Forms Of Allergic Conjunctivitis Research Articles

Translation, adaptation, and psychometric properties of the Brazilian-Portuguese version of the Quality of Life in Children with Vernal Keratoconjunctivitis questionnaire.

The prevalence of ocular allergy varies according to the population and location of the study. Severe forms of ocular allergy are associated with compromised quality of life. In this study, we aimed to evaluate the application of the Brazilian-Portuguese version of the Quality of Life in Children with Keratoconjunctivitis questionnaire to children and adolescents with different subtypes of allergic conjunctivitis. A total of 48 patients (aged 5-12 years) with allergic conjunctivitis were included in this study. They were enrolled and monitored at a specialized center. After the clinical appointment, the children responded to the questionnaire on two occasions at an interval of 30 days. Individual scores (ranging from 0 to 3) of the 16 items were added. The Brazilian-Portuguese version of the Quality of Life in Children with Keratoconjunctivitis questionnaire demonstrated good translation, adaptation, and intellectual properties, with substantial internal consistency (Cronbach's α coefficient = 0.702). There was no significant difference between the responses of the two interviews, revealing good reproducibility. The moderate/severe forms of allergic conjunctivitis had significantly higher quality of life scores (indicating a poorer quality of life) than the mild forms. The Brazilian-Portuguese version of the Quality of Life in Children with Keratoconjunctivitis proved to be quick, reliable, and reproducible for assessing the quality of life in children with allergic conjunctivitis. However, its ability to detect changes resulting from symptom aggravation or treatment needs to be further evaluated.

Research progress in Chinese and Western medicine for the treatment of Vernal keratoconjunctivitis

Vernal keratoconjunctivitis (VKC) is a form of allergic conjunctivitis, also known as spring ophthalmia because of its recurrent and cyclical nature, which occurs in spring and summer. The main symptoms are ocular itching, photophobia and tearing, discharge, and foreign body sensation, and physical signs include flattened and thickened lid conjunctiva with pavement-like papillae, and gum-like thickening of the corneal rim of the upper lid (Horner-Trantas nodule). The pathogenesis of VKC is not yet fully understood and remains controversial. There are currently many treatment options for VKC, with the mainstream treatments being Western medicine and Chinese medicine, but with varying efficacy and individual differences. The author reviews the progress of research in the treatment of VKC with Chinese and Western medicine.

Characteristics of changes in the structures of the anterior eye of rabbits at acute opisthorchosis and paracoenogonymosis

The purpose of the research is studying changes in the structures of the anterior eye of rabbits at acute opisthorchosis and paracoenogonymosis in experiment.Materials and methods. The studies were performed on sexually mature male rabbits. The first group consisted of animals infected with 50 metacercariae Opisthorhis felineus (Rivolta, 1884) (n = 3), and the second consisted of animals infected with 50 metacercariae Paracoenogonimus ovatus (Katsurada, 1914) (n = 3). The animals from the third group were control (n = 3). The study at opisthorchosis was performed at 1, 2, 3, 4 and 5 weeks after infection, and the study at paracoenogonymosis was only performed at 1 and 2 weeks in connection with rapidly proceeding infection. These groups were compared within 1 and 2 weeks and according to specific changes. The clinical study included the upper and lower eyelids turned outwards in animals, and examination of the conjunctival surface of the eyelids, epicanthus (third eyelid), cornea, limbus and sclera of the eyeball, and eyelash less edge of the eyelids at all periods of observation. The measurements were carried out with a millimeter ruler along the longest part of the formation. The data were processed statistically by calculating the arithmetic mean (M) with the standard error of mean (σ) using the Microsoft Excel 2007 software package, and changes in characteristics were assessed at follow-up by the Wilcoxon rank sum test.Results and discussion. In the acute phase of opisthorchosis, the structures of the anterior eye are damaged, which occurs after the first week of infection in the form of allergic conjunctivitis, episcleritis. We found follicular formations in the upper eyelid, in the outer corner of the eye with further synulosis by the 5th week, and vascular enhancement of the upper eyelid. Conjunctival and corneal changes a month later were of the type of trachomatous pannus with conjunctival hyperemia of both eyelids, edema, and reddening of the free eyelash less edge. The infection by P. ovatus showed no follicular formations or eyelid edema for two weeks. Thus, at opisthorchosis, we observed the phenomena of combined pathology of the visual organ with a specific component for which an independent name can be distinguished, specific parasite-associated ophthalmitis.

