatment Algorythms of Patients with Seasonal Allergic Conjunctivitis

Objective. To assess tolerability and the time of onset of clinical effect of dual­-action antihistamine agents — Epinepta® (epinastine 0.05 %) and olopatadine 0.1 % in patients with seasonal allergic conjunctivitis (SAC).Subjects and methods. This was a prospective multicenter observational study. One hundred fifty patients with SAC (n = 150) were included into the study and divided into two groups (n = 75) in each. Patients in group 1 received epinastine 0.05 %, while patients into group 2 received olopatadine 0.1 %. Evaluation of clinical symptoms severity was performed using itching scale, hyperemia Efrone scale, eyelid swelling scale, lacrimation P. Munk scale, Shirmer test and Norn probe. Patients and healthcare providers satisfaction rate was assessed by Likert scale, patients self-­control diary that helped to assess dry eye severity symptoms. Treatment period lasted 14 days.Results. Seasonal allergic conjunctivitis treatment with epinastine 0.05 % or olopatadine 0.1 % was equally effective. However epinastine 0.05 % was causing dry eye symptoms in lesser degree than olopatadine 0.1 %. These results refer to all parameters assessed by patients’ self­-control diary — itching, discomfort, burning, eye blockage feeling.Conclusion. The study evaluated epinastine 0.05 % advantages compared to olopatadine 0.1 % in tear film preservation and causing less pronounced symptoms of dry eye in patients with acute seasonal allergic conjunctivitis. Monotherapy of seasonal allergic conjunctivitis with epinastine 0.05 % demonstrated high efficacy and lead to SAC clinical manifestations regress. Epinastine 0.05 % is recommended as a first line treatment of SAC.

Incidence of Acute Allergic Conjunctivitis in Workers at the Port of Santos

Incidence of Acute Allergic Conjunctivitis in Workers at the Port of Santos

High baseline prevalence of atopic comorbidities and medication use in children treated with allergy immunotherapy in the REAl-world effeCtiveness in allergy immunoTherapy (REACT) study.

Respiratory allergy, commonly manifesting as allergic rhinitis (AR) and asthma, is a chronic progressive disease that frequently starts in childhood. Allergy immunotherapy (AIT) is the only causal treatment for respiratory allergy with the potential to modify the underlying cause of allergy and, ultimately, prevent disease progression. This analysis aimed to determine if AIT is received sufficiently early to halt the progression of allergic disease, by characterizing the burden and progression of disease in children prior to AIT initiation in real-life clinical practice. The REAl-world effeCtiveness in allergy immunoTherapy (REACT) study was a large retrospective cohort study using German claims data between 2007 and 2017. Characteristics of two pre-defined AIT age cohorts from the REACT study - children (aged <18 years) and adults (aged ≥18 years) - were evaluated during the 1-year period before the first AIT prescription. For comparison, a control group of all subjects with a confirmed diagnosis of AR and without prescriptions for AIT was included. Burden of disease was assessed using diagnostic codes for atopic comorbidities [e.g., atopic dermatitis (AD), asthma, and acute allergic conjunctivitis] and non-atopic comorbidities (e.g., migraine, headache); medication use, recorded as prescriptions for symptom-relieving AR medication and reliever/controller medication for asthma, was also assessed. Data were analyzed descriptively, using summary statistics. Both children (n = 11,036) and adults (n = 30,037) showed a higher prevalence of atopic comorbidities and a greater drug burden prior to AIT initiation compared to AR patients not treated with AIT (n = 1,003,332). In the two age-specific AIT cohorts, children consistently showed the highest prevalence of atopic comorbidities compared to adults (AIT children, AIT adults - asthma: 41.4%, 34.5%; AD: 19.9%, 10.2%; acute allergic conjunctivitis: 13.6%, 10.2%). Generally, prescriptions per year for symptom-relieving AR and asthma treatments were also higher for children initiating AIT vs. adults (AIT children, AIT adults - AR prescriptions per subject: 1.72, 0.73; asthma prescriptions per subject: 1.42, 0.79). Children with AR who are offered AIT in real-life show considerable disease burden prior to initiation. As AIT may alleviate the burden and halt the progression of allergic disease, considering AIT earlier in the disease course may be warranted.

