Conjunctival Test Research Articles

Changes in conjunctival cytology and tear function tests with radioiodine treatment for hyperthyroidism

Radioiodine (RAI) is used in the treatment of hyperthyroidism and differentiated thyroid cancer. Radioiodine therapy is associated with dry eyes and some side effects are seen especially due to beta rays. In this study, the functional and cytological status of lacrimal glands after RAI therapy was evaluated. Twenty-five patients with a mean age of 55.16 years with planned low-dose RAI therapy were evaluated. Just before and 6 months after the treatment, the lacrimal glands were evaluated with tear break-up time (BUT), Schirmer's test, impression cytology and "Ocular Surface Disease Index (OSDI)" questionnaire. The mean value of Schirmer's test was 16.20 ± 3.61 pre-treatment and 11.28 ± 4.39 post-treatment for the right eye, and 15.76 ± 3.27 and 10.60 ± 4.42 for the left eye, respectively. The mean value of Schirmer's test decreased significantly post-treatment in both eyes (p = 0.0001). The BUT score also decreased significantly post-treatment (p = 0.001). The mean value of OSDI score was 27.5 ± 8.02 pre-treatment and 46.36 ± 10.27 post-treatment. The mean value of OSDI score increased post-treatment (p = 0.0001). The impression scores also increased post-treatment in both eyes (p = 0.0001). Even low-dose (≤30 mci) RAI treatment affects lacrimal gland functions. Low-dose RAI causes a decrease in the value of Schirmer's test and the BUT test, and an increase in the value of OSDI score and impression scores.

Sicca complex among Egyptian patients with chronic hepatitis C virus infection

The objective of this study was to assess the prevalence of sicca complex (SC) in patients with chronic hepatitis C virus (HCV) infection and its association with clinical and laboratory features of liver disease. Subjective and objective criteria of xerophthalmia and xerostomia were investigated in 120 HCV Egyptian patients. The lacrimal gland function was assessed by: tear film break-up time and lid parallel conjunctival folds test (LIPCOF), dacroscintigraphy (DSG) for lacrimal drainage and that of salivary glands by sialoscintigraphy. Sixty six of 120 patients (55%) had SC; all (100%) were proved to have xerostomia by sialoscintigraphy and xerophthalmia detected by ophthalmologic tests. Using dacroscintigraphy all SC patients (100%) were positive for lacrimal drainage abnormalities. Only 10.1% were symptomatic for SC. None of our patients had anti-Ro or anti-La antibodies. The presence of SC was associated with older age (r = 0.28, p = 0.00), female gender (p = 0.001), cirrhosis (r = 0.34, p = 0.00), thrombocytopenia (r = -0.72, p = 0.00), and rheumatologic manifestation (p = 0.000), but not with viral load (r = 0.19, p = 0.06). DSG showed significant statistical correlation with ophthalmologic tests (r = 0.87, p = 0.00). High prevalence of SC in HCV Egyptian patients was detected. LIPCOF and DSG are objective and noninvasive methods for early diagnosis of xerophthalmia and assessment of the nasolacrimal drainage, respectively. Hindrance of lacrimal drainage proved by DSG was frequently encountered in HCV patients with SC (100%) and strongly correlated with xerophthalmia.

Fungal Flora at Solid Waste Storage Centres and Their Potential Allergenic Effects on the Workers

Purpose: The aim of this study was to find out the fungal flora at solid waste storage centres and its potential allergenic effects on the workers. Methods: Air samples from 10 solid waste storage centres were collected and plates were incubated for up to 14 days. The isolated fungi were identified by standard methods. In total, 599 solid waste sanitation workers who worked in those areas were questioned about nasoconjunctival and skin allergic symptoms and then underwent skin prick tests with different mould extracts. Results: Aspergillus sp., Cladosporium sp., Rhizopus sp., Penicillium sp., Alternaria sp. and Trichoderma sp. were isolated in all areas, Aspergillus being the most abundant mould followed by others. According to skin prick tests, positivity to Aspergillus fumigatuswas found to be in the first order by 10.68%. There was a significant correlation between the nasal and conjunctival symptoms and skin test positivity to house dust mites (p = 0.002, p = 0.03). Skin complaints were correlated with skin test positivity to Penicillium notatum ( p = 0.04). Conclusion: Our findings showed that the workers of solid waste storage centres are under a moderate risk of becoming sensitised to some mould species, especially to Aspergillus sp. The environmental measurements and periodical medical check-ups must be taken into account in solid waste storage centres in order to assess the health risks.

