Ocular Itching Research Articles

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.

Green and sensitive detection of olopatadine in aqueous humor using a signal-on fluorimetric approach: GREEnness assessment.

Olopatadine (OLP) is widely utilized as an effective antihistaminic drug for alleviating ocular itching associated with allergic conjunctivitis. With its frequent usage in pharmacies, there arises a pressing need for a cost-effective, easily implementable, environmentally sustainable detection method with high sensitivity. This study presents a novel signal-on fluorimetric method for detecting OLP in both its pure form and aqueous humor. The proposed approach depends on enhancing the weak intrinsic fluorescence emission of OLP, achieving a remarkable increase of up to 680% compared to its intrinsic fluorescence. This enhancement is achieved by forming micelles around protonated OLP using an acetate buffer (pH 3.6) and incorporating a solution of sodium dodecyl sulfate (SDS) surfactant. A strong correlation (R = 0.9996) is observed between the concentration of OLP and fluorescence intensities ranging from 1.0 to 100.0 ng mL-1 with a limit of detection of 0.22 ng mL-1. This described method is successfully employed for quantifying OLP in both its powder form and pharmaceutical eye drops. Furthermore, it demonstrates robust performance in determining OLP in artificial aqueous humor with a percentage recovery of 99.05 ± 1.51, with minimal interference from matrix interferents. Moreover, the greenness of the described method was evaluated.

Bilastine 0.6% Preservative-free Eye Drops: A Once-daily Treatment for Allergic Conjunctivitis.

Bilastine is a second-generation antihistamine approved for the symptomatic treatment of allergic rhinoconjunctivitis and urticaria. The present trial evaluated the efficacy and safety of a new bilastine 0.6% preservative-free eye drop formulation for the symptomatic treatment of allergic conjunctivitis. This phase 3, multicenter, double-masked, randomized study compared the efficacy, safety, and tolerability profile of bilastine 0.6% ophthalmic solution with that of ketotifen 0.025% and vehicle. The primary efficacy endpoint was reduction in ocular itching. The Ora-CAC® Allergen Challenge Model was used to assess ocular and nasal symptoms at 15 minutes (onset of action) and 16 hours after treatment. Patients (N=228) were 59.6% male, and the mean (SD) age was 44.1 (13.4) years. Bilastine demonstrated efficacy in reducing ocular itching compared to vehicle at both onset of action and 16 hours after treatment (P<.001). Symptoms improved with ketotifen compared to vehicle 15 minutes after treatment (P<.001). Bilastine demonstrated statistical noninferiority to ketotifen for all 3 post-CAC timepoints at 15 minutes after instillation, based on an inferiority margin of 0.4. Compared with vehicle, bilastine improved in conjunctival redness, ciliary redness, episcleral redness, chemosis, eyelid swelling, tearing, rhinorrhea, ear and palate pruritus, and nasal congestion at 15 minutes after treatment (P<.05). Ophthalmic bilastine was safe and well tolerated. Mean drop comfort scores were significantly better for bilastine than for ketotifen immediately upon instillation (P<.05) and similar to those of vehicle. Ophthalmic bilastine effectively reduced ocular itching for 16 hours after administration, suggesting that it could be used as a once-daily treatment for the signs and symptoms of allergic conjunctivitis. ClinicalTrials.gov identifier: NCT03479307.

Function of gastrin-releasing peptide receptors in ocular itch transmission in the mouse trigeminal sensory system