- The present comparative cross sectional study was planned to compare cytokine levels in the tear of patients with acute allergic conjunctivitis

- The present comparative cross sectional study was planned to compare cytokine levels in the tear of patients with acute allergic conjunctivitis

Evaluation of AYUSH PE Eye drops in the management of acute allergic conjunctivitis

Abstract Introduction: Ocular allergy is one of the most common prevalent clinical conditions in the world with a rapid increase in the past few years. It has a multifactorial etiology and is a conjunctival inflammatory response due to immunoglobulin E-mediated mast cell activation. The disease is characterized by itching, redness, burning sensation, and watering of eyes which go off and on. Abhishyanda, a disease having similar characteristics, is described in Ayurveda, for which extensive treatment modalities are available in the classical texts. Hence, a safe, and cost-effective potent Ayurveda drug, AYUSH PE Eye drops was developed after undergoing all quality assurance tests. Materials and methods: A multicenter open-labeled single-group prospective study was conducted at four research institutes of the Central Council for Research in Ayurvedic Sciences (CCRAS), Ministry of AYUSH, from May 2019 to December 2019. A total of 221 participants who had signs and symptoms of acute manifestation of allergic conjunctivitis (AC) were enrolled based on purposive sampling at four study sites. The participants were evaluated based on the signs and symptoms of AC using the visual analog scale score (0–100). Two drops of the drug AYUSH PE Eye drops were instilled to the affected eyes six times a day and the patients were reviewed after 1 week. The medicine was then stopped and a second follow-up was done again after 1 more week. Results: A total of 217 participants were analyzed for the outcomes. Statistically significant changes were observed in all the assessment parameters, namely itching, redness of eyes, watery discharge, lid swelling, foreign body sensation, liking for warm touches, heaviness in eyes, feeling of stickiness in eyes, the appearance of allergic hue in eyes, feeling of excessive cold in eyes, and slimy secretions from eyes at 7th day (P &lt; 0.001) and at 14th day (P &lt; 0.001) as compared to baseline. Conclusion: AYUSH PE Eye drops are safe and effective in the management of acute AC.

Identification of Risk Factors for Dupilumab-associated Ocular Surface Disease in Patients with Atopic Dermatitis.

This study identified risk factors for the development of dupilumab-associated ocular surface disease in patients with moderate-to-severe atopic dermatitis in a large prospective daily practice cohort. Data from the Dutch BioDay Registry were used to assess the risk of developing dupilumab-associated ocular surface disease, by performing univariate and multivariate logistic regression analyses. A total of 469 patients were included, of which 152/469 (32.4%) developed dupilumab-associated ocular surface disease. Multivariate analysis showed a statistically significant association of the development of dupilumab-associated ocular surface disease with a history of any eye disease (history of self-reported episodic acute allergic conjunctivitis excluded) combined with the use of ophthalmic medication at the start of dupilumab (odds ratio 5.16, 95% confidence interval 2.30–11.56, p < 0.001). In conclusion, a history of any eye disease (history of self-reported episodic acute allergic conjunctivitis excluded) combined with the use of ophthalmic medication at baseline was associated with the development of dupilumab-associated ocular surface disease in patients with atopic dermatitis.

Therapeutic Efficacy of Topical Olopatadine 0.1% Versus Ketotifen Fumarate in Allergic Conjunctivitis

Objective: To compare the therapeutic efficacy of topical Olopatadine 0.1% versus Ketotifen Fumarate among the patients diagnosed with allergic conjunctivitis at Armed forces institute of ophthalmology.&#x0D; Study Design: Prospective comparative study.&#x0D; Place and Duration of Study: Armed forces Institute of Ophthalmology, Rawalpindi, from Jan 2020 to Jan 2021.&#x0D; Methodology: Patients diagnosed with allergic conjunctivitis by consultant ophthalmologist fulfilling the exclusion/inclusion criteria were included in the study. They were divided into two groups by block randomization with group A receiving Olopatadine 0.1%, while group B just received the Ketotifen Fumarate. Symptoms were assessed on a symptom severity score upon diagnosis before the start of medication and then after 72 hours of treatment by a different consultant ophthalmologist who was unaware of the group of patients.&#x0D; Results: A total of 100 patients were included in each group. The mean age of the study participants was 30.944 ± 3.349 years. 148 (74%) patients were males while 52 (26%) were females. The difference in mean score of symptoms in group A was 5.76 ± 1.39 while in group B was 3.33 ± 2.51. Application of t-test revealed that topical Olopatadine 0.1% was superior to Ketotifen Fumarate in reducing the symptoms of acute allergic conjunctivitis on the third day of treatment (p-value&lt;0.001).&#x0D; Conclusion: Seasonal allergic conjunctivitis was the commonest type of allergic conjunctivitis seen in our study participants. Topical Olopatadine 0.1% emerged as a better treatment option when compared to Ketotifen Fumarate for immediate management of acute allergic conjunctivitis among patients managed at a tertiary...................

