Allergic Conjunctivitis Research Articles

Abnormalities of the Conjunctiva, Sclera, Cornea, and Anterior Chamber in Pathological Myopia

Pathological myopia is characterized by typical complications in the fundus resulting from the progression of high myopia. These complications include posterior staphyloma, myopic maculopathy, and widespread choroidal atrophy. This review aims to understand the abnormalities of the conjunctiva, sclera, cornea, and anterior chamber associated with pathological myopia.Patients with pathological myopia are found to be more prone to the dry eye syndrome. This condition is explained by increased axial length, increased proptosis, and rapid evaporation of the tear film. Children with allergic conjunctivitis are shown to have a higher risk of developing myopia and that finding is explained with induced retinal inflammation promoting myopia progression. Posterior staphyloma is one of the diagnostic features of pathological myopia, which can lead to the development of myopic maculopathy. It occurs due to changes in the curvature of the sclera. It is challenging to find a direct relationship between pathological myopia and corneal or anterior chamber abnormalities. Besides, searches for components of pathological myopia have not yielded sufficient results. Understanding the anterior segment abnormalities associated with pathological myopia can play a significant role in the treatment and management of the disease. Future researches should focus on the etiology of axial elongation and factors related to the formation of posterior staphyloma. If the pathogenesis of staphylomas can be elucidated, more specific treatment methods may be developed.

Investigating the Causal Relationship Between Gut Microbiota and Allergic Conjunctivitis: A Two-Sample Mendelian Randomization Study

ABSTRACT Purpose To investigate the causal association between gut microbiota and allergic conjunctivitis. Methods A two-sample Mendelian randomization (MR) analysis was performed using the summary statistics of gut microbiota (18,340) from MiBio-Gen consortium and allergic conjunctivitis data (n = 218,792) obtained from the IEU Open GWAS project. F-statistics and sensitivity analyses were used to address potential biases and ensure the reliability of our findings. Reverse MR analysis was conducted to assess the possible of reverse causal relationships. Results The inverse variance weighted estimates revealed the protective potential of the phylum Euryarchaeota against allergic conjunctivitis (OR = 0.87, p = 6.17 × 10−4). On the other hand, the genus Christensenellaceae R.7 group (OR = 0.75, p = 2.89 × 10−3), family Peptostreptococcaceae (OR = 0.83, p = 6.22 × 10−3), genus Lachnospiraceae FCS020 group (OR = 0.82, p = 0.02) all showed a suggestive protective association with allergic conjunctivitis. Additionally, sensitivity analysis confirmed the robustness of the above associations. In the reverse MR analysis, no significant causal association was found between gut microbiota and allergic conjunctivitis. Conclusion This study has revealed a potential causal correlation between the phylum Euryarchaeota and allergic conjunctivitis, offering new insights to improve prevention and treatment of this condition.

A comparative study of efficacy and tolerability of bepotastine besilate (1.5%) and olopatadine hydrochloride (0.1%) eye drops in allergic conjunctivitis in a tertiary care hospital of the southern part of India

Background: Allergic conjunctivitis is increasing with the rise in the levels of allergens. Drug therapy is usually needed in addition to avoidance of general allergens to treat this condition. Both bepotastine besilate and olopatadine hydrochloride ophthalmic solutions are newer additions in the treatment of allergic conjunctivitis having dual properties of second-generation antihistaminics along with mast cell stabilizing activity. Aims and Objectives: The aim of the study was to compare the efficacy and tolerability of bepotastine besilate (1.5%) and olopatadine hydrochloride (0.1%) eye drops in patients presenting with allergic conjunctivitis in a tertiary care hospital of Southern part of India. Materials and Methods: Sixty patients who were clinically diagnosed to be suffering from allergic conjunctivitis were selected as participants for the study. They were randomly distributed into two groups consisting of 30 patients each. One group received eye drop bepotastine (1.5%) and the other group received eye drop olopatadine (0.1%), with each patient receiving the medication twice daily for a duration of 2 weeks. During the first visit, all the patients were assessed for the signs and symptoms and subsequently re-assessed at weekly intervals for a period of 2 weeks. They were also advised to report occurrence of any unwanted drug reaction during the weekly follow-up visits. Results: The above study showed the effectiveness of both bepotastine and olopatadine eye drops in decreasing the signs and symptoms of allergic conjunctivitis. Significant clinical improvement was found in all participants, whereas deterioration was found in none of them. Statistically significant improvement of itching and redness of eyes was observed with use of both the study drugs mentioned beforehand. Both the drugs were well tolerated by the patients. Statistically significant reduction of itching and foreign body sensation was found to be more in patients using bepotastine eye drops compared to those using olopatadine eye drops. Only two patients using bepotastine eye drops complained of having a mild burning sensation in eyes. Conclusion: From this study, bepotastine and olopatadine eye drops have been observed to be safe and efficacious in allergic conjunctivitis. Bepotastine eye drop was found to be more efficacious to relieve itching and foreign body sensation compared to that of olopatadine eye drops.