The prevalence of allergic conjunctivitis in itchy eyes has increased constantly worldwide owing to environmental pollution. Currently, anti-allergic and antihistaminic eye drops are used; however, there are many unknown aspects about the neural circuits that transmit itchy eyes. We focused on the gastrin-releasing peptide (GRP) and GRP receptor (GRPR), which are reportedly involved in itch transmission in the spinal somatosensory system, to determine whether the GRP system is involved in itch neurotransmission of the eyes in the trigeminal sensory system. First, the instillation of itch mediators, such as histamine (His) and non-histaminergic itch mediator chloroquine (CQ), exhibited concentration-dependent high levels of eye scratching behavior, with a significant sex differences observed in the case of His. Histological analysis revealed that His and CQ significantly increased the neural activity of GRPR-expressing neurons in the caudal part of the spinal trigeminal nucleus of the medulla oblongata in GRPR transgenic mice. We administered a GRPR antagonist or bombesin-saporin to ablate GRPR-expressing neurons, followed by His or CQ instillation, and observed a decrease in CQ-induced eye-scratching behavior in the toxin experiments. Intracisternal administration of neuromedin C (NMC), a GRPR agonist, resulted in dose-dependent excessive facial scratching behavior, despite the absence of an itch stimulus on the face. To our knowledge, this is the first study to demonstrate that non-histaminergic itchy eyes were transmitted centrally via GRPR-expressing neurons in the trigeminal sensory system, and that NMC in the medulla oblongata evoked facial itching.

Correlations between IL-36 family cytokines in peripheral blood and subjective and objective assessment results in patients with allergic rhinitis

BackgroundInterleukin (IL)-36 family cytokines have received increasing attention, especially in the fields of inflammation and immunity research. However, whether IL-36 family cytokine levels are correlated with the results of the assessment of allergic rhinitis (AR) and affect the severity of AR remains unknown. Therefore, this study aimed to investigate the correlations between IL-36 family cytokine levels and subjective and objective assessment results and to further analyze the possible mechanisms of IL-36 family cytokines in the development of AR.MethodsAn enzyme-linked immunosorbent assay (ELISA) was used to detect the concentrations of the IL-36 family cytokines IL-36α, IL-36β, IL-36γ, IL-36Ra, and IL-38 in the peripheral blood of patients with AR. The condition of patients with AR was assessed by 22-item sino-nasal outcome test (SNOT-22) score, visual analogue scale (VAS) scores for disease severity, and serum inhalant allergen immunoglobulin E (IgE) detection. Correlations between IL-36 family cytokine levels and subjective and objective assessment results in patients with AR were analyzed.ResultsThe concentration of IL-36α in the peripheral blood of patients with AR was the highest, and the concentration of IL-36β was the lowest. The concentration of IL-36α was higher in juvenile patients than in adult patients, and there was a difference in the IL-36Ra level between the perennial allergen group and the seasonal allergen group. There was a positive correlation between IL-36α level and IL-36γ level, IL-36γ level and IL-36Ra level, and IL-36Ra level and IL-38 level, and IL-36β level was positively correlated with IL-36Ra and IL-38 levels, respectively. IL-36α level was positively correlated with VAS score for nasal congestion symptom. IL-36β level was positively correlated with the total VAS score for ocular symptoms and VAS scores for ocular itching and eye pain symptoms. However, there was no correlation between the levels of all cytokines in IL-36 family and SNOT-22 score, the number of positive inhaled allergens, or the highest positive intensity of allergen specific immunoglobulin E (sIgE).ConclusionPeripheral blood IL-36 family cytokines play an important role in AR, and the concentrations of IL-36α and IL-36β were related to the severity of symptoms in patients with AR.

Efficacy of once-daily ophthalmic bilastine for the treatment of allergic conjunctivitis: a dose-finding study.