Act quickly when treating atopic keratoconjunctivitis to avoid adverse outcomes

Atopic keratoconjunctivitis (AKC) is the most severe form of allergic conjunctivitis and, if inadequately treated, can cause vision loss. Treatment aims to minimize symptoms, recurrence and consequent eye rubbing, which cause long-term eye damage. First-line treatment generally involves the use of topical ophthalmic formulations of mast-cell stabilizers and/or antihistamines, corticosteroids, calcineurin inhibitors and immunomodulators (used in that order). Systemic formulations of these drugs can be used to treat refractory cases of AKC or when deemed appropriate for the individual.

Atopic Keratoconjunctivitis: Pharmacotherapy for the Elderly

Among the different forms of allergic conjunctivitis, atopic keratoconjunctivitis has distinct characteristics, defined by a more common onset in late adolescence or early adulthood, but also affecting the elderly, and with a higher prevalence in male individuals. However, the prevalence of atopic keratoconjunctivitis is scarcely investigated, and the data are often uncertain because other allergic nasal or respiratory disorders occur concomitantly. Mast cells, eosinophils, basophils, and T cells are involved in the pathogenesis of atopic keratoconjunctivitis. Despite its denomination as atopic, negative responses to skin tests or in-vitro immunoglobulin E tests are common. In fact, atopic keratoconjunctivitis can be attributed to a combination of T-helper-1 and T-helper-2 responses, but a higher prominence for T-helper-1 cells was found. The most common symptoms of atopic keratoconjunctivitis are bilateral ocular itching, burning, and tearing with a perennial presentation, although some patients may have seasonal exacerbations in winter or summer. Other symptoms such as photophobia, blurred vision, and mucous chewy discharge, owing to the accumulation of cells and mucin, may occur. The diagnosis of atopic keratoconjunctivitis is mainly clinical, asaccepted diagnostic criteria or laboratory tests are not available. The treatment of atopic keratoconjunctivitis is aimed at controlling symptoms, decreasing relapse and exacerbations, and reducing vision loss. Therapeutic options comprise topical ophthalmic drops, including cromones, antihistamines, corticosteroids, and calcineurin inhibitors. Topical ointments are also available for corticosteroids and calcineurin inhibitors. Severe forms may require systemic medications including antihistamines, corticosteroids, and calcineurin inhibitors. Atopic keratoconjunctivitis therapy in the elderly does not differ from the adult population, but the occurrence of multi-morbidities and concomitant drug treatment, which are common in this age group, requires a careful evaluation to determine appropriate and personalized treatment.