Identification of Risk Factors for Dupilumab-associated Ocular Surface Disease in Patients with Atopic Dermatitis.

This study identified risk factors for the development of dupilumab-associated ocular surface disease in patients with moderate-to-severe atopic dermatitis in a large prospective daily practice cohort. Data from the Dutch BioDay Registry were used to assess the risk of developing dupilumab-associated ocular surface disease, by performing univariate and multivariate logistic regression analyses. A total of 469 patients were included, of which 152/469 (32.4%) developed dupilumab-associated ocular surface disease. Multivariate analysis showed a statistically significant association of the development of dupilumab-associated ocular surface disease with a history of any eye disease (history of self-reported episodic acute allergic conjunctivitis excluded) combined with the use of ophthalmic medication at the start of dupilumab (odds ratio 5.16, 95% confidence interval 2.30-11.56, p < 0.001). In conclusion, a history of any eye disease (history of self-reported episodic acute allergic conjunctivitis excluded) combined with the use of ophthalmic medication at baseline was associated with the development of dupilumab-associated ocular surface disease in patients with atopic dermatitis.

Tele-ophthalmology as an aid tool for primary care physicians in the IDF, during the Covid-19 lockdown.

PurposeTo describe tele-ophthalmology consultations for primary-physicians in the IDF during the Covid-19 lockdown.MethodsRetrospective cross-sectional study. Medical records of tele-ophthalmology consultations from March to June 2020 were reviewed.ResultsThe study included 245 cases in which an ophthalmologist was consulted. In 62.0% cell-phone camera photographs were used. The mean age was 21.5 ± 6.4 years. The most common diagnoses were acute-conjunctivitis (8.6%); conjunctival-hyperemia (non-specific diagnosis, 8.2%); scleritis/episcleritis (7.3%); chronic allergic-conjunctivitis (7.3%); chalazion (7.3%) hordeolum (6.5%); acute allergic-conjunctivitis (4.5%). 37.6% of patients received primary physician-based treatment, 24.9% of patients received specialist-based treatment. 13.1% were referred to the ER. The consult prevented ER referral for 39.2% and changed the physician's treatment plan in 70.6% of cases. Foreign-body sensation complaints were more likely treated by a primary-physician (p = 0.015). Cases with suspected foreign-body diagnosis were referred more to the ER (p < 0.001). For most cases of eyelid complaints and diagnoses, primary physician care was sufficient (p < 0.001). Conjunctival complaints and diagnoses received significantly more ophthalmologist-based treatment (p < 0.001). Corneal disorders were significantly referred more to the ER (p = 0.001).ConclusionDespite of possible ethical and legal problems and clinical limitations of this instrument, Tele-ophthalmology using objective aids such as smartphone photography can be an efficient tool in aiding the primary-physician, especially for patients with low access to ophthalmologists, with major impact on patient management.

Effectiveness of Subconjunctival Cyclosporine in Treatment of Acute Allergic Conjunctivitis in a Rat-Model.