Bilastine is a non-sedating second-generation antihistamine for the symptomatic treatment of allergic rhinoconjunctivitis and urticaria. This trial aimed to evaluate the optimal dose, efficacy, and safety of a newly developed once-daily preservative-free ophthalmic formulation of bilastine for allergic conjunctivitis. This phase 2, single-center, double-masked, randomized study evaluated the efficacy of 3 doses of a bilastine ophthalmic formulation (0.2%, 0.4%, and 0.6%) compared to vehicle for the treatment of allergic conjunctivitis. The primary efficacy endpoint was ocular itching reduction. The Ora-CAC® Conjunctival Allergen Challenge model was used to assess ocular and nasal symptoms at the onset of action (15 minutes), 8- and 16-hours post-treatment. Tolerance and safety were also evaluated. A total of 121 adults with seasonal and/or perennial ocular allergy were randomized. Bilastine ophthalmic formulation 0.2%, 0.4% and 0.6% were significantly superior (p>0.001) to vehicle for the treatment of ocular itching at 3, 5 and 7 minutes post-challenge at onset of action (15 minutes) and 8 hours post-treatment. Bilastine 0.6% was also effective at 16 hours post-treatment. Treatment differences for bilastine 0.6% were statistically significant (p<0.001) compared to vehicle at all timepoints for tearing, eyelid swelling, and nasal symptoms. No relevant adverse events were observed. All the tested ophthalmic bilastine doses were efficacious in rapidly reducing ocular itching. The 0.6% formulation was effective up to 16 hours post-treatment, making it suitable for once-daily administration. The new formulation was safe and well tolerated.

Chronic eyelid and ocular itch

Chronic eyelid and ocular itch affect many patients seeking dermatologic or ophthalmologic care and have a high burden on patient quality of life. Clinicians should consider the broad range of possible diagnoses when approaching the patient with itch of the eyes or eyelids lasting more than 6 weeks. Allergic conjunctivitis and allergic contact dermatitis are the most common causes of chronic itch of the eyes and eyelids, respectively. Other diagnoses to consider include atopic dermatitis, xerosis, neurogenic itch, dry eye syndrome, seborrheic dermatitis, blepharitis, rosacea, lichen simplex chronicus, and papulosquamous disorders. If no organic cause can be elucidated, diagnoses of psychogenic pruritus or chronic pruritus of unknown origin may be considered. Herein, we discuss the possible etiologies of chronic eyelid and ocular itch inclusive of clinical presentation, diagnostic considerations, and current therapies.

Effects of Punctal Occlusion on Ocular Itching and Conjunctival Redness Associated with Allergic Conjunctivitis

Purpose Punctal occlusion using punctal plugs has been successfully used to treat the signs and symptoms of dry eye disease. However, the effects of punctal occlusion on the symptoms of allergic conjunctivitis (AC) have been less well documented. There is some concern among clinicians that punctal occlusion may make signs/symptoms of allergic conjunctivitis worse by trapping allergens on the eye. The objective of this post hoc analysis was to address this question and thus assess the effect of punctal occlusion alone on ocular itching and conjunctival redness associated with AC. Methods This was a pooled post hoc analysis of three randomized, double-blind, placebo insert-controlled clinical trials in subjects with AC. Enrolled subjects were generally healthy adults with ocular allergies and a positive skin test reaction to perennial and/or seasonal allergens. The study used a modified version of the traditional conjunctival allergen challenge (CAC) model, which included multiple, repeated allergen challenges following placement of the intracanalicular insert. Subjects were rechallenged on Days 6, 7 and 8; Days 13, 14 and 15; and Days 26, 27 and 28. Results The data set included 128 subjects that were administered placebo. Baseline mean (SD) ocular itching and conjunctival redness scores were 3.52 (0.44) and 2.97 (0.39), respectively. On post-insertion Days 7, 14 and 28, mean itching scores were 2.62, 2.26 and 1.91, respectively, representing 26%, 36% and 46% itching reductions, respectively (p < 0.001). On Days 7, 14 and 28, mean conjunctival redness scores were 1.98, 1.90, and 2.08, respectively, representing 33%, 36%, and 30% redness reductions, respectively (p < 0.001). Conclusions Based on this post hoc pooled analysis, punctal occlusion with a resorbable hydrogel intracanalicular insert did not worsen ocular itching or conjunctival redness in this patient population.

A survey‐based study on diagnosis and management of vernal keratoconjunctivitis

A survey‐based study on diagnosis and management of vernal keratoconjunctivitis

A dexamethasone ophthalmic insert (Dextenza) for allergic conjunctivitis.