Seasonal and Perennial Allergic Rhinoconjunctivitis

Seasonsal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC) as well as intermittent and persistent allergic rhinitis are widespread diseases. Because a combined occurrence of ocular and nasal symptoms is very common the summarising term allergic rhinoconjunctivitis is frequently used. SAC and PAC representing the two acute forms of allergic conjunctivitis account for more than 90% of all cases of allergic conjunctivitis. Compared to the chronic forms of allergic conjunctivitis their course of disease is milder. Nevertheless because of their high prevalence and the proven influence on patients' quality of life they possess clinical and socioeconomic relevance. Allergic rhinoconjunctivitis is caused by a type 1 IgE-mediated hypersensitivitity reaction that is provoked by aeroallergens in the majority of cases. The pathognomonic sign is itching. Besides, typical ocular findings are chemosis, conjunctival injection,watery secretion and lid swelling. Otorhinolaryngologists' findings include rhinorrhea, postnasal drip and sneezing. Problems in breathing through the nose resulting from nasal obstruction can cause impaired nighttime sleep and daytime somnolence. In addition to a reduction of allergen exposure by modification of environment and life style factors, in mild forms of SAC and PAC artificial tears are recommended. Topical antihistamines can generate rapid relief from acute symptoms and itching. Topical mast cell stabilisers however provide long-term effects. Dual action drugs that combine antihistamines and mast cell stabilisers show increased patient compliance due to reduced application frequency. Use of topical steroids should be cautious and only temporary. For prolonged treatment periods unpreserved anti-allergic eye-drops should be preferred. Combined topical antihistamines and new-generation topical nasal steroids often used by otorhinolaryngologists demonstrate a good safety profile without systemic side effects. In summary, allergic rhinoconjunctivitis represents a common disease pattern that can be treated effectively. Once it is diagnosed correctly targeted treatment results in improved patients' quality of life quickly.

Seasonal and Perennial Allergic Rhinoconjunctivitis

Seasonal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC) as well as intermittent and persistent allergic rhinitis are widespread diseases. Because a combined occurrence of ocular and nasal symptoms is very common the summarising term allergic rhinoconjunctivitis is frequently used. SAC and PAC representing the two acute forms of allergic conjunctivitis account for more than 90 % of all cases of allergic conjunctivitis. Compared to the chronic forms of allergic conjunctivitis their course of disease is milder. Nevertheless because of their high prevalence and the proven influence on patients' quality of life they possess clinical and socioeconomic relevance. Allergic rhinoconjunctivitis is caused by a type 1 IgE-mediated hypersensitivity reaction that is provoked by aeroallergens in the majority of cases. The pathognomonic sign is itching. Besides, typical ocular findings are chemosis, conjunctival injection, watery secretion and lid swelling. Otorhinolaryngologists' findings include rhinorrhea, postnasal drip and sneezing. Problems in breathing through the nose resulting from nasal obstruction can cause impaired nighttime sleep and daytime somnolence. In addition to a reduction of allergen exposure by modification of environment and life style factors, in mild forms of SAC and PAC artificial tears are recommended. Topical antihistamines can generate rapid relief from acute symptoms and itching. Topical mast cell stabilisers however provide long-term effects. Dual action drugs that combine antihistamines and mast cell stabilisers show increased patient compliance due to reduced application frequency. Use of topical steroids should be cautious and only temporary. For prolonged treatment periods unpreserved anti-allergic eye-drops should be preferred. Combined topical antihistamines and new-generation topical nasal steroids often used by otorhinolaryngologists demonstrate a good safety profile without systemic side effects. In summary, allergic rhinoconjunctivitis represents a common disease pattern that can be treated effectively. Once it is diagnosed correctly targeted treatment results in improved patients' quality of life quickly.

Trends in prevalence and treatment of ocular allergy.

This review describes recent findings and trends in prevalence and treatment of allergic ocular diseases. Although the major focus is on seasonal and perennial allergic conjunctivitis, related disorders will also be considered. Published reports from countries around the world suggest that the spectrum of atopic diseases, including seasonal and perennial allergic conjunctivitis, is continuing its pattern of increasing prevalence, which has been well documented over the past few decades. In addition, although treatment modalities have focused on topical formulations including antihistamines and corticosteroids, there is a significant emphasis on immunotherapy as an alternative treatment modality, particularly in the USA. Allergic conjunctivitis is a key component in the spectrum of allergic diseases that is sometimes collectively referred to as rhinoconjunctivitis. Because of its high prevalence worldwide, it exacts an increasing toll in terms of patient discomfort, morbidity, and loss of productivity. Current estimates suggest that at least 20% of the overall population suffers from some form of allergic conjunctivitis, many without ever seeking treatments. In addition, a significant proportion of patients experience chronic forms of allergy that are less responsive to existing therapies. Recent approval of immunotherapy-based treatments may address this therapeutic gap.