Can conjunctival provocation test facilitate the diagnosis of food allergy in children?

Background Food allergy is common in children, occurring in 5–7.5%. The diagnosis may, however, be difficult. Elevated IgE or positive skin prick test to a food allergen is often considered proof of allergy, but may represent sensitisation without clinical manifestations. For a precise diagnosis oral challenge is necessary, but this is often not performed because of risk of serious allergic reactions. The aim of this study was to evaluate whether conjunctival provocation test would facilitate the diagnosis of IgE-mediated food allergy. Methods One hundred and forty-nine children with 174 possible diagnoses of food allergy were included. General examination, skin prick test and specific IgE were performed, as well as conjunctival provocation test of the suspected food allergen. Open food challenges and double-blind placebo controlled tests were performed in order to diagnose possible food allergy. Results Forty-six children with strongly positive conjunctival reactions (rubor, itching, oedema) to fifty food allergens were all proven to have allergy to the food in question. The children with negative conjunctival provocation tests showed no allergic reactions when challenged. Conclusions We find that a strongly positive conjunctival reaction to a food allergen correlates well with true allergy. An oral challenge should be carefully performed. With a negative conjunctival test an oral challenge may safely be performed.

Challenge Tests in the Diagnosis of Latex Allergy

The aim of this study is to evaluate the sensitivity, specificity and safety of challenge tests and their usefulness in the diagnosis of latex allergy. Forty adult subjects (F/M = 34/6, aged 18-66 yrs) with a history of adverse reactions after latex exposure and positive prick test and/or specific IgE to latex were enrolled. They were compared with 20 control subjects. They underwent provocative (cutaneous, mucous-oral, sublingual, conjunctival, nasal, bronchial, vaginal) tests. Symptoms and drug scores were recorded for each patient during challenges. All patients reacted to at least one of the following: cutaneous, nasal and conjunctival tests. No systemic reactions requiring epinephrine occurred. Of the challenges, the vaginal test resulted as the safest, but it had low sensitivity and many limits related to the procedure. According to our data, bronchial and nasal tests had the highest sensitivity (76% and 82% respectively), and were more precise than other tests in determining latex exposure and symptoms, but the bronchial test also presented the highest rate of risk. Mucous and cutaneous tests resulted as the most reliable. For all the tests, specificity and positive predictive value were 100%. All control subjects resulted negative to all challenges. There were no statistically significant changes in skin and serologic tests between the first and second visits. Correlations between MIS and skin tests and between MIS and serum tests were not found. Challenges can be considered safe diagnostic procedures. Tests that most faithfully reproduce natural exposure, on the basis of a patient's history, are preferable.

Sublingual desensitization in children with congenital malformations and latex allergy

The frequency of latex allergy in children requiring multiple surgery ranges from 16.7% to 65%. The aim of this study was to investigate the safety and efficacy of latex desensitization in a group of 10 patients with a history of multiple surgical procedures and clinically manifested allergy to latex. We selected 10 children (female-male ratio = 5:5), aged 4-16 yr (mean +/- s.d.: 9 +/- 4), with a history of multiple surgical procedures, adverse reactions to latex and positive skin test to latex and/or specific immunoglobulin E (IgE). Latex allergy diagnosis was confirmed by specific provocation tests (cutaneous, sublingual, mucous, conjunctival tests). Rush (4-day) sublingual desensitization was performed with increasing doses of latex extract (ALK Abellò) under patients' tongue until the highest dose of 500 microg of latex. A maintenance therapy (10 drops of undiluted solution three times a week) was recommended. During the 2-yr follow-up mean values of specific IgG4 and IgE, eosinophilic cationic protein and total IgE did not show significant variations. Patients did not manifest any adverse effect during the rush phase and only two patients manifested mild local symptoms during the maintenance therapy. All the challenges showed a reduction in terms of percentage of positivity and mean scores. All the patients showed a reduction of the mean individual score (p < 0.001). Furthermore patients who needed dental examination or surgery underwent such procedures without the occurrence of symptoms. Our preliminary results show sublingual desensitization to latex can be an important therapeutic tool in the management of young allergic patients requiring multiple operations.