The FDA has approved Dextenza (Ocular Therapeutix), a dexamethasone ophthalmic insert, for treatment of ocular itching associated with allergic conjunctivitis. Dextenza was approved earlier for treatment of ocular inflammation and pain following ophthalmic surgery.

A Comparison of the Onset of Action and Duration of Action of Olopatadine Hydrochloride Ophthalmic Solution 0.7% to Loratadine 10 mg in Preventing Ocular Itching in Subjects with Allergic Conjunctivitis

This study evaluated the efficacy of 2 over-the-counter products indicated for ocular itching. It was hypothesized that a single-dose of Pataday® Once Daily Relief Extra Strength (olopatadine hydrochloride ophthalmic solution 0.7%) would be more effective than a single-dose of Claritin® Tablets 24-Hour (loratadine 10mg) in preventing ocular itching associated with allergic conjunctivitis.

Safety and Performance of an Artificial Tear Containing Arabinogalactan, Trehalose and Hyaluronic Acid in the Treatment of Dry Eye in Subjects with Signs of Inflammation of the Ocular Surface

Background: In this study it has been evaluated the safety and the clinical performance of a new combination of topical solution based on arabinogalactan, trehalose and hyaluronic acid, in reducing symptoms and signs of inflammation in a selected population affected by dry eye disease. Methods: The study enrolled 25 patients (ranging from 57 to 71 years) with signs and symptoms of dry eye disease. They received a combination therapy with arabinogalactan, trehalose and hyaluronic acid one drop three times a day for the first week and subsequently according to their symptoms. Ocular surface disease index score, tolerability and adherence were used to evaluate subjective symptoms of dry eye disease at enrolment (T0), week 1 (T1) and week 4 (T2). Clinical signs were assessed at T0 and T2. The assessment plan included: slit-lamp examination of the anterior segment, uncorrected and corrected visual acuity, ocular protection index, tear film break up time, osmolarity, meniscometry, evaluation of conjunctival hyperemia according to Efron’s classification, the presence of MMP-9, conjunctival and corneal staining and intraocular pressure. Results: The study group showed significant improvement in several clinical parameters after treatment. Ocular surface disease index score was significantly lower at the end of the follow up period, also evaluation of tolerability (ocular burning, ocular itching and blurred vision), before and after instillation, showed a statistically significant improvement at T0 and T1. Improvements in tear film break up time, meniscometry results and conjunctival and corneal hyperemia were statistically significant in the study group (p &lt;0.05). A statistically significant, decrease in MMP-9 levels was also observed. Conclusions: Preliminary findings suggest that the new combination of topical solution based on arabinogalactan, trehalose and hyaluronic acid, could be effective in reducing early inflammatory markers, symptoms and signs, associated with the progression of dry eye disease.

“A COMPARATIVE STUDY OF EFFICACY AND SAFETY OF ALCAFTADINE 0.25% VERSUS OLOPATADINE HYDROCHLORIDE 0.2% IN ALLERGIC CONJUNCTIVITIS AT A TERTIARY CARE HOSPITAL”

Background: Ocular itching is the hallmark symptom of allergic conjunctivitis, accompanied by tearing, conjunctival redness, eyelid swelling and chemosis. Alcaftadine and Olopatadine hydrochloride are classied as dual-acting antiallergic agents, used in treatment of Allergic conjunctivitis. Objective: To compare efcacy and safety of Alcaftadine 0.25% and Olopatadine hydrochloride 0.2% eye drops among patients with allergic conjunctivitis. Ophthalmology out-patient department at Minto Ophthalmic Hospit Settings and Design: al, Bangalore Medical College and Research Institute, Bengaluru; prospective, randomized, comparative study. This study Methods and Material: was conducted among 120 patients suffering from grade 3 Allergic Conjunctivitis and efcacy measured in terms of proportion of patients achieving symptomatic relief of allergic ocular signs and symptoms from grade 3 to grade 0 from baseline to 2 weeks, using TOSS score (Total Ocular Symptoms Score) and Conjunctival Hyperaemia scale. Safety assessed by monitoring treatment-emergent adverse effects. Continuous data assessed by unpaired, paired 't' test and repeated measures-ANOVA and categorical data by chi-square test. p-value &lt; 0.05 was considered as statistically signicant, whereas &lt; 0.001 as highly signicant. Greater proportion of patients achieved symptomatic reli Results: ef in Alcaftadine group (98.3%) compared to Olopatadine hydrochloride group (90%) at end of 2 weeks. A signicant and faster reduction in TOSS score was observed from baseline to 2 weeks in Alcaftadine treated group compared to Olopatadine hydrochloride group (p&lt;0.05). Adverse events reported were headache, burning sensation and mild redness in both groups Alcaftadine 0.25% demonstrated greater efcacy in reduci . Conclusion: ng ocular signs and symptoms of Allergic conjunctivitis from baseline to 2 weeks, compared to Olopatadine hydrochloride 0.2% with minimal side-effects.