A Clinical Study of Vernal Keratoconjunctivitis

Objectives: To study the variations in epidemiological characteristics, clinical features, disease process and various modalities of management in VKC. Materials and Methods: A hospital based prospective study of 70 patients presenting with symptoms of allergic conjunctivitis was done at Department of Ophthalmology, J.J.M. Medical College, Davangere, from June 2012 to May 2013. Multiple epidemiological (age, sex) and clinical parameters (type, symptoms, treatment, failure of treatment) were studied. All patients were appropriately managed and reviewed once in fortnight and follow up ranged from a minimum of 3 months to 6 months.Results: Vernal keratoconjunctivitis was found to be the commonest type (64.3%) of allergic conjunctivitis. It was found to affect young males below 16 years (66.7%). Mean age group to be affected was 13.75 years with a mean duration of 4.87 years. Seasonal occurrence (75.5%) and itching (100%) were the predominant features. Palpebral form was the most common form of the disease (49%). Pulse steroid therapy was found to be a safe and effective method of management of vernal conjunctivitis. Conclusion: VKC is a common form of allergic conjunctivitis in a tropical country like ours. It is a bilateral, recurrent debilitating form of disease found to affect young males below 16 years. VKC is associated with other systemic atopy or family history of allergic disorders. Conjunctival eosinophils can be used as an evidence for diagnosis of VKC.

Occupational rhinitis and allergic conjunctivitis

Occupational rhinitis is an inflammatory disease of the nose, which is characterised by intermittent or persistent symptoms, arising from causes and conditions attributable to a particular work environment and not from stimuli encountered outside the workplace. Its clinical symptoms such as nasal congestion, sneezing, rhinorrhoea, itching, nasal airflow limitation are very similar to the symptoms of allergic rhinitis caused by other (classical) agents. Occupational allergic conjunctivitis is an IgE mediated disease, provoked by a substance in the air of the workplace. Its clinical signs (itching, tearing, conjunctival hyperaemia and oedema and, in some cases when the cornea is also involved, blurred vision, photosensitivity) are similar to other forms of allergic conjunctivitis. Risk factors (which in most of the cases occur in both diseases) include history of atopy, high concentration of the irritant agent and multiple irritant agents in the air of the workplace. Atopy has been associated with an increased risk of specific sensitisation to a variety of high molecular weight agents. For the diagnosis of occupational rhinitis and occupational allergic conjunctivitis objective investigations such as allergen specific provocations are necessary in addition to clinical and occupational history. Management of these occupational diseases needs environmental interventions (increasing ventilation, decreasing the time of exposure, substitution of the irritant agent). Medical treatment of occupational rhinitis is very similar to other allergic diseases: oral antihistamines, local (nasal) corticosteroids, combined (antihistamine plus membrane stabilizer) eyedrops. The most important step in medical treatment of occupational allergic conjunctivitis is the daily application of combined eyedrops (for example: olopatadine). Orv. Hetil., 2014, 155(5), 170-175.

Allergic conjunctivitis in children: from pathogenesis to therapy

In the article data about classification, pathogenesis, clinical manifestations and treatment of different forms of allergic conjunctivitis in children are presented.

Classification of ocular allergy

The purpose of this article is to summarize the clinical presentations associated with the classification of ocular allergy. This article also serves to summarize recent findings of pathophysiological mechanisms associated with ocular allergy and to highlight recently improved diagnostic methods for ocular allergic inflammation. The term allergic conjunctivitis may not sufficiently describe all forms of allergic eye disease, thus a new classification system is desirable, preferably derived from the varied pathophysiological mechanisms operating in the different forms of ocular allergy. Recent published material has further characterized the roles that inflammatory and structural cells have in ocular allergic inflammation. Improved diagnostic methods have also been developed to assess the underlying causes of ocular allergy. The underlying immune responses of ocular allergies are complex, indicating the critical need to understand the pathophysiology behind these diseases. Extensive research over the past several years has provided valuable insight into understanding the pathophysiology associated with the different forms of allergic conjunctivitis. Further clarification of the mechanisms associated with different forms of ocular allergy is essential for improved methods of classification, diagnosis, and treatment.