Assessing Prevalence and Severity of Dry Eye Disease Across Various Types of Allergic Conjunctivitis

Background: Allergic conjunctivitis (AC) is a prevalent ocular condition triggered by environmental allergens, causing significant discomfort and reduced quality of life. Dry Eye Disease (DED), marked by ocular discomfort and visual disturbances, frequently overlaps with AC symptoms. This study examines the prevalence of DED in AC patients and explores the relationship between different AC types and DED severity. Method: A cross-sectional, observational study was conducted from June to September 2023 in the Department of Ophthalmology at a tertiary center in North India. A total of 264 AC patients aged 18 years and older with itchy eyes were included. Patients with contact lens use, recent ocular surgery, trauma, corneal pathology, or certain systemic diseases were excluded. DED was assessed using the Ocular Surface Disease Index (OSDI), Schirmer’s test, and Tear Film Break-Up Time (TFBUT). Results: DED was found in 70% of AC patients, with 20% mild, 19% moderate, and 32% severe cases. Females were more affected (64%). VKC patients showed higher tear production and better TFBUT scores. PAC patients had the most severe DED. Conclusion: DED is common in AC patients, with PAC associated with more severe DED, while VKC shows milder symptoms. Tailored treatment approaches are needed for managing AC and DED.

Manajemen Rhinitis Alergi

Allergic rhinitis (AR) is an atopic disease characterized by symptoms of nasal congestion, clear rhinorrhea, sneezing, postnasal drop, and nasal pruritis. The disease affects one in six people and is associated with significant morbidity, loss of productivity, and health care costs. Historically, AR was considered a disease process in the nasal airways only, although it is not serious, allergic rhinitis should be considered as a quite serious condition because it can affect the sufferer's quality of life due to the severity of the symptoms experienced and can also cause various complications. However, the development of integrated airway theory has classified AR as a component of the systemic allergic response, with other related conditions, such as asthma and atopic dermatitis, having an underlying systemic pathology. Even though it is not serious, allergic rhinitis should be considered as a quite serious condition because it can affect the sufferer's quality of life due to the severity of the symptoms experienced and can also cause various complications. In addition to nasal symptoms, patients with AR may also experience allergic conjunctivitis, non-productive cough, Eustachian tube dysfunction, and chronic sinusitis. Once diagnosed, AR can be treated in a variety of ways, with intranasal glucocorticoids being the first line of therapy.

Ocular disorders and compliance to protective eyewear among quarry workers in Akamkpa local government area of cross river state, Nigeria