BackgroundEye allergy is widely spread worldwide. The treatment includes topical anti-histamines, steroids and non-steroidal drugs. Steroids are the first choice by many ophthalmologists, but unfortunately they may cause serious side effects. Cyclosporine A (CsA) is an immunomodulator drug that can improve eye allergy and reduce the need for steroids; however, topical preparation of CsA is difficult because of the lipophilic nature of the drug.MethodsAn experimental study included 16 rats with induced allergy were divided into 2 groups. Group 1: allergic non-treated (6 rats), and Group 2: allergic treated with 0.5 mL subconjunctival CsA 1% (10 rats). Half of each group was sacrificed at 24 hrs and the other half at 1 week. Conjunctival hyperemia and eosinophilic cell count were assessed at each time.ResultsGroup 2 (CsA treated) showed significantly lower hyperemia score and eosinophilic count at both 24 hrs and 1 week. No ocular complications were noted.ConclusionSubconjunctival CsA was safe and effective in treating ocular allergy through improving conjunctival hyperemia and reducing eosinophilic cell count with no significant ocular side effects.

External Ophthalmomyiasis Presenting as Acute Allergic Conjunctivitis in a Patient Belonging to Urban Population of East India- A Rare Case Report

External Ophthalmomyiasis Presenting as Acute Allergic Conjunctivitis in a Patient Belonging to Urban Population of East India- A Rare Case Report

A Murine Model of Acute Allergic Conjunctivitis Induced by Continuous Exposure to Particulate Matter 2.5.

Several pieces of epidemiologic evidence have indicated PM2.5 (particulate matter with a diameter of 2.5 μm or less) as a causing factor of allergic conjunctivitis, but without experimental elucidation of mechanism. In the present study, PM2.5 in solution was directly applied to the mouse ocular surface to elucidate whether PM2.5 might cause allergic conjunctivitis, and its underlying mechanisms were analyzed. ICR mice were challenged for 18 consecutive days with eye drops containing PM2.5 at 3.2, 6.4, and 12.8 mg/mL in 0.9% NaCl saline, along with the controls prepared in parallel without PM2.5 and another control group treated with both PM2.5 at 12.8 mg/mL and artificial tears. On day 19, the whole eyes and meibomian glands were harvested for histopathological analyses and assessment of clinical scoring, tear volume, tear breakup time, and tear ferning. Furthermore, goblet cells by periodic acid Schiff stain and infiltrated eosinophils by Giemsa stain were quantified and compared among study groups. Clinical scoring showed more eyelid edema, tearing, and scratching behaviors, with longer tear breakup time under the influence of increased PM2.5 concentrations. Tear ferning assay showed less tear crystal formation and decreased crystal branches after exposure to PM2.5. In addition, higher goblet cell density in the upper palpebral conjunctiva and extensive eosinophil infiltration in the entire conjunctiva and in the meibomian glands were induced by PM2.5. These results demonstrate that PM2.5 can induce symptoms similar to clinical allergic conjunctivitis and that the murine acute allergic conjunctivitis model can be induced by direct exposure to PM2.5.

Allergic Conjunctivitis

Allergic conjunctivitis is a condition characterized by conjunctival inflammation caused by airborne allergens. The symptoms include: itching, excessive lacrimation, discharge, and conjunctival hyperaemia pink eye). The disease usually affects young adults and is associated with other allergic conditions like allergic rhinitis, and bronchial asthma for example. There are three types of allergic conjunctivitis, namely acute allergic conjunctivitis, seasonal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC). The diagnosis is primarily clinical and the prevalence is on the increase. Therapeutic modalities include a combination of topical vasoconstrictor and antihistamine therapies, topical antihistamines with mast cell stabilising properties, topical mast cell stabilisers, topical glucocorticosteroids and (in some cases) oral antihistamines when necessary.

Topical treatment options for allergic conjunctivitis

Allergic conjunctivitis can be classified as an acute or chronic condition. Acute allergic conjunctivitis encompasses seasonal allergic conjunctivitis and perennial allergic conjunctivitis. The more severe chronic conditions include vernal keratoconjunctivitis, acute keratoconjunctivitis and giant papillary conjunctivitis. The mainstay in the treatment of allergic conjunctivitis remains the use of topical dual-acting agents which have mast cell stabilising properties and act as antihistamines. Although corticosteroids are among the most effective agents in the treatment of allergic conjunctivitis, they can cause serious adverse effects and their use should be reserved for short-term “pulse” treatment to gain quick control of the symptoms. Topical nonsteroidal anti-inflammatory drugs can also cause corneal melting. However, their use may be considered in severe cases to reduce the use of topical steroids. Several new agents acting at newly identified targets in the inflammatory process are under investigation for the treatment of allergic conjunctivitis.