Trends in the Pharmacology of Inflammatory and Allergic Eye Disorders

Ocular allergies are one of the most common diseases presenting to the general ophthalmologist. Allergic eye disease includes a spectrum of different clinical entities: the seasonal and perennial allergic conjunctivitis and the more severe forms vernal keratoconjunctivitis and atopic keratoconjunctivitis. A wide spectrum of topical pharmacological agents has been developed for the treatment of the different forms of ocular allergy. These include mast cell stabilizers, pure antihistamines, new dual-acting agents with antihistamine and mast-cell stabilizer properties and non-steroidal antiinflammatory drugs (NSAIDs). All these drugs are very effective in controlling signs and symptoms of mild and moderate forms of allergic reaction and are mainly free of adverse reaction in the chronic use. Topical corticosteroids remain the mainstay in the aggressive treatment of sight-threatening forms of allergic conjunctivitis, although their long-term use is limited by the risk of severe ocular side effects. For this reason, newer immunosuppressive drugs, such as cyclosporine and tacrolimus, have been tested in the treatment of some forms of ocular allergy demonstrating an high safety profile. New potential therapeutic strategies include the modulation of the immune system through a switch of the allergic response from a Th2-dominated immune profile towards a Th1 response.

The central role of conjunctival mast cells in the pathogenesis of ocular allergy

Ocular allergic diseases are characterized by specific activation of conjunctival mast cells with subsequent release of preformed and newly formed mediators. Mast-cell numbers on the ocular surface are increased in all forms of allergic conjunctivitis. Mast-cell activation plays a central role in the development of the ocular allergic reaction, which can be divided into an early and a late inflammatory phase. Mast-cell mediators have been measured in tears of patients suffering from various forms of allergic conjunctivitis, and in sensitized patients after specific ocular allergen challenge. Histamine and tryptase are the most studied mediators in tears of allergic patients. Several cytokines, such as IL-4 and TNF-a, are also produced and released by conjunctival mast cells, and probably play a role in the immunoregulation on the ocular surface. In vitro studies of the characteristics and biologic functions of conjunctival mast cells highlight their central role in the pathogenesis of ocular allergy, and have led to new opportunities to evaluate anti-allergic compounds. This review discusses the role of conjunctival mast cells in the development of ocular allergic diseases.

Eosinophil cationic protein in tears in allergic conjunctivitis.

AIMS/BACKGROUND--Eosinophil cationic protein (ECP) is a quantifiable product secreted by activated eosinophils. The aim of this study was to assess the degree of eosinophil activity in different clinical stages of various forms of allergic conjunctivitis. METHODS--Tears were collected in glass capillary tubes from 14 subjects with seasonal allergic conjunctivitis (SAC), 23 subjects with vernal keratoconjunctivitis (VKC), 16 subjects with atopic keratoconjunctivitis (AKC), 10 subjects with giant papillary conjunctivitis (GPC), and 16 healthy control subjects. The samples were analysed in duplicate with a radio-immunoassay for ECP. RESULTS--Statistically significant differences were evident between healthy controls and allergic subjects (p < 0.001). Subjects with AKC and VKC had significantly higher tear ECP values than subjects with GPC and SAC. In addition, there was a significant correlation between ECP values and disease severity in all disorders. CONCLUSION--The data suggest a particular pathogenic role of the eosinophil in VKC and AKC, and a less pronounced but still important eosinophil involvement in the disease processes of GPC and SAC.