The quarry industry over time has played a pivotal role in the transformation of the physical environment but with attendant negative effects on workers. This study ascertained the pattern of work related ocular disorders and compliance to protective eye devices among quarry workers in Akamkpa LGA, Cross River State Nigeria. This descriptive cross sectional study employed the use of a structured interview followed by a comprehensive external examination of the eyes of the subjects by qualified eye care practitioners. Data generated was analysed using the Statistical Product for Service Solution (SPSS) version 25.0. Results were presented descriptively using tables and figures. The study took place in 8 quarry sites located in 4 communities randomly selected and involved 184 subjects randomly selected comprising of 140 (76.09%) males and 44 (23.91%) females. The age of the participants ranged from 18-60 years with a mean age of 32.03±2.23 (SD). The study revealed that predominant ocular symptoms experienced were blurry vision (31.5%), itchy eyes (27.94%), ocular irritation/ grittiness (15.55%), eye/ headaches (12.46%) and discharges (9.61%). The most common ocular surface anomalies observed were pterygium (41.80%), corneal scar/ ulceration (18.03%) and allergic conjunctivitis (16.39%), while the most frequent type of eye injuries reported were superficial foreign bodies, blunt trauma and superficial ocular abrasion accounting for 50.92%,30.06% and 11.04% respectively. Injuries due to quarrying activities were more common among labourers (41.10% and 29.45% among stone crushers and stone processors respectively), while workers with less than 5 years work experience reported more work related eye injury (74.85%) with broken stones (80.39%) accounting for most of the injuries. Similarly, a majority (94.7%) of the participants had knowledge of Personal Protective Eye Devices (PPEDs) only 26.44% had the appropriate PPEDs and just 30.43% of them complied regularly with their usage during work. There was a statistically significant association between work experience and the occurrence of work related ocular injuries (p>0.001) but the use of PPEDs has no statistically significant association with the occurrence of eye injuries. The study concluded that workers at the Akamkpa quarry, Nigeria suffered various types of work related ocular anomalies and while a majority of them had prior knowledge of the benefits of PPEDs, the level of availability and utilization is relatively low and recommended health education and strict enforcement of safety regulations.

Correlation between forkhead box P3 (rs3761548) gene polymorphism and serum interleukin13 as biomarkers of severity in Egyptian allergic conjunctivitis: a retrospective study.

The genetic variants that alter human Forkhead Box P3 (FOXP3) function may have a part in the establishment of allergic conjunctivitis. Our study aimed to evaluate the FOXP3 polymorphism, serum interleukin13 (IL13) and total immunoglobulin E (IgE) levels in allergic conjunctivitis and assess their role as biomarkers for allergic conjunctivitis risk and severity. This study included 52 cases and 52 controls. Blood samples were taken from allergic conjunctivitis patients and controls for total IgE, IL13 measurement and detection of FOXP3 (rs3761548) gene polymorphism. There was a statistically significant difference between the allergic conjunctivitis group and healthy control group regarding FOXP3 (rs3761548) polymorphism with those have AA genotype are 12 times at risk for allergic conjunctivitis and A allele increases the risk of allergic conjunctivitis by about 4 times. There was statistically significant difference between mild/moderate and severe allergic conjunctivitis regarding FOXP3 (rs3761548) polymorphism with those have AA genotype are 53 times at risk for severe allergic conjunctivitis and A allele increases the risk of severe allergic conjunctivitis by about 6 times. Also, there was a significantly higher value of total IgE IU/ml, IL13 Pg/ml value in severe allergic conjunctivitis compared to moderate/mild allergic conjunctivitis. The best cutoff values of total IgE and serum IL13 for detecting the severity of allergic conjunctivitis were ≥320 IU/ml and ≥40 Pg/ml and the area under the curve were 0.89 and 0.95 respectively. The research significantly contributes to find correlation of FOXP3 polymorphism, total IgE and IL13 with risk and severity of allergic conjunctivitis which are limited in the literature on the perceived value relevance of FOXP3 polymorphism in allergic conjunctivitis risk and severity.

Development of a Temperature and pH Dual-Sensitive In-Situ Gel for Treating Allergic Conjunctivitis.