Comparative Evaluation of Olopatadine 0.01% Combined Fluorometholone 0.1% Treatment Versus Olopatadine 0.01% Combined Ketorolac 0.4% Treatment in Patients with Acute Seasonal Allergic Conjunctivitis

Purpose: To evaluate the therapeutic effects of low-effective steroid fluorometholone 0.1% and non-steroidal anti-inflammatory ketorolac 0.4% when concomitantly used with olopatadine 0.01% in relieving clinical signs and symptoms of acute seasonal allergic conjunctivitis (SAC).Methods: In this randomized, placebo-controlled, multi-center study, 104 eyes of 52 patients with the diagnosis of SAC were conducted. The patients were assigned into two groups to receive either olopatadine and fluorometholone one eye and placebo in the contralateral eye or olopatadine and ketorolac one eye and placebo in the contralateral. The clinical signs (chemosis, mucus secretion, eyelid edema) and symptoms (itching, redness, tearing, burning) of the patients were evaluated by summing up the scores using a 3-point scale. Results were analyzed by Mann-Whitney U test, p values less than 0.05 were defined as significant.Results: All parameters were improved less amount on the first day of the treatment in both groups, however, significant reduction in clinical signs and symptoms were seen on the 10th day compared with those receiving placebo. Fluorometholone was found superior to ketorolac in reducing redness, mucus secretion, chemosis and eyelid edema (p = 0.032 for redness, p = 0.028 for mucus secretion, p = 0.030 for chemosis, p = 0.042 for eyelid edema) and both drugs were similar in alleviating the symptoms itching, burning and tearing (p = 0.074 for itching, p = 0.064 for burning, p = 0.072 for tearing).Conclusions: Fluorometholone was better than ketorolac in relieving redness, chemosis, mucus secretion and eyelid edema when concomitantly used with olopatadine, however, these two drugs were found equal in attenuating the symptoms itching, burning and tearing.

Effectiveness of Nonpharmacologic Treatments for Acute Seasonal Allergic Conjunctivitis

To investigate whether artificial tears and cold compress alone or in combination provide a treatment benefit and whether they were as effective as or could enhance topical antiallergic medication. Randomized, masked clinical trial. Eighteen subjects (mean age, 29.5±11.0 years) allergic to grass pollen. Controlled exposure to grass pollen using an environmental chamber to stimulate an ocular allergic reaction followed by application of artificial tears (ATs), 5 minutes of cold compress (CC), ATs combined with CC, or no treatment applied at each separate visit in random order. A subset of 11 subjects also had epinastine hydrochloride (EH) applied alone and combined with CC in random order or instillation of a volume-matched saline control. Bulbar conjunctival hyperemia, ocular surface temperature, and ocular symptoms repeated before and every 10 minutes after treatment for 1 hour. Bulbar conjunctival hyperemia and ocular symptoms decreased and temperature recovered to baseline faster with nonpharmaceutical treatments compared with no treatment (P <0.05). Artificial tears combined with CC reduced hyperemia more than other treatments (P <0.05). The treatment effect of EH was enhanced by combining it with a CC (P <0.001). Cold compress combined with ATs or EH lowered the antigen-raised ocular surface temperature to less than the pre-exposure baseline. Artificial tear instillation alone or CC combined with ATs or EH significantly reduced the temperature (P <0.05). Cold compress combined with ATs or EH had a similar cooling effect (P >0.05). At all measurement intervals, symptoms were reduced for both EH and EH combined with CC than CC or ATs alone or in combination (P <0.014). After controlled exposure to grass pollen, CC and AT treatment showed a therapeutic effect on the signs and symptoms of allergic conjunctivitis. A CC enhanced the use of EH alone and was the only treatment to reduce symptoms to baseline within 1 hour of antigenic challenge. Signs of allergic conjunctivitis generally were reduced most by a combination of a CC in combination with ATs or EH.

