Ocular Itching Research Articles

Evaluating the efficacy of epinastine ophthalmic solution using a conjunctivitis allergen challenge model in patients with birch pollen allergic conjunctivitis

BackgroundThe efficacy of epinastine 0.05% ophthalmic solution for pollen allergic conjunctivitis has already been shown in a conjunctival allergen challenge (CAC) test using cedar pollen as a challenge. The present study investigated the efficacy of this solution against birch pollen conjunctivitis in a CAC test. MethodsTen adult subjects (eight males and two females) with asymptomatic birch pollen conjunctivitis were enrolled in this study. The average age of the subjects was 41.1 years. This study was conducted during a period without birch pollen dispersion. In each subject, the epinastine 0.05% ophthalmic solution was instilled in one eye, and an artificial tear fluid was instilled in the fellow eye in a double-blind manner. Five minutes or 4 h after the drug instillation, both eyes were challenged with an optimal concentration of birch pollen, and ocular itching and conjunctival hyperemia were then graded. Tears were collected before the drug instillation and 20 min after the pollen challenge, and the histamine level was measured. ResultsThe ocular itching scores and palpebral conjunctival hyperemia scores of the epinastine-treated eyes were significantly lower than those of the contralateral control eyes when the eyes were pretreated with the drug 4 h before the CAC. There was a significant correlation between the tear histamine level and mean ocular itching score of three time points (3, 5 and 10 min) following the CAC in the control eyes but not the epinastine-treated eyes. ConclusionsEpinastine is effective in suppressing ocular itching and conjunctival hyperemia in birch pollen conjunctivitis.

Pediatric Allergic Rhinitis: the Stepwise Treatment Approach

Treatment of allergic rhinitis in children requires a thoughtful, stepwise approach. Before considering medication for rhinitis, possibly chronic medication, you must (1) confirm disease based on symptoms or testing for offending allergens, (2) implement environmental controls when possible, (3) understand how allergy medication will affect children, and (4) recognize the need to use the minimum amount of medicine necessary to treat symptoms. Special attention to the impact of medication on school performance and social interactions is important when treating children. For intermittent symptoms, an oral antihistamine should be tried first. Chronic symptoms will respond best to a topical nasal steroid spray. Spending the time to figure out what most troubles the child will focus therapy (such as an antihistamine eye drop when ocular itching is a primary symptom) and prevent use of unnecessary medication. Moving past medication to immunotherapy is an important next step as we look for ways to change the natural course of atopic disease. There are now multiple approved forms of immunotherapy in the USA; this should allow a tailored approach to treating symptoms that have progressed beyond pharmacologic therapy. These layers of therapy, environmental control, pharmacologic management focused on bothersome symptoms, and immunotherapy, naturally allow for escalation of treatment with increasing symptoms. Working with the parents is imperative to fully understand the impact symptoms are having on the child and to achieve compliance with medications. This combined, stepwise approach will lead to good relief for the child and satisfaction among both parents and treating physician.

Topical Olopatadine in the Treatment of Allergic Conjunctivitis: A Systematic Review and Meta-analysis

ABSTRACTPurpose: To assess the safety and efficacy of topical olopatadine versus placebo and other topical anti-allergic medications in treating allergic conjunctivitis.Methods: We systematically searched the literature for randomized-controlled trials that included patients with allergic conjunctivitis, compared olopatadine versus placebo or alternative anti-allergic medications, and examined itch, conjunctival hyperemia, composite symptom or sign scores, and/or occurrence of adverse events. We assessed the safety and efficacy of topical olopatadine when compared with placebo or alternative anti-allergic medications using meta-analysis.Results: When compared with placebo, topical olopatadine is associated with a pooled-mean difference (MD) in ocular itch of –1.33 (p < 0.00001) and ocular hyperemia of –0.92 (p < 0.00001). When compared with other agents, olopatadine was inferior to alcaftadine on ocular itch (pooled-MD = 0.39; p < 0.00001) but comparable with epinastine and ketotifen.Conclusions: Topical olopatadine is a safe and effective treatment modality for allergic conjunctivitis, whereas alcaftadine appears to be superior to olopatadine in reducing ocular itch.