The purpose of this study was to improve the efficacy of olopatadine hydrochloride (OT) in treating allergic conjunctivitis (AC). To achieve this goal, we developed an eye formulation without antimicrobial agents using a temperature-pH dual-sensitive in situ gel technology combined with heat sterilization. Various types of carbomers were evaluated and their optimal doses determined. The prescription containing poloxamer 407 (P407) and poloxamer 188 (P188) was optimized using central composite design for response surface methodology (CCD-RSM). The final optimized dual-sensitive in situ gel (TP-gel) consisted of 0.1% olopatadine hydrochloride, 18.80% P407, 0.40% P188, 0.30% Pemulen™TR-1(TR-1), 4.0% mannitol, and 0.08% Tri(hydroxymethyl)aminomethane(Tris).Sterilization was performed at a temperature of 121℃ for a duration of 20 min. Experimental results showed that TP-gel had good safety profile and remained on the ocular surface for approximately (65.83 ± 8.79) minutes, which is four times longer than eye drops. The expression levels of IL-13, IL-17, and OVA-IgE in mouse ocular tissues with allergic conjunctivitis treated with TP-gel were significantly reduced. This suggests that TP-gel has the potential to be an effective treatment method for allergic conjunctivitis.

Epidemiological investigation of allergic rhinitis in children aged 6-12 years in Bayannur City, China.

Allergic rhinitis (AR) is an inflammatory condition of the nasal mucosa triggered by exposure to non-harmful substances. Over the past decade, the prevalence of AR in Chinese children has been steadily increasing. However, detailed epidemiological data on AR in children from Bayannur City are lacking. This study randomly selected six primary schools in Bayannur City. Electronic questionnaires were distributed via the web, and parents and children completed the questionnaires by scanning the two-dimensional code within a designated timeframe. Statistical analysis was performed on the collected data. A total of 4,754 valid responses were obtained. The self-reported prevalence of AR among children in Bayannur city was 39.79%. Multivariate analysis revealed that male gender, belonging to an ethnic minority, a history of food or drug allergies, frequent antibiotic use (≥3 times per year in the past two years, with each course lasting ≥3 days), and residence in urban or pastoral areas was associated with an increased prevalence of AR in children. The proportion of children experiencing moderate to severe AR hat impacted their studies or daily life was 48.78%. Chronic AR was reported in 56.71% of cases. Among AR patients with other allergic conditions, the incidence rates were as follows: bronchial asthma 35.99%, upper airway cough syndrome (UACS) 64.32%, secretory otitis media (SOM) 22.41%, obstructive sleep apnea hypopnea-syndrome (OSAHS) 49.58%, allergic dermatitis (AD) 48.72%, and allergic conjunctivitis (AC) 85.20%. The prevalence of AR was 50.30% in urban areas, 13.733% in rural areas and 20.90% in pastoral areas. Seasonal effects on AR prevalence were notably significant in urban and pastoral regions. The prevalence of AR among children in Bayannur city was 39.80%. Of those with AR, 48.72% experienced significant impacts on their learning or daily life, while only 14.80% had no other allergic conditions. There were significant variations in the prevalence and onset of AR among children between urban, agricultural and pastoral areas.

Exploring the Impact of Pre-existing Allergic Conjunctivitis on the Efficacy of Refractory Medications in Chronic Spontaneous Urticaria: A TrinetX Database Analysis

Chronic Spontaneous Urticaria, often characterized by pruritic hives, can significantly impact quality of life [1][4]. Standard treatment involves second-generation antihistamines, but some cases may become refractory, requiring stronger medications such as cyclosporine A [2]. Purpose: To investigate the association of allergic conjunctivitis alongside CSU and use of cyclosporine A compared to those without pre-existing AC in treating CSU, using TrinetX database. Methods: Analysis included ICD-10 codes ‘urticaria, unspecified, ‘idiopathic urticaria,’ or ‘other urticaria’ for patients seen during 2020-2024, with at least two consecutive visits at least 4-6 weeks apart, in addition to receiving a second-generation H1-antihistamine treatment. Compare prevalence of cyclosporine use between two cohorts: AC (+) x urticaria x pretreated with H1 and AC (-) x urticaria x pretreated with H1 and patients with and without AC, requiring the addition of cyclosporine A to H1 for treatment of CSU over an observation period of 5 years. Propensity score matching to pair the two cohorts for age, sex, and race [3]. Results: In AC (+) x urticaria x pretreated with H1 group, there were 38,530 patients, out of which 446 required the addition of cyclosporine treatment, resulting in a risk percentage of 1.158%. In AC (-) x urticaria x pretreated with second-generation antihistamine group, with 415,786 patients, 2,812 required the addition of cyclosporine treatment, resulting in a lower risk percentage of 0.676%. Risk Ratio (RR) is calculated as 1.711, with a 95% confidence interval of (1.55, 1.89). Conclusion: A greater proportion of CSU patients with AC required cyclosporine compared to those without AC.