A mouse model of allergic conjunctivitis permitting tear eosinophil quantification

IntroductionAllergic conjunctivitis is an immune-mediated inflammatory disease of the conjunctiva that is induced by antigens. Allergic conjunctivitis can cause various symptoms such as ocular itching, hyperemia and edema. Developing experimental animal models that show clinical symptoms and methods for quantitative and objective evaluation is important for understanding allergic conjunctivitis. Therefore, this study aimed to develop an ovalbumin (OVA)-induced mouse model of allergic conjunctivitis and a useful method for evaluating symptoms of allergic conjunctivitis. MethodsICR mice were sensitized by an intraperitoneal injection of OVA in PBS containing alum on days 0 and 5. Subsequently, local sensitization was then performed once daily from days 14 to 28, by instilling OVA in PBS into the both eyes. Drug treatment was administered once daily from days 14 to 28. Mice were randomly assigned topical treatment groups: Group 1, 0.1% betamethasone; Group 2, 0.025% levocabastine; Group 3 PBS (control). ResultsMice showed marked eye scratching behavior, hyperemia, edema, infiltration of eosinophils into tears and increased antigen-specific immunoglobulin E antibody levels in tears and the serum. These symptoms were inhibited by instillation of levocabastine and betamethasone, which are used clinically for the treatment of allergic conjunctivitis. DiscussionThis method may be useful for evaluation of the symptoms of allergic conjunctivitis in experimental and clinical settings. In particular, the developed method, which measures the number of eosinophils in tears collected with phenol red threads, may enable the quantitative, objective, and noninvasive evaluation of the severity of allergic conjunctivitis.

Neuropathic pain and itch: mechanisms in allergic conjunctivitis.

Allergic conjunctivitis is highly prevalent and affects up to one third of the general population. The current understanding of the pathophysiology and therapeutic strategies center around the type 2 inflammatory pathway. However, there is an increasing body of evidence that suggests neurogenic mechanisms also play a role in allergic inflammation, with a substantial proportion of allergic conjunctivitis patients experiencing both ocular itch and pain. Unmyelinated C fibres on the ocular surface transmit histaminergic itch and can be directly activated by mast cell mediators. The conjunctival mucosa also contains TRPV1+ (histamine-dependent) and TRPA1+ (histamine-independent) neurons that enhance ocular pain and itch in allergic conjunctivitis. Allergen-complexed IgE also binds directly to FcεRI expressed on peripheral neurons. Environmental aeroallergens can also directly stimulate neuronal nociceptors to release inflammatory substances. Allergic inflammation thus stimulates nerve terminals to release vasoactive and inflammatory neuropeptides, leading to a cyclical neuronal dysregulation that augments mast cell activity. These repetitive cycles lead to both peripheral and central sensitization and neuronal plasticity, resulting in decreased itch/pain thresholds and a heightened itch/pain response. Neurogenic mechanisms including peripheral and central sensitization may drive chronic ocular itch and pain secondary to allergic inflammation. Research into these pathways may help to identify therapeutic targets in allergic conjunctivitis patients with refractory symptoms.