Impact of Vernal Keratoconjunctivitis on School Children in Egypt

ABSTRACTPurpose: To evaluate the prevalence of vernal keratoconjunctivitis (VKC) and its impact on school children in Egypt. Methods: A total of 3,706 students from six randomly selected schools of Menoufia were included where 126 had symptoms according to the VKC related symptoms questionnaire. Selected children were referred to a hospital for further assessment. Results: The mean age of included children was 8.79±31.87 years, with a VKC prevalence of 3.3%, and male-to-female ratio of 2.3:1. The most frequently reported symptoms were ocular itching, followed by burning sensation, tearing, red eye, discharge, and photophobia. Signs vary between mild and severe cases; however, all cases had a negative impact on school attendance and performance. Conclusion: The prevalence of VKC differs according to the age group of included cases and the local temperature of the study area. School attendance, performance, lifestyle, and social activities were negatively affected by VKC.

Chronic ocular itch in an ophthalmology clinic: Prevalence and characteristics

Chronic ocular itch in an ophthalmology clinic: Prevalence and characteristics

Efficacy and safety comparison of topical loteprednol and topical non-steroidal anti-inflammatory drugs in seasonal allergic conjunctivitis: a prospective open label comparative study

Background: Seasonal allergic conjunctivitis (SAC) one of the most common ocular immunological disorder affecting wide population. Various classes of drugs are been used to control allergic inflammation. Traditionally topical glucocorticoids have been used for SAC. However, repeated and continuous use of steroids is associated with various complications like increase in intraocular pressure, posterior sub capsular cataract, increased susceptibility for infections and delayed wound healing. Hence the current emphasis is to prefer topical NSAIDs as they are free from various steroid related complications. As there is paucity of information regarding the comparative efficacy of topical steroids and NSAIDs, the present study was taken up. The main objective was to study the comparative efficacy and safety of three topical NSAIDs: flurbiprofen, diclofenac, ketorolac and the topical steroid loteprednol, in SAC. Methods: A prospective, comparative study enrolled 40 patients for SAC. All study drugs were instilled 4 times daily for 4 weeks. Patients were assessed for objective and subjective parameters of inflammation at baseline and weekly intervals for 4 weeks using four point scales, and also observed for any side effects. The anti-inflammatory action was assessed by the change in mean scores from basal and at various intervals. Results: Loteprednol was more effective than the three NSAIDs, only ketorolac comparable to loteprednol in relieving ocular itching. Study drugs showed good safety and tolerability, with only minimal local side effects. Conclusions: SAC the topical steroid loteprednol was found superior to NSAIDs.

Ocular itch associated with allergic conjunctivitis: latest evidence and clinical management.

Allergic conjunctivitis is one of the most common allergic conditions worldwide. Its incidence is increasing due to changing climate, pollution, increased pollen loads, and the subject's heightened immunological sensitivity in response to these environmental changes. The pathophysiology predominantly involves immunoglobulin E-related mast-cell activation, with release of histamine and other mediators contributing to the propagation of the response by calling in other immune cells and further inflammation. This article presents the evolution of ocular allergy treatments, from vasoconstrictors, to antihistamines and mast-cell stabilizers, to the dual-acting agents, as well as corticosteroid and immunomodulatory options. Future targets for allergy treatment are also discussed.

Experience Of Ocular Symptoms Among Allergic Rhinitis Patients Depending On The Type Of Aeroallergens