Association Between Pterygium and Ocular, Periocular, and Systemic Inflammatory Conditions: a Large-Scale National Study.

The purpose of this study was to examine the incidence of ocular, periocular, and systemic inflammatory conditions among patients with pterygium and assess if these conditions are risk factors of pterygium development. A case-control study was conducted using electronic medical records from Clalit Health Services in Israel between 2001 and 2022. Patients diagnosed with pterygium were included; for each case, 3 controls were matched based on birth year, sex, and ethnicity. Mixed models were used to assess differences in the groups' demographic characteristics of ocular and systemic diseases. Generalized estimating equation logistic regression was used to estimate the odds ratios (ORs) and adjust for confounders. A total of 94,652 patients diagnosed with pterygium and 378,608 matched controls were included in the study. The average age of patients with pterygium was 53 ± 16 years; 54% were male. A significant association was found between pterygium and vernal keratoconjunctivitis (OR 2.12, 95% confidence interval [CI], 1.90-2.36), chronic allergic conjunctivitis (OR 1.69, 95% CI 1.58-1.82), blepharitis (OR 1.66, 95% CI 1.61-1.70), and chalazion (OR 1.27, 95% CI 1.23-1.33). A significant association was also found between pterygium and systemic conditions as unspecified systemic allergy (OR 1.08, 95% CI 1.04-1.13), asthma (OR 1.08, 95% CI 1.04-1.11), and atopic dermatitis (OR 1.14, 95% CI 1.08-1.19). Various inflammatory and allergic diseases-ocular, periocular, and systemic-increase the risk of pterygium. Further research is needed to investigate the role of inflammation in pterygium development.

Immunotherapy: Current indications and recommendations in the management of ocular allergy

Abstract Allergic diseases, including allergic conjunctivitis (AC), pose a significant health burden, affecting both developed and developing nations. Despite its importance, AC is often underreported, leading to underestimated incidence and prevalence. The coexistence of AC with allergic rhinitis and its comorbidity with asthma underscore its clinical relevance. The prevalence of nasal symptoms with eye symptoms related to eye allergy varies among different age groups and regions worldwide. Climatic factors, aeroallergens, and environmental exposure play significant roles in the prevalence of ocular allergies. Allergen immunotherapy (AIT) represents the only disease-modifying treatment for IgE-mediated allergic diseases. This review provides a comprehensive overview of the history, mechanisms, and evidence of AIT for ocular allergies, with a focus on AC. The primary routes of AIT, subcutaneous immunotherapy (SCIT), and sublingual immunotherapy (SLIT) are discussed in detail. The evidence for AIT in treating AC is extensive and demonstrates its effectiveness in alleviating ocular symptoms, reducing medication usage, and improving the quality of life in patients. Both SCIT and SLIT have shown positive results, with SLIT having a more favorable safety profile. Considerations for initiating and maintaining AIT, including adherence, financial burden, and treatment duration, are highlighted. In summary, AIT is a valuable treatment option for AC, offering long-term symptom relief and potential cost-effectiveness. By understanding the history, mechanisms, and evidence of AIT, healthcare providers can better manage ocular allergies and improve patient outcomes.

Corneal biomechanics in patients with allergic conjunctivitis.