In vivo and in vitro allergenicity of the domestic mite Chortoglyphus arcuatus

Chortoglyphus arcuatus is frequently identified in mattress dust samples in coastal areas of northern Spain. To establish the prevalence of positive skin test reactions to C. arcuatus and to analyze its allergenicity and cross-reactivity. One hundred thirty-eight consecutive patients entered the study. The main referred symptoms were rhinoconjunctivitis and asthma. Skin tests were performed with extracts of Dermatophagoides pteronyssinus, Lepidoglyphus destructor, Tyrophagus putrescentiae, C. arcuatus, and Glycyphagus domesticus. Enzyme-linked immunosorbent assay inhibition experiments were conducted with the different mite species and immunoblots with serum samples from 31 sensitized patients. Conjunctival provocation tests were performed in 10 patients with C. arcuatus-positive skin test reactions and in 9 with negative results; all the patients had positive skin test reactions to D. pteronyssinus. The prevalence of positive skin test reactions to D. pteronyssinus was 94.2% and to C. arcuatus was 58%. There was a significant correlation between the number of mites to which patients were sensitized and the time of disease evolution (P = .02). Results of enzyme-linked immunosorbent assay inhibition experiments suggested minimal cross-reactivity between C. arcuatus and D. pteronyssinus. Immunoblot results confirmed specific IgE binding to several bands. Conjunctival test results were positive in 9 of 10 C. arcuatus-positive individuals and slightly positive in 2 of 9 C. arcuatus-negative, D. pteronyssinus-positive individuals. There is a high prevalence of sensitization to C. arcuatus in northern Spain. Sensitization to this species should be considered of clinical significance. There is minimal cross-reactivity between C. arcuatus and D. pteronyssinus.

Conjunctival Flora in Patients with Human Immunodeficiency Virus Infection

Purpose: To compare the conjunctival flora of human immunodeficiency virus (HIV)-positive and HIV-negative patients. Also, to assess the prophylactic effect of oral clarithromycin against Mycobacterium avium complex on the conjunctival flora of HIV-positive patients. Methods: Ninety-four eyes of 47 HIV-positive patients and 122 eyes of 61 control patients were examined. All participants had a detailed anterior segment examination, including conjunctival cultures and laboratory blood tests. Culture results for different organisms were evaluated by chi-square analysis between the groups. The effect of systemic antibiotic treatment on the conjunctival flora of patients with HIV infection was evaluated by chi-square analysis. Results: Bacterial organisms in the conjunctival sac were detected in four out of 28 (14.3%) eyes of HIV-positive patients treated with systemic clarithromycin and in 32 out of 66 (48.5%) eyes of HIV-positive patients without systemic clarithromycin treatment (p < 0.01). The CD4-positive T-cell counts in these groups were 158/μl and 416/μl, respectively (p < 0.01). Bacterial organisms were also detected in 46 of 122 (37.7%) control eyes. No difference was observed in the types and proportions of organisms isolated from the conjunctiva between HIV-positive patients without systemic clarithromycin treatment and controls. Conclusion: There was no difference between the conjunctival flora of HIV-negative and HIV-positive patients. Systemic clarithromycin treatment decreased the conjunctival flora of HIV patients, including those who had a CD4 count that was less than 50/μl.