Abstract The aim of this study was to determine the frequency of ocular symptoms and compare the demographic and clinical characteristics in AR patients depending on sensitisation to various types of aeroallergens. Allergic rhinitis is defined as an IgE-mediated inflammation of the lining of the nose that is characterized by nasal symptoms, including nasal congestion, sneezing, itching of nose and runny nose. Patients suffering from allergic rhinitis frequently experience ocular symptoms such as ocular redness, eye itching and tears. The frequency of ocular symptoms in our study population was 27,6%. No statistical significance was found in the mean ages of the patients who did or did not experience ocular symptoms p&gt;0,05 (p=0,243). Our results indicated that there were no statistical differences (p&gt;0,05) among the groups of allergic rhinitis patients based on experiencing nasal symptoms according to the types of aeroallergens. Our results indicated that there were significant experiences of ocular symptoms in patients who were sensitised to outdoor aeroallergens (p&lt;0,001) and significant sensitisation to both outdoor and indoor aeroallergens (p&lt;0,05). Experiencing the examined ocular symptoms, including ocular redness, eye itching and tears, demonstrated highly statistical significance (p&lt;0,001) among the groups of allergic rhinitis patients who were sensitised to indoor aeroallergens and outdoor aeroallergens, and there was statistical significance (p&lt;0,05) among the groups of allergic rhinitis patients who were sensitised to indoor aeroallergens and both types of aeroallergens (indoor and outdoor). Ocular symptoms are more common in patients who are sensitised to outdoor aeroallergens.

A histamine-independent itch pathway is required for allergic ocular itch

Non-histaminergic TRPA1 neural pathway is required for the development of allergic ocular itch. Pharmacological inhibition of TRPA1 channel can lead to novel therapeutic strategies to treat ocular itch in severe allergic conjunctivitis.

Allergic conjunctivitis in a tertiary eye hospital, Nigeria

Background: Worldwide, approximately 1/3 of the populations are affected by allergic diseases. Ocular allergy symptoms presented in 40-80% of the affected individuals. Allergic eye disease is a localized allergic condition that is frequently associated with rhinitis and occasionally with asthma. The symptoms and signs can manifest as conjunctivitis, blepharitis, blepharoconjunctivitis, or keratoconjunctivitis.Objective: To determine the pattern of presentation of ocular allergy in the study population and to create awareness among health professional and the public.Methods: A four months hospital based cross sectional study involving administration of self explained structured questionnaires to all consented patients that presented at our eye care facility on accounts of ocular itching during the study period was conducted. All the patients had comprehensive eye assessment by consultant ophthalmologist. Data was analyzed with SPSS version 18Results: Of 200 patients that presented with conjunctivitis during the study period 163 (82%) patients were due to allergic conjunctivitis. There were 80 males and 83 females. Majority (43.6%) of the patients were within the age groups of 17 years-33 years, followed by 0-16 years (42.3%). Majority of the patients 102 (62.3%) presented with symptoms of ocular itching and redness. Only 18 (11%) of the patients were a known asthmatic. However, 73 (44.8%), 87 (53.4%) and 79 (48.5%) of these patients have family history of asthma, atopy and ocular allergy respectively. Most of the patients 161 (98.8%) were treated with medication, while only two patients had surgical intervention (cornea ulcer debridement).Conclusion: Allergic conjunctivitis is the commonest reasons why patients present with conjunctivitis at our eye clinic and it is commonest in the active age group. Eye health education about ocular allergy is underscored.Journal of Kathmandu Medical CollegeVol. 3, No. 4, 2014Page: 149-152

Efficacy and safety of olopatadine hydrochloride 0.77% in patients with allergic conjunctivitis using a conjunctival allergen-challenge model.