Allergic conjunctivitis (AC) comprises a group of conditions triggered by environmental allergens, substantially diminishing the quality of life, particularly among children and adolescents. The mechanical impact of eye rubbing in patients with AC is known to induce biomechanical alterations in the cornea. Modern instruments enable the detection and quantification of these corneal biomechanical changes. The ocular response analyzer and CorVis ST have become standard tools for assessing corneal biomechanical properties. We conducted a review of studies that have investigated corneal biomechanics in patients with AC using both devices to elucidate the association between corneal biomechanical changes and early ectasia development. Our analysis highlights significant findings regarding the tomographic biomechanical index parameter in corneal biomechanics among patients with AC. These findings underscore the importance of ocular screening for all patients to promptly detect subclinical keratoconus changes, thereby improving disease management and outcomes.

Allergen Testing: A Review of the Indications, Procedures, and Limitations in Ocular Allergy.

Allergen-based diagnostics are essential in the management algorithm of allergic diseases. Unlike systemic allergy, where the indications and interpretation of these diagnostic modalities are well established, their utility in ocular allergy is not well-defined. With the rising prevalence of ocular allergies and the need for personalized treatment strategies, there is a growing demand for precision allergen diagnostics. This review describes the commonly used tests with their indications, procedures, and limitations. A review of the literature was carried out on articles on allergen diagnostics in ocular allergy, and after excluding articles that were not relevant, 82 papers were included in the current review. IgE-mediated pathways contribute significantly to seasonal and perennial ocular allergy and partly to vernal keratoconjunctivitis. Most diagnostic techniques aim to detect IgE sensitization. In vivo tests include skin prick (SPT), intradermal, and patch tests. SPT is considered the gold standard and directly evaluates the presence of allergen-specific IgE in the skin. In vitro tests measure total and specific IgE from either tears or sera. Tear IgE measurement is relatively specific for allergic conjunctivitis and can provide insight into the potential allergens responsible for local sensitization. The conjunctival provocation test can help establish true allergy, especially in patients with polysensitization. This review also provides an overview of evidence in literature segregated based on the test employed. This includes 17 studies on only SPT; 42 studies on IgE measured in serum, tears, or both; and 20 studies which have evaluated both SPT and IgE. The pattern of allergen sensitization can guide recommendations for avoidance measures and immunotherapy. Thus, this could create a corticosteroid-sparing therapy avenue in these patients, reducing disease severity and resulting visual morbidity.

Sex-dependent differential increase of specialized pro-resolving mediators in extracellular vesicles secreted by human primary conjunctival goblet cells during allergic inflammation

AimsConjunctival epithelium lines the inside of the eyelids and covers the sclera, thus providing stability to the eye surface. Goblet cells in conjunctival epithelium (CjGCs) are well known for their mucin-secretion function, which wet and protect the ocular surface, but other aspects are still not well understood. To expand our understanding beyond their mucin-secreting function, we investigated CjGC-secreted extracellular vesicles (EVs) and lipid mediators therein. Materials and methodsUsing histamine-mediated allergic inflammation in human primary CjGCs (HCjGCs) as a disease model, we quantified using ELISA a proinflammatory mediator PGE2 and two specialized pro-resolving mediators (SPMs) LXA4 and RvD1 in EVs secreted during allergic inflammation. Key findingsAt 18 h post histamine stimulation, the amount of LXA4 and RvD1 in EVs was notably higher compared to those in unstimulated. Interestingly, this increase was only observed in female EVs but not in males. The mean fold increase of LXA4 and RvD1 in female EVs was 3.9 and 3.4, respectively, but it was only 0.9 and 1.0 in male EVs. Supplying docosahexaenoic acid (DHA, the source of RvD1 and other SPMs) to the culture medium during the allergic inflammation resulted in even higher mean fold increase of 5.3 and 6.9 for LXA4 and RvD1 in female EVs, respectively, but it was only 0.5 and 0.8 in male EVs. SignificanceWe conclude that HCjGCs show a clear sex difference in allergic response. Our results may also provide a new insight into the male predisposition to severe forms of allergic conjunctivitis and potential improvement in disease care in the clinic.

Safety and efficacy of a novel 0.5% epinastine topical eyelid cream in allergic conjunctivitis: a phase 3 trial.