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.

Reproxalap Activity and Estimation of Clinically Relevant Thresholds for Ocular Itching and Redness in a Randomized Allergic Conjunctivitis Field Trial.

IntroductionThis clinical trial assessed the activity of reproxalap, a novel reactive aldehyde species modulator, and estimated clinically relevant thresholds for changes in ocular itching and redness in an allergic conjunctivitis field trial.MethodsThis was a randomized, double-masked, vehicle-controlled phase 2 trial. Patients with ragweed-associated allergic conjunctivitis were assessed over 28 days in an environmental setting with approximately four doses per day of either 0.25% reproxalap, 0.5% reproxalap, or vehicle. Patients recorded ocular itching, redness, tearing, and eyelid swelling scores (each with a 0–4 scale, except for a 0–3 scale for swelling), and completed the Allergic Conjunctivitis Quality of Life Questionnaire at the beginning and end of the trial.ResultsMixed model of repeated measures analysis demonstrated statistically lower itching and tearing scores (pooled P = 0.026 and P < 0.001, respectively) and numerically lower redness and eyelid swelling scores than vehicle on days when pollen exceeded the 95th percentile value. Using three anchor-based and three distribution-based approaches, the meaningful within-patient change and the between-group meaningful difference for patient-reported ocular itching and redness was estimated to be approximately 0.5. The most common treatment-emergent adverse event associated with reproxalap was transient irritation upon instillation.ConclusionIn a field clinical trial, reproxalap was well tolerated and superior to vehicle in reducing ocular itching on high-pollen days. The clinical meaningfulness threshold estimates of 0.5 units are among the first such calculations generated for the standard ocular itching and redness scores, providing important context for the clinical interpretation of clinical trials in allergic conjunctivitis.

Neuronal Fc\u03b5RI\u03b1 directly mediates ocular itch via IgE-immune complex in a mouse model of allergic conjunctivitis

BackgroundClassical understanding of allergic conjunctivitis (ACJ) suggests that ocular itch results from a mast cell-dependent inflammatory process. However, treatments that target inflammatory mediators or immune cells are often unsatisfying in relieving the stubborn itch symptom. This suggests that additional mechanisms are responsible for ocular itch in ACJ. In this study, we aim to determine the role of neuronal FcεRIa in allergic ocular itch.MethodsCalcium imaging was applied to observe the effect of IgE-immune complex in trigeminal neurons. Genomic FcεRIa knockout mice and adeno-associated virus (AAV) mediated sensory neuron FcεRIa knockdown mice were used in conjunction with behavioral tests to determine ocular itch. In addition, immunohistochemistry, Western blot and quantitative RT-PCR were used for in vitro experiments.ResultsWe found that FcεRIα was expressed in a subpopulation of conjunctiva sensory neurons. IgE-IC directly activated trigeminal neurons and evoked acute ocular itch without detectible conjunctival inflammation. These effects were attenuated in both a global FcεRIa-knockout mice and after sensory neuronal-specific FcεRIa-knockdown in the mouse trigeminal ganglion. In an ovalbumin (OVA) induced murine ACJ model, FcεRIα was found upregulated in conjunctiva-innervating CGRP+ sensory neurons. Sensory neuronal-specific knockdown of FcεRIa significantly alleviated ocular itch in the ACJ mice without affecting the immune cell infiltration and mast cell activation in conjunctiva. Although FcεRIα mRNA expression was not increased by IgE in dissociated trigeminal ganglion neurons, FcεRIα protein level was enhanced by IgE in a cycloheximide-resistance manner, with concordant enhancement of neuronal responses to IgE-IC. In addition, incremental sensitization gradually enhanced the expression of FcεRIα in small-sized trigeminal neurons and aggravated OVA induced ocular itch.ConclusionsOur study demonstrates that FcεRIα in pruriceptive neurons directly mediates IgE-IC evoked itch and plays an important role in ocular itch in a mouse model of ACJ. These findings reveal another axis of neuroimmune interaction in allergic itch condition independent to the classical IgE-mast cell pathway, and might suggest novel therapeutic strategies for the treatment of pruritus in ACJ and other immune-related disorders.