BackgroundSymptom relief for the duration of 24 hours after treatment would benefit patients with allergic conjunctivitis.ObjectiveTo compare the safety and efficacy of olopatadine 0.77% with vehicle or olopatadine 0.2% in patients with allergic conjunctivitis in a conjunctival allergen-challenge clinical study.Patients and methodsIn this Phase III, multicenter, double-masked, parallel-group, randomized trial, patients with allergic conjunctivitis received olopatadine 0.77%, its vehicle, or olopatadine 0.2%, administered once at visits 3A (day 0), 4A (day 14 ±2), and 5 (day 21 +3). Allergic conjunctivitis-associated sign and symptom assessments included ocular itching, conjunctival redness, total redness, chemosis, and tearing scores. Adverse events and ocular safety parameters were also assessed.ResultsA total of 202 qualifying patients were randomized. Olopatadine 0.77% was superior (P<0.001) to vehicle for treatment of ocular itching at 3, 5, and 7 minutes postchallenge at onset of action and 16- and 24-hour duration of action. Conjunctival redness mean scores were significantly lower for olopatadine 0.77% versus vehicle at all three post-conjunctival allergen-challenge time points: onset (−1.52 to −1.48; P<0.001), 16 hours (−1.50 to −1.38; P<0.01), and 24 hours (−1.58 to −1.38; P<0.05). At 24 hours, olopatadine 0.77% was superior to olopatadine 0.2% at all three postchallenge time points for ocular itching (P<0.05), conjunctival redness (P<0.05), and total redness (P<0.05). No clinically relevant differences in safety parameters or adverse events were observed between the treatment groups.ConclusionOlopatadine 0.77% is superior to both its vehicle and olopatadine 0.2% for the treatment of allergen-mediated ocular itching and conjunctival redness. Ocular itching symptom relief is maintained over 24 hours, supporting once-daily dosing and demonstrating a comparable safety profile to olopatadine 0.2%.

A new allergic rhinitis therapy (MP29‐02*) provides effective and rapid symptom relief for patients who suffer most from the bothersome symptoms of nasal congestion or ocular itch

Background Allergic rhinitis (AR) patients often present with a predominant symptom. Nasal congestion and ocular symptoms have the greatest negative impact on patients’ quality of life [1]. Our aim was to assess the efficacy of MP29-02* (a novel intranasal formulation of azelastine hydrochloride [AZE] and fluticasone propionate [FP] in an advanced delivery system) in seasonal AR (SAR) patients presenting with nasal congestion or ocular itch predominantly compared to AZE, FP or placebo (PLA) nasal sprays.

Effect of alcaftadine 0.25% on ocular itch associated with seasonal or perennial allergic conjunctivitis: a pooled analysis of two multicenter randomized clinical trials.

PurposeSeasonal and perennial allergic conjunctivitis represent the majority of cases of ocular allergy. This analysis was designed to evaluate the efficacy and safety of once-daily alcaftadine 0.25% in preventing ocular itching associated with seasonal or perennial allergic conjunctivitis.Subjects and methodsPooled data from two double-masked, multicenter, placebo-controlled studies using the conjunctival allergen challenge (CAC) model of allergic conjunctivitis were analyzed. Subjects randomized to receive treatment with alcaftadine 0.25% or placebo were challenged with seasonal (grass, ragweed, trees) or perennial (cat dander, cat hair, dog dander, dust mites, cockroach) allergens, 16 hours after treatment instillation. The primary efficacy measure was subject-evaluated mean ocular itching at 3 minutes post-CAC. Secondary measures included ocular itching at 5 and 7 minutes post-CAC. The proportion of subjects with minimal itch (itch score <1) and zero itch (itch score =0), and safety were also assessed.ResultsA total of 189 subjects enrolled in the two studies were treated with alcaftadine or placebo. Overall, 129 subjects were challenged with seasonal allergens and 60 subjects were challenged with perennial allergens. Alcaftadine 0.25% achieved a statistically significant reduction in mean itch score at 3, 5, and 7 minutes post-CAC compared with placebo in subjects challenged with seasonal allergens (P<0.0001 at all time points) and those challenged with perennial allergens (P<0.0001 at all time points). A higher percentage of subjects treated with alcaftadine compared with placebo achieved minimal itch (P≤0.001 versus placebo at all time points) and zero itch (P<0.05 at all time points except 7 minutes for perennial) when challenged with either seasonal or perennial allergens. No treatment-related or serious adverse events were reported.ConclusionOnce-daily alcaftadine 0.25% ophthalmic solution was well tolerated and demonstrated effective relief of ocular itching in subjects challenged with allergens classic for triggering either seasonal or perennial allergic conjunctivitis.

Efficacy of olopatadine versus epinastine for treating allergic conjunctivitis caused by Japanese cedar pollen: a double-blind randomized controlled trial.