The high prevalence of allergic conjunctivitis in Japan necessitates novel, easy-to-use treatment options for prophylactic use. We evaluated the safety and efficacy of a newly-developed 0.5% epinastine topical eyelid cream to prevent the development of allergic conjunctivitis. This was a phase 3, single-centre, double-masked, intra-patient randomised trial in asymptomatic adults (aged 20-65 years) with seasonal allergic conjunctivitis in Japan. The left and right eyes of eligible patients were randomised to receive a topical application of either 0.5% epinastine cream (~ 30mg per dose) to one eye or placebo cream to the other (on the outer skin of the upper and lower eyelids) after a conjunctival antigen challenge (CAC) test. Symptom severity was assessed up to 24h post-treatment. Primary efficacy endpoints were mean ocular itching and conjunctival hyperaemia severity scores in each eye; safety endpoints included adverse events (AEs) and adverse drug reaction (ADRs). In total, 30 patients (60 eyes) were included in the study. The 0.5% epinastine topical eyelid cream reduced mean ocular itching scores (difference in least squares means ± standard error, - 1.12 ± 0.214; p < 0.0001) and mean conjunctival hyperaemia scores (- 0.54 ± 0.197; p = 0.0097) 24h after treatment versus placebo. The 0.5% epinastine topical eyelid cream was well tolerated, with no AEs or ADRs reported. With its novel route of administration, 0.5% epinastine topical eyelid cream may be considered a unique, easy-to-use, once-daily treatment option to prevent the onset of seasonal allergic conjunctivitis.

Comparative inhibition by oral bilastine, parenteral dexchlorpheniramine, and a new bilastine parenteral (i.v. and i.m.) formulation of histamine-induced wheal and flare response: A randomised phase I trial

BackgroundBilastine is a well-known non-sedating second-generation antihistamine authorised worldwide for the symptomatic treatment of allergic rhinoconjunctivitis (seasonal and perennial) and urticaria with proven efficacy and good safety and tolerability profile. When the oral route is not suitable or a rapid onset of action is preferred, parenteral formulations represent an effective treatment option. However, the parenteral formulations currently available are sedating antihistamines. The objective of this research was to compare the peripheral anti-H1 activity of different bilastine formulations (i.v., i.m. and oral) and dexchlorpheniramine among them also versus placebo. MethodsThis was a single-dose, randomized, crossover, double-blind, placebo-controlled, phase I clinical study performed on 25 adult healthy volunteers that compared the peripheral antihistaminic activity of a single dose of bilastine 12 mg i.v., bilastine 12 mg i.m., bilastine 20 mg oral tablets and dexchlorpheniramine 5 mg i.m. among them and versus placebo by inhibiting the histamine-induced wheal and flare (W&F) response. Pharmacokinetics, safety, and tolerability were also evaluated. ResultsAll bilastine formulations showed a rapid onset of action (15 min for parenteral and 30 min for the oral formulation), and the maximum effect in both wheal (i.v. 74.44 %; i.m.:74.29 %; oral 70,27 %) and flare area reduction (i.v. and i.m. 80.63 %; oral 77.67 %), was significantly larger compared to dexchlorpheniramine i.m. (25.85 % for wheal and 28.65 % for flare) and placebo (1.35 % for wheal and 4.02 % for flare). A more pronounced reduction in itching score was reached for bilastine oral, followed by i.m. and i.v. formulations. No serious adverse events (SAEs) were reported during the study, and 8 treatment-emergent adverse events (TEAEs) were reported by 5 subjects, all resolved without sequelae. For psychomotor assessments, dexchlorpheniramine i.m. showed a fast onset of drowsiness, as well as decreased attention and coordination when compared to all bilastine formulations and placebo. ConclusionsAll bilastine formulations showed a peripheral H1-blocking effect inducing a significantly greater inhibition of the wheal and flare response as compared to dexchlorpheniramine i.m. or placebo and provided a greater reduction of the itching sensation score. This study reconfirmed that bilastine has no sedative effect, even in a parenteral formulation. These results suggest that new bilastine parenteral formulation (i.v. or i.m.) may represent a suitable alternative for patients requiring immediate treatment of histamine-mediated type I hypersensitivity reactions, such as acute urticaria, or in those cases where oral administration is not possible.