Demography, clinical profile and efficacy of dual action topical agents in patients of vernal keratoconjunctivitis from rural population of eastern Rajasthan state of India

Purpose: To study demographic and clinical profile of patients with vernal Keratoconjunctivitis (VKC) and to assess the efficacy and safety of treatment with topical agents having dual antihistaminic and mast cell stabilizing properties.Materials and Methods: This is a prospective, observational study of 100 patients of VKC. All demographic data and clinical features of VKC was observed and recorded. Patients were treated with one of the two treatment options namely Bepotastine besilate 1.5% and Olopatadine hydrochloride ophthalmic solutions. Typical symptoms and signs of VKC namely ocular itching, watering, conjunctival hyperemia, tarsal papillary hyperplasia and limbal involvement including Horner Trantas dots were recorded at baseline and at time of follow up on 7th day, 15th and 30th day using simplified scoring. Safety assessment was also done. Results: After 4 weeks of drug therapy, patients in both arms showed significant improvement in the symptoms and signs.Conclusion: VKC is a disease of younger population and having male preponderance. Both Bepotastine besilate 1.5% and Olopatadine hydrochloride 0.1% ophthalmic solutions were effective and safe in reducing the clinical symptoms and signs of VKC. However both the agents lacked efficacy in severe limbal forms of VKC.

Efficacy of Bepotastine versus Olopatadine Ophthalmic Solutions in Mild to Moderate Vernal Keratoconjunctivitis as a Sole Therapy

Introduction: Vernal Keratoconjunctivitis (VKC) is a chronic, seasonally exacerbated allergic ocular inflammation of the conjunctiva. It affects predominantly the school going male population and is not so common. There is a paucity of comparative studies on efficacies of dual-action topical agents having both antihistamine and mast cell stabilizing properties. These are currently the first line drugs in the management of mild to moderate VKC. Aim: To compare the efficacy and safety of bepotastine besilate 1.5% and olopatadine Hydrochloride (HCl) 0.1%, ophthalmic solutions in mild to moderate VKC patients. Materials and Methods: This prospective, comparative study was conducted in the Ophthalmology Department at National Institute of Medical Sciences Hospital, Jaipur, Rajasthan, India, from January 2020 to January 2021. It included 76 patients having mild to moderate VKC who were randomized into two groups of 38 patients each. Each group was assigned to be treated with one of the two treatment options namely bepotastine besilate 1.5% and olopatadine HCl 0.1% ophthalmic solutions. Typical symptoms and signs of VKC like ocular itching, watering, mucoid discharge, conjunctival hyperaemia and tarsal papillary hypertrophy were recorded at baseline and at the time of followup on 7th day, 15th and 30th day using simplified scoring 4-point scales ranging from 0-3. Safety assessment was also done. Friedman’s test and Mann-Whitney’s U test were performed for intra-arm and inter-arm analysis of continuous variables respectively. Nominal categorical data between the groups were compared using the Chi-square test. The p-value &lt;0.05 was considered as statistically significant. Results: The mean age of the participants was 10.49 ± 2.95 years and the male to female ratio (M:F) was 1.7:1. After 30 days of drug therapy, patients in both arms showed significant improvement in the symptoms and signs scoring of VKC. There was no statistically significant difference in efficacy on interarm analysis at baseline and subsequent follow-ups. Almost all patients became free from their symptoms and signs at the end of the study. However, 25 of 38 (65.8%) patients in bepotastine treated group and 23 of 38 (60.5%) patients in olopatadine treated group had residual tarsal papillae. None of the patients in either group reported any significant adverse effects. Conclusion: Both bepotastine besilate 1.5% and olopatadine HCl 0.1% ophthalmic solutions are safe and equally effective in alleviating the clinical symptoms and signs of mild to moderate VKC.