Rhinoconjunctivitis and asthma caused by vine pollen: A case report

Background: The vine ( Vitis vinifera) is a cultivated plant that is found in some European and American countries. Its pollen gathers in small quantities during a short pollination period in the months of May and June. Allergy to vine pollen has not been previously documented. Objective: We sought to describe a case report of allergy to vine pollen documented on the basis of anamnesis, cutaneous, provocation, and specific IgE determination tests. Methods: An allergenic extract was obtained from collected V vinifera pollens by aqueous standard procedures. Pollen counts and pollination periods of this and other common pollens in the area where the patient became symptomatic were studied. Cutaneous tests and the presence of specific IgE to the pollen extracts were performed by prick, CAP, and RAST techniques. Bronchial and conjunctival tests with the involved pollen extracts were also carried out to identify the sensitizing allergens. Five healthy subjects and 5 pollinic patients were used as control subjects and underwent the same tests. Results: Skin prick test responses with vine pollen at different concentrations were positive for the studied patient and negative for the control subjects. Patient serum revealed a total IgE titer of 334 IU/mL and a specific IgE value of 1.3 PRU/mL (RAST class 2) to vine pollen. Bronchial and conjunctival provocation test responses were also positive when the patient was challenged with V vinifera extract. Conclusion: Exposure to the pollen of the vineyard plants ( V vinifera) can induce immunologic sensitization and rhinoconjunctivitis/asthma. (J Allergy Clin Immunol 1999;103:262-6.)

Reliability of diagnostic tests for contact allergy to mydriatic eyedrops.

Adverse reactions due to the administration of mydriatic eyedrops are not uncommon. In Spain, the most commonly used are phenylephrine, tropicamide and cyclopentolate hydrochloride. In this study, 37 patients with adverse reactions to the administration of mydriatic eyedrops were investigated from January 1993 to June 1997. The aim was to assess the reliability of the diagnostic methods used, particularly the adequate concentration of allergens and the introduction of conjunctival challenge as a safe and accurate diagnostic tool in those patients who could not be diagnosed by other methods. Phenylephrine was the drug most frequently causing sensitization (93.5%) among the 31 allergic patients. Preservatives were the cause in only 1. Patch testing detected allergy in 68.5% of the subjects. 2 concentrations (1% and 10%) and vehicles (pet. and aq.) were used for phenylephrine. The most reliable was 10% aq. Reading at D4 was more useful than at D2. The sensitivity of the patch test was low (72.4%) and its negative predictive value (NPV) poor (42%). In 24% of patients, allergy to phenylephrine was detected only by conjunctival challenge test. This diagnostic method is safe and helpful and has not previously been used to diagnose adverse reactions due to mydriatic eyedrops.

Effects of immunotherapy with a purified standardized allergen preparation of Dermatophagoides farinae in adults with perennial allergic rhinoconjunctivitis

Immunotherapy (IT) was performed for 12 months with a purified and standardized preparation of Dermatophagoides farinae. Twenty adults with rhinoconjunctivitis sensitive to house-dust mite were given IT, and a similar group of 11 patients served as open controls. A total of 512 injections were given. Twenty-eight episodes of allergic side-effects occurred, 13 general and 15 local, most of them during the initial incremental dose period. No severe reactions started later than 30 min after the injection. One patient suffered anaphylactic shock. In this patient, specific antibodies fell immediately, followed by an increase within 1 week. The therapy group improved significantly in relation to the open controls in patients' subjective evaluation of symptoms (P < 0.028) and skin (P < 0.0001) and conjunctival (P < 0.001) sensitivity. Specific IgE increased in controls (P < 0.0001) but not in IT-treated patients during the "mite season"; that is, there was a significant difference in change during the observation period (P < 0.0001). There was also a difference in change of specific IgG between the groups during the first 4-5 months and the whole year (P < 0.0001), but not from 4-5 months to 12 months. In contrast to changes in antibody titers (IgG, P = 0.04), changes in conjunctival (P < 0.01) and especially skin sensitivity (P < 0.005) correlated well with subjective improvement. This implies that the skin prick test and the conjunctival test can be recommended for follow-up of IT.(ABSTRACT TRUNCATED AT 250 WORDS)

Allergen immunotherapy with an immunochemically characterized grass pollen extract: change in follow-up sensitization parameters

A perennial hyposensitization treatment over 2 years was performed in 18 pollen-allergic patients (14 children, 4 adults) with a standardized and purified graspollen extract. The selection for therapy was provided by allergen titration in skin prick test, conjunctival test and by the estimation of specific IgE to timothy. The reported decrease of seasonal symptoms was accompanied by reduced sensitivity in skin test and conjunctival provocation test (p less than 0.001, p less than 0.05). No consistent change in specific IgE was observed at the end of the study. Specific IgG antibodies significantly rised and persisted (p less than 0.001). A successful hyposensitization treatment with graspollen could be monitored by in-vivo and in-vitro parameters.