Supramolecular hydrogel of mycophenolic acid for treating allergic conjunctivitis

Mycophenolic acid (MPA) is an immunosuppressant less commonly utilized in allergic conjunctivitis. Peptide-based hydrogels improve material performance and are used in different biomedical applications. The current study reported that a cationic peptide Nap-FFKK and MPA were co-assembled into K–M hydrogel for sustained MPA delivery. The study evaluated cytotoxicity in vitro and its effectiveness in alleviating allergic conjunctivitis symptoms with a model. The current study demonstrates a promising strategy for using peptides as vehicles for sustained MPA delivery to the eye for ophthalmic applications.

The Efficacy and Safety of Dexamethasone Intracanalicular Insert Use in Patients with Chronic Seasonal/Perennial Allergic Conjunctivitis: A Systematic Review and Meta-Analysis.

This meta-analysis evaluated the efficacy and safety of DEXTENZA, an intracanalicular dexamethasone insert, for the treatment of seasonal/perennial allergic conjunctivitis. Multiple databases, including PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, the Directory of Open Access Journals, and Scopus, were searched for randomized controlled trials (RCTs) comparing the efficacy of DEXTENZA with a placebo. The primary efficacy endpoint was the change in the conjunctival allergen challenge (CAC) model. The GRADE approach was used to assess the certainty of evidence, and the revised Cochrane risk of bias tool for randomized trials was employed to assess bias. Four RCTs involving 323 participants met the eligibility criteria, and all had a low risk of bias. A meta-analysis revealed a statistically significant increase in the mean CAC change for conjunctival itching, with low heterogeneity among measurements at 3 minutes (P<0.00001, I2=47%), 5 minutes (P<0.00001, I2=46%), and 7 minutes (P<0.00001, I2=41%). Additionally, the meta-analysis found a statistically significant increase in the mean CAC change for conjunctival redness with low heterogeneity (P<0.00001, I2=15%). The pooled analysis showed no significant difference (P=0.57, I2=0%) between the DEXTENZA and placebo groups in the frequency of adverse events. DEXTENZA has emerged as a promising and viable treatment option for patients with seasonal/perennial allergic conjunctivitis and is an effective alternative to current therapeutic modalities.

Visual Impairment and Refractive Error Among Deaf and Hard of Hearing Learners in Ghana

Introduction This study aims to assess the prevalence of visual impairment and refractive error among learners who are deaf or hard of hearing in schools for Deaf students in Ghana. Methods A descriptive cross-sectional study design was used to assess the distance visual acuity with the logMAR “E” chart, and ocular health was assessed with an ophthalmoscope and handheld slit lamp with a 90 D lens. Results A total of 1,914 learners were examined in six schools for Deaf students in Ghana. Their ages ranged from 5 to 43 years ( M = 15.18 ± 4.53 years). There were more males (55.5%) than females (44.5%) in the study. Among the learners, 91.1% were deaf, followed by mild hard of hearing (4.0%) and profound hard of hearing (1.8%), among others. Also, 94.8% of the learners had typical vision, followed by moderate visual impairment (2.5%), mild visual impairment (1.4%), and blindness (1.3%) before the provision of spectacles. There was no association between visual impairment (i.e., blindness and visual impairment) and sex among the learners ( p &lt; .05). The leading causes of visual impairments were refractive error and cataracts, while the leading cause of ocular morbidity was allergic conjunctivitis. The prevalence of visual impairment was reduced by almost 2-fold after the provision of spectacles. Discussion The prevalence of deafblindness was low among the learners, with uncorrected refractive errors as the leading cause of mild and moderate visual impairment. If these learners had not been identified through this study, they would have continued to struggle to access the curriculum visually. Implications for Practitioners There is a need to assess hearing and visual functions among learners with disabilities in developing countries like Ghana.