Conjunctival provocation test in ophthalmology daily practice

AbstractConjunctival provocation Test (CPT) is the main technique that may lead to the etiologic diagnosis of allergic conjunctivitis (AC). In most cases of seasonal and acute AC, the relationship with an allergen exposure is easily assessed. But in cases of perennial AC or in vernal as well as in atopic keratoconjunctivitis, the pertinence of the sensitization should be evidenced. To do this, CPT is the one tool available. The ophthalmologist plays a major role in its daily practice. Before CPT, a slit lamp examination is mandatory to avoid any contraindication (elevated clinical scoring, corneal impairment). The rating of symptoms occurring during CPT requires the ophthalmologist's collaboration as well as management of reactions consecutive to the instillation of increasing doses of allergens. Thus CPT requires a narrow collaboration between the ophthalmologist and the allergist.

Anti-allergic ophthalmic drugs in general practice: which, why and when?

Ocular allergies present in many different guises. They may vary from self-limiting episodes of acute allergic conjunctivitis, to potentially sight-threatening chronic conditions, such as vernal keratoconjunctivitis. This article provides a brief description of the different ocular allergic conditions to aid accurate diagnosis. It also focuses on the different types of anti-allergic ophthalmic preparations and how to employ them in a logical, stepwise management strategy to obtain optimal results, while minimising exposure to potent drugs with potentially serious side-effects.

Topical tacrolimus for the management of acute allergic conjunctivitis in a mouse model

Acute allergic conjunctivitis is a constantly challenging condition that often requires steroids for effective management. Alternative treatment options are needed due to the potential side effects of steroids. Tacrolimus has been used for vernal/atopic conjunctivitis. The aim of our study was to investigate the therapeutic effect of topical administration of 0.03% tacrolimus (eye drops or ointment) in comparison to 0.1% dexamethasone in a mouse model of acute allergic conjunctivitis. BALB/c mice were sensitized by an intraperitoneal injection of 10μg/0.2ml ovalbumin (OVA) absorbed on ALUM (2.0mg) on days 1 and 8. They were challenged by topical instillation of 2μl of 15% OVA (absorbed in 10% glycerol) twice daily, on days 15-21. Treatment was administered twice daily on days 17-21. Mice were randomly assigned topical treatment groups: Group 1, 0.1% dexamethasone drops; Group 2, 0.03% tacrolimus drops; Group 3, 0.03% tacrolimus ointment; Group 4 PBS drops (control). On day 22 all mice underwent clinical evaluation, blood sampling for IgE levels, and conjunctivas were removed for eosinophil counting. IgE and OVA-specific IgE levels were similar among all groups, demonstrating induction of allergic reaction in all mice. Significantly lower clinical scores were found among all treated groups as compared to controls (P < 0.001), while no significant difference was found among the three treatment groups (P > 0.05). Conjunctival eosinophil counts were significantly lower in Group 1 (P < 0.05) as compared to the other groups. The clinical efficacy of topical 0.03% tacrolimus was similar to 0.1% dexamethasone for acute allergic conjunctivitis.

Relation Between Total Tear IgE and Severity of Acute Seasonal Allergic Conjunctivitis

Purpose: Measurement of total tear immunoglobulin E (IgE) is useful for the diagnosis of allergic conjunctivitis, but it is still unknown whether measurement of total tear IgE is useful for assessment of the severity of allergic conjunctivitis. We evaluated the relation between the total IgE level in tears and objective signs of allergic conjunctivitis.Methods: A prospective, nonrandomized, and cross-sectional study was conducted in 84 patients with allergic conjunctivitis (allergic group) and 80 age- and sex-matched healthy control subjects (control group). The total tear IgE score was obtained with the Allerwatch® test (0, 1, and 2), and ten severity scores (0, 1, 2, 3) were determined for objective ocular findings of the palpebral and bulbar conjunctiva, as well as limbal and corneal lesions.Results: The scores for total tear IgE and each of the objective ocular findings were higher in the allergic group than in the control group (all p < 0.01). The total tear IgE score was correlated with the severity of each clinical feature of allergic conjunctivitis (p < 0.01), except for corneal epithelial damage in the allergic group. Multivariate analysis revealed that the severity of giant papillae was the most important indicator of the total tear IgE score (odds ratio = 1.33, p < 0.00001).Conclusion: The total tear IgE score was correlated with the scores for objective signs of allergic conjunctivitis. This rapid test for total IgE in tear fluid is easy to perform and could be used to assess the severity of allergic conjunctivitis on an outpatient basis.