107 SPECIFICITY AND SAFETY OF THE CONJUNCTIVAL PROVOCATION TEST (CPT)

30 children -age range 3-16 yrs (mean 8 ± 3 SD)- 20 of whom Dermatophagoides pteronissinus (Dt pt) sensitive and 10 other allergens sensitive (control group), were submitted in a blind trial to CPT with Dt p5 extract. None of the patients had been hyposensitised previously, was locally treated with drugs or presented eye involvment. After a preliminary biomicroscopic test, every 20 minutes first an 0,03% albumin solution and then a Dt pt extract at growing concentrations (1,000 - 10,000 - 100,000 BU/ml) were administered alternatively in both eyes. 10 minutes after each instillation allergen-induced eye alterations were observed. A score was given to conjunctival and pericheratic congestion, chemosis and tear secretion. Albumin was never followed by any reaction. The Dt pt allergic patients showed, in comparison with the control group, major eye alterations even at the medium (10,000 BU/ml) Dt pt extract concentration (score 3,6 vs 0,65; P < 0,05). Conjunctival test turns out to be safe, specific, highly sensitive and therefore useful in screening doubtful cases.

Relationship between the results of bronchial, nasal and conjunctival provocation tests in patients with asthma.

Skin tests and bronchial, nasal and conjunctival provocation tests with pollen and animal dander allergens were performed in thirty patients with atopic asthma. In vivo test results were compared only when the same batch of allergen had been used. A nasal reaction was mostly elicied at a lower concentration of allergen than was needed to elicit a bronchial reaction (P less than 0.01). Positive nasal reactions were often obtained when the corresponding bronchial tests were negative. The conjunctiva reacted to lower concentrations than the bronchi in a third of the instances of testing, with most of these being tests with mugwort allergen (P less than 0.05). A positive skin test in cases with a negative bronchial challenge test was often accompained by a positive nasal test and in some cases by a positive conjunctival test. It is concluded that nasal or conjunctival provocation tests do not replace bronchial challenge tests. In an asthmatic patient who gives no reaction to bronchial challenge with a particular allergen, a positive skin test may reflect a nasal allergy.

Relationship between nasal and conjunctival tests in patients with allergic rhinitis.

Simultaneous conjunctival and nasal provcation tests, a total of 174 test pairs, were carried out in fifty patients with allergic rhinitis, using serially diluted antigen solutions of birch, Timothy grass and mugwort pollen, as well as cat and dog dander. The nasal mucosa was found to be more sensitive than the conjunctival mucosa in ninety-six test pairs (55%). This differs from earlier reports. Nasal reaction only was observed in twenty-nine instances (17%). Posterior rhinomanometry was also used to evaluate test reactions, but was found to yield little additional information. In 43% of nasal provocation tests, which according to other criteria were positive, the rhinomanometric results were negative. Despite a fairly good correlation between the results obtained by nasal and conjunctival challenge, the results point to organ specificity in type I reactions. Provocation tests, if indicated in a thorough allergy evaluation, should be performed in the shock organ. The provocation methods and interpretation of reactions of this study differ from those of earlier reports. Comparison of results is difficult and standardization of methods is needed.