IntroductionThe objective of this study was to compare the efficacy and safety of olopatadine versus epinastine in healthy Japanese adults with a history of allergic conjunctivitis to Japanese cedar pollen.MethodsThis Phase IV double-blind randomized controlled clinical trial comprised three clinical visits over 30 days. Screening tests were performed to identify subjects with a history of allergic conjunctivitis to Japanese cedar pollen in terms of skin sensitivity and positive bilateral reactions to a conjunctival allergen challenge (CAC) with Japanese cedar pollen at Visit 1, and confirmation by a positive bilateral CAC reaction at Visit 2. At Visit 3, the subjects were randomized to receive one drop of olopatadine HCl ophthalmic solution 0.1% (olopatadine) in the left or right eye (1:1 ratio). All subjects received one drop of epinastine HCl ophthalmic solution 0.05% (epinastine) in the contralateral eye as an active control. Five min later, the subjects underwent bilateral CAC tests with one drop of the allergen solution at the concentration that elicited positive reactions at Visits 1 and 2. Efficacy outcomes included the severity of ocular itching at 5, 7, and 15 min and the severity of conjunctival hyperemia at 7, 15, and 20 min after the CAC test, as graded by the investigator by biomicroscopy.ResultsFifty people participated in this study (25 per group). Olopatadine significantly reduced ocular itching at 7 and 15 min (both p < 0.05) and conjunctival hyperemia at 7 and 20 min (p = 0.0010 and p < 0.05, respectively) after allergen exposure compared with epinastine. There were no adverse events for either treatment.ConclusionThe results of this single-dose study suggest that olopatadine is superior to epinastine in terms of suppressing ocular itching and hyperemia induced by Japanese cedar pollen during CAC tests. Further studies are needed to confirm these findings in real-life settings.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-014-0156-2) contains supplementary material, which is available to authorized users.

Ocular itch relief with alcaftadine 0.25% versus olopatadine 0.2% in allergic conjunctivitis: pooled analysis of two multicenter randomized clinical trials.

IntroductionThe efficacy and safety of the once-daily topical ophthalmic solutions, alcaftadine 0.25% and olopatadine 0.2%, in preventing ocular itching associated with allergic conjunctivitis were evaluated.MethodsPooled analysis was conducted of two double-masked, multicenter, active- and placebo-controlled studies using the conjunctival allergen challenge (CAC) model of allergic conjunctivitis. Subjects were randomized 1:1:1 to receive alcaftadine 0.25%, olopatadine 0.2%, or placebo. The primary efficacy measure was subject-evaluated mean ocular itching at 3 min post-CAC and 16 h after treatment instillation. Secondary measures included ocular itching at 5 and 7 min post-CAC. Ocular itch was determined over all time points measured (3, 5, and 7 min) post-CAC and the proportion of subjects with minimal itch (itch score <1) and zero itch (itch score = 0) was also assessed.ResultsA total of 284 subjects were enrolled in the two studies. At 3 min post-CAC and 16 h after treatment instillation, alcaftadine 0.25% achieved a significantly lower mean itch score compared with olopatadine 0.2% (0.50 vs. 0.87, respectively; P = 0.0006). Alcaftadine demonstrated a significantly lower mean itch score over all time points compared with olopatadine (0.68 vs. 0.92, respectively; P = 0.0390); both alcaftadine- and olopatadine-treated subjects achieved significantly lower overall mean ocular itching scores compared with placebo (2.10; P < 0.0001 for both actives). Minimal itch over all time points was reported by 76.1% of alcaftadine-treated subjects compared with 58.1% of olopatadine-treated subjects (P = 0.0121). Treatment with alcaftadine 0.25% and olopatadine 0.2% was safe and well tolerated; no serious adverse events were reported.ConclusionOnce-daily alcaftadine 0.25% ophthalmic solution demonstrated greater efficacy in prevention of ocular itching compared with olopatadine 0.2% at 3 min post-CAC (primary endpoint), and over all time points, 16 h post-treatment instillation. Alcaftadine and olopatadine both provided effective relief compared with placebo and were generally well tolerated.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-014-0155-3) contains supplementary material, which is available to authorized users.