86.Separation and allergenic behavior of allergenic active substances in conjunctival test in sea-squirt asthma

86.Separation and allergenic behavior of allergenic active substances in conjunctival test in sea-squirt asthma

Studies on the allergenic fungal spores of the Delhi, India, metropolitan area: Clinical aspects

A comprehensive investigation was done to evaluate the allergenic fungi in India. Results of 11,773 skin tests on 1,079 patients with nasobronchial allergy and 1,165 skin tests on 55 healthy persons with 29 antigens of fungi common in Delhi, India, are presented and compared. There were 5.9 per cent markedly positive (2+ to 4+) skin reactions in patients but none in healthy control subjects, who showed only 5.1 per cent 1+ reactions as compared with 8.9 per cent in patients. If 1+ reactions are included, there were 14.7 per cent positive skin reactions in the allergic patients. Bronchial tests were positive in about 66 per cent and conjunctival tests were positive in 38 per cent of the patients who had given positive skin reactions to the same antigens. The bronchial and conjunctival tests were negative in negative skin reactors, and conjunctival tests were also negative in 1+ skin reactors. About 29 fungi found in our environment are arranged in order of allergenicity based on the frequency of markedly positive skin reactions (2+ to 4+) produced by them.

Hymenoptera sensitivity: I. Conjunctival testing in insect allergy

Conjunctival testing to a whole body mixture of bee, wasp, hornet, and yellow jacket in Coca's solution was carried out in an attempt to develop a simple clinical test which would be useful in verifying a history suggestive of stinging insect allergy. Approximately 60 per cent of 52 insect-sensitive patients undergoing hyposensitization therapy demonstrated positive reactions; whereas only 8 per cent of control subjects reacted similarly. This suggests that false positive conjunctival reactivity to Hymenoptera is unlikely, but that clinically significant numbers of patients will be falsely negative. Further implications are discussed.

Bronchial hypersensitivity to extract of Candida albicans

Eighty-one inpatients, 14 years of age and older, were challenged qualitatively with aerosols of physiological saline, 30 per cent glycerine, extracts of common inhalant allergens, and extracts of Candida albicans (Hollister-Stier) at concentrations up to 10,000 PNU per milliliter delivered through a hand nebulizer. The same patients were tested intradermally and conjunctivally with C. albicans extract. Sputum specimens were obtained from each patient and cultured for the Candida group of organisms. Passive transfer studies for the presence of reagin to C. albicans were made between the effects of inhalation of C. albicans extract and Escherichia coli endotoxin in six patients. Fifteen patients were given control injections and hyposensitization treatment with C. albicans extract and observations were made of bronchial sensitivity by means of either qualitative or quantitative inhalation challenge. The results indicate that C. albicans hypersensitivity is a factor of importance in some patients with severe asthma. The immediate skin response to 1:1,000 extract and reaction of the bronchial tree to other mold extracts were correlated with a positive bronchial reaction to C. albicans extract in the patients studied; the conjunctival test, the delayed skin response to 1:1,000 extract, the bronchial reaction to extract of house dust or pollens, positive sputum cultures, and a history of long-term corticosteroid or antibiotic administration were not so correlated. The mechanism of response differs from that to E. coli endotoxin.

ANAPHYLACTOID REACTION FOLLOWING AN INTRADERMAL TEST OF TETANUS ANTITOXIN.

Case Studies1 December 1963Anaphylactoid Reaction Following an Intradermal Test of Tetanus AntitoxinROBERT E. REISMAN, M.D., CARL E. ARBESMAN, M.D., F.A.C.P., NOEL R. ROSE, PH.D.ROBERT E. REISMAN, M.D.Search for more papers by this author, CARL E. ARBESMAN, M.D., F.A.C.P.Search for more papers by this author, NOEL R. ROSE, PH.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-59-6-883 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptPotential anaphylactoid reactions to horse serum can generally be avoided by prior skin or conjunctival testing. Horse serum products, most frequently tetanus antitoxin, are usually withheld from positive reactors, or, if administered, done so very cautiously. Although serious reactions have occasionally occurred from intradermal testing itself, the immunological pathogenesis of such anaphylactoid reactions has not been thoroughly documented.The following studies give some insight into the mechanisms involved, and also can be contrasted with the previously studied immunopathogenesis of primary serum disease (1-3).CASE HISTORYJ. R., a 20-year-old male college student, lacerated his left palm with a piece of...