Efficacy of epinastine hydrochloride ophthalmic solution in allergic conjunctivitis by conjunctival cedar pollen allergen challenge

BackgroundEpinastine hydrochloride is a selective histamine H1 receptor antagonist that also inhibits IgE receptor-mediated histamine release from mast cells. ObjectiveTo show the superiority of epinastine 0.05% ophthalmic solution (epinastine) to placebo ophthalmic solution (placebo) and noninferiority to olopatadine 0.1% ophthalmic solution (olopatadine) for cedar pollen antigen-induced ocular itching and conjunctival hyperemia. MethodsThe study was conducted in ophthalmologically asymptomatic adult volunteers with seasonal allergic conjunctivitis using a conjunctival allergen challenge test. Subjects were randomized into 3 groups (n = 87) to evaluate superiority to placebo (visits 4 to 6) and 2 groups (n = 86) to evaluate noninferiority to olopatadine (visit 7). At each visit, a single administration of the study medication was instilled at 15 minutes (visit 4), 4 hours (visit 5), 8 hours (visit 6), and 4 hours (visit 7) before the conjunctival allergen challenge test. Ocular itching and conjunctival hyperemia of allergic conjunctivitis were assessed after the conjunctival allergen challenge test. ResultsFor the primary end point, epinastine showed superiority to placebo for the inhibition of ocular itching and conjunctival hyperemia induced at 4 hours after the dose (equivalent to 4-times-daily dosing). For the secondary end points, epinastine significantly inhibited itching and conjunctival hyperemia induced at 15 minutes and 8 hours after the dose (equivalent to 2-times-daily dosing) compared with placebo. In addition, epinastine demonstrated noninferiority to olopatadine for ocular itching and conjunctival hyperemia. No adverse drug reactions or serious adverse events were reported throughout the study, indicating that epinastine has a good safety profile. ConclusionEpinastine is effective and safe for the treatment of allergic conjunctivitis. Trial RegistrationClinicaltrials.gov identifier NCT01363700.

Treatment of allergic conjunctivitis with bepotastine besilate ophthalmic solution 1.5%.

PurposeTo examine the pooled per-protocol ocular end points from two conjunctival allergen challenge (CAC) clinical trials of the dual-action antihistamine bepotastine besilate ophthalmic solution (BBOS) 1.5%.MethodsTwo Phase III, placebo-controlled, double-masked, randomized clinical trials were conducted at a total of six separate centers using the CAC model of allergic conjunctivitis. The same study design was employed for both clinical trials, with subjects randomly assigned to either BBOS 1.5% (n=78) or placebo (n=79) treatment. Each subject received one eye drop of the test agent bilaterally at different study visits 15 minutes, 8 hours, or 16 hours prior to a CAC. Primary ocular end points included changes in ocular itching reported at 3, 5, and 7 minutes and conjunctival hyperemia assessed at 7, 15, and 20 minutes following each CAC. Secondary ocular end points included chemosis as well as episcleral and ciliary hyperemia judged by investigators, and tearing (scored as either absent or present) and eyelid swelling judged by subjects.ResultsA statistically significant reduction in ocular itching was observed for BBOS 1.5% treatment compared to placebo at all time points (P<0.0001), while measures for onset and 8-hour persistence of action also reached clinical significance (ie, ≥1.0 unit difference) at a majority of time points. In addition, a significant reduction in conjunctival hyperemia was achieved at a majority of time points during the onset of action CAC test. Secondary end points were also significantly improved compared to placebo, most prominently for reduced tearing at all study visits and reduced eyelid swelling at the onset of action and 8-hour study visits. Adverse events were generally mild and transient.ConclusionBBOS 1.5% rapidly reduced CAC-induced ocular itching with duration of effectiveness of at least 8 hours after dosing. Certain secondary signs of inflammation were also significantly reduced.

Total IgE and eotaxin (CCL11) contents in tears of patients suffering from seasonal allergic conjunctivitis.

BackgroundTo prospectively investigate patients with seasonal allergic conjunctivitis (SAC) during the pollen season and test associations between tears total IgE, eotaxin concentrations, and SAC severity.MethodsEnrolled patients presented ocular symptoms and clinical signs of SAC at the time of presentation. Ocular itching, hyperaemia, chemosis, eyelid swelling, and tearing were scored, and the sum of these scores was defined as the clinical score. Conjunctival papillae were separately graded. We measured eotaxin concentration in tears by an enzyme-linked immunosorbent assay (ELISA) and total tear IgE by Lacrytest strip.ResultsAmong thirty patients (30 eyes), 11 showed neither tear IgE nor tear eotaxin, while 15 out of 19 patients with positive IgE values presented a positive amount of eotaxin in their tears (Fisher’s test: p < 0.001). The mean eotaxin concentration was 641 ± 154 (SEM) pg/ml. In patients with no amount of tear IgE, we observed a lower conjunctival papilla grade than in patients whose tears contained some amount of IgE (trend test: p = 0.032). In the 15 patients whose tear eotaxin concentration was null, tear IgE concentration was 5.3 ± 3.5 arbitrary units; in the other 15 patients whose eotaxin was positive, IgE reached 21 ± 4.3 arbitrary U (Mann–Whitney: p < 0.001). We measured 127 ± 47 pg/ml eotaxin in patients with no history of SAC but newly diagnosed as suffering from SAC, and 852 ± 218 pg/ml eotaxin in patients with a known SAC (p = 0.008). In contrast, tear IgE concentrations of both groups did not differ statistically significantly (p = 0.947).ConclusionsIf IgE and eotaxin secreted in tears are major contributors in SAC pathogenesis, they however act at different steps of the process.

Specific IgE for wheat in tear fluid of patients with allergic conjunctivitis

Context: Allergy to hydrolyzed wheat protein in facial soap has become a major social issue in Japan. It has been reported that the most frequent early symptoms of allergy to hydrolyzed wheat protein in soap are allergic conjunctivitis and rhinitis, while wheat-dependent exercise-induced anaphylaxis can be induced by long-term use.Objective: We evaluated the relation between tear fluid levels of specific IgE for wheat and the features of allergic conjunctivitis.Methods: A prospective, non-randomized, cross-sectional study was conducted in 103 patients with moderate to severe allergic conjunctivitis (allergic group) and 20 age- and sex-matched healthy control subjects (control group). Specific IgE for wheat was measured in tear fluid with an immunochromatography assay, and a skin prick test (SPT) was also performed. Symptoms (sneezing, rhinorrhea, nasal obstruction, ocular itching, and lacrimation) were assessed in each subject along with the activities of daily living (ADL) score and the total ocular symptom score for allergic conjunctivitis. A severity score (0, 1, 2, or 3) was assigned for various changes of the palpebral and bulbar conjunctiva, as well as for limbal and corneal lesions associated with allergic conjunctivitis.Results: The IgE positive rate and specific IgE score were both higher in the allergic group than in the control group (71.8% versus 40.0% and 1.9 ± 0.7 versus 1.4 ± 0.5). A positive SPT for wheat was also more frequent in the allergic group than in the control group (6.8% versus 0.0%). Within the allergic group, patients with a positive SPT had higher specific IgE scores than patients with a negative SPT (3.3 ± 0.5 versus 1.8 ± 0.6, p < 0.001). In the allergic group, the wheat IgE level in tear fluid was correlated with the severity of allergic conjunctivitis symptoms, including ocular itching (r = 0.665), tearing (r = 0.672), and the total ocular symptom score (r = 0.204). Wheat IgE in tear fluid was also correlated with the severity of rhinitis symptoms, including sneezing (r = 0.610), nose blowing (r = 0.640), and nasal obstruction (r = 0.677). Furthermore, the tear fluid wheat IgE score was correlated with five objective features of allergic conjunctivitis (p < 0.05).Conclusions: These results suggest that wheat allergy may be involved in the development of allergic conjunctivitis.

Rare simultaneous occurrence of two supposedly antagonistic diseases: Vogt-Koyanagi-Harada disease and allergic conjunctivitis

Rare simultaneous occurrence of two supposedly antagonistic diseases: Vogt-Koyanagi-Harada disease and allergic conjunctivitis