Perennial Allergic Conjunctivitis Research Articles

A review on pathophysiology and managements of allergic conjunctivitis

Allergic disorder is a serious issue affecting 40% of the population. The most well-known visual illness in clinical practise is undoubtedly visual sensitivity. The impact of numerous variables, including genetics and pollution, is taken into account by experts. Therefore, this review is intends to provide the detailed description related to pathophysiology and managements of allergic conjunctivitis.The study was performed by literature survey of original research articles published in Pubmed, Science direct, Web of Science, Scopus and Google etc.The two primary types of allergic conjunctivitis are perennial allergic conjunctivitis (PAC) and seasonal allergic conjunctivitis (SAC). The common effects of SAC and PAC are shivers, weeping, mucus production, and redness; nonetheless, these structures do not impair vision. However, vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC) are the most alarming types of visual allergic conjunctivitis, which impact the cornea and can impair vision if not properly recognised and treated. Allergic conjunctivitis symptoms include itchy, stinging red eyes and yellow pus during sleep. The major objectives of treatment for allergic conjunctivitis are to lessen and manage symptoms and raise quality of life. This involves minimising itchiness, as well as redness, tears, edoema of the conjunctiva or the eyelids, and other related disorders. Breaking the pattern of inflammation and reducing it are additional therapy objectives for patients with chronic allergen exposure and persistent illness. Mast cell stabilisers, corticosteroids, antihistamines, NSAIDs, dual-acting antiallergics, anti-leukotrienes, anti-IgE, and some other drugs are used to treat allergic conjunctivitis.There are the different types of allergic conjunctivitis among which the more prevalence types of allergic conjunctivitis are SAC and PAC while the more severe types are VKC and AKC. There are different types of medicines available for treatment of allergic conjunctivitis.

Topical Tacrolimus in Anterior Segment Disorders in Ophthalmology: A Review.

The purpose of this study is to emphasize topical tacrolimus's role in treating anterior segment diseases in ophthalmology. The present study analyzed research papers and publications from international databases, including Pubmed, MedLine, Google Scholar, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), and Scopus to highlight the significance and advantages of topical application of tacrolimus and its efficacy in treating allergic eye disorders, immune-mediated diseases, and other ocular surface disorders. Tacrolimus and cyclosporine are the two most commonly used topical immunosuppressants in ophthalmology. Tacrolimus is a selective calcineurin inhibitor administered for the prevention and treatment of allograft rejection in solid organ transplant recipients and has a similar mechanism of action to cyclosporine. Management of immune-mediated inflammatory anterior segment requires intense immunosuppression and studies have shown that tacrolimus is ten to hundred times more effective than cyclosporine. Abbreviations: IL-2 = interleukin-2, FDA = Food and Drug Administration Agency, GvHD = graft versus host disease, (Ig)E = immunoglobulin E, SAC = seasonal conjunctivitis, PAC = perennial allergic conjunctivitis, VKC = vernal keratoconjunctivitis, AKC = allergic keratoconjunctivitis, GPC = giant papillary conjunctivitis, PKC = phyctenular keratoconjunctivitis, DED = dry eye disease, TBUT = tear break up time.

Alergiczne zapalenie spojówek

Allergic conjunctivitis is the most common manifestation of conjunctivitis, affecting up to 40% of the population, mostly children and young adults. Among the risk factors there are air pollution, southern latitude and coexisting allergy. The disease develops when IgE-class antibodies are activated by an allergen and later Th2-dependent humoral response is activated. In seasonal and perennial allergic conjunctivitis the symptoms are limited to conjunctiva, however in vernal keratoconjunctivitis and atopic keratoconjunctivitis also the cornea can be affected. Giant papillary conjunctivitis is not an allergy but a response to irritating surface agents, most frequently a contact lens. In treatment there are three groups of medications used: antihistaminic, non-steroid anti inflammatory and steroids. Due to rise of allergic conjunctivitis, it is crucial to accurately diagnose and treat those conditions.

Allergic conjunctivitis: Treatment updates and long-term monitoring

Allergic conjunctival diseases have a significant impact on the ocular surface, affecting the conjunctiva, cornea, and eyelids. Estimates indicate that approximately 35% of North Americans are affected by these diseases. Seasonal and perennial allergic conjunctivitis are the most common and mildest forms of ocular allergic disease, affecting 15–20% of the population. More severe conditions of ocular allergenic diseases include atopic keratoconjunctivitis (AKC), vernal keratoconjunctivitis (VKC), and giant papillary conjunctivitis (GPC). This article will review allergic conjunctivitis classifications, ocular sequelae, and a simplified treatment algorithm.

Diagnosis and pharmacological management of allergic conjunctivitis

Background: Allergic conjunctivitis is an immune disease primarily attributed to a type 1 hypersensitivity reaction in the conjunctiva of the eye. Based on clinical findings and pathogenesis, allergic conjunctivitis is classified into the following subtypes: seasonal allergic conjunctivitis, perennial allergic conjunctivitis, atopic keratoconjunctivitis, vernal keratoconjunctivitis, and giant papillary conjunctivitis.Current Concepts: The recommended initial treatment for allergic conjunctivitis involves the use of dual-effect agents exerting both antihistamine and mast cell stabilizing effects. If symptoms persist despite the application of these agents, coexisting allergic rhinitis should be considered a possible contributing factor, as this condition can also lead to ocular symptoms. Concurrent treatment of allergic rhinitis is necessary. Although oral antihistamines effectively alleviate symptoms associated with allergic conjunctivitis, potential systemic side effects must be carefully considered, particularly in older individuals and children. Steroid eye drops should be used for limited durations to minimize side effects. Unlike seasonal and perennial allergic conjunctivitis, vernal keratoconjunctivitis, atopic keratoconjunctivitis, and giant papillary conjunctivitis involve both type 1 hypersensitivity reactions and type 4 hypersensitivity mediated by T cells. In cases where dual-effect agents or steroid eye drops fail to yield improvements, topical immunosuppressants such as cyclosporine A or tacrolimus can be effective.Discussion and Conclusion: The pharmacological treatment of allergic conjunctivitis involves the initial use of dual-effect agents, with concurrent treatment of allergic rhinitis if present. Importantly, atopic and vernal keratoconjunctivitis can potentially lead to permanent vision loss, necessitating the application of steroid eye drops or immunosuppressant eye drops.

Association between keratoconus and allergic conjunctivitis in children attending a Tertiary Hospital in Nigeria.

Objective: To ascertain an association between keratoconus and allergic conjunctivitis and to know if it is necessary to investigate all patients with allergic conjunctivitis for keratoconus. Methods: A hospital-based prospective study in which the eyes of children presenting with ocular allergic diseases were examined. Social demographics and clinical data were captured in a questionnaire. All the patients underwent keratometry using the autorefractor-keratometer and the pachymeter was used to measure the central corneal thickness. Data analysis was done with IBM SPSS version 28 for Windows. Frequency and chi-square were used as descriptive statistics to determine the association between dependent and independent variables. Inferential statistics using one-way ANOVA and t-test. P - Value at <0.05 was considered statistically significant. Results: 121 children with allergic conjunctivitis were reviewed. Males were 72 and females 49. The visual acuity was 6/ 6-6/ 18 in 116, and mild visual impairment - 6/ 18-6/ 60 in 5. The most common complaint was frequent itching in 109 (90.1%). Keratometry was normal in 120 (99.5%), while probable keratoconus was found by keratometry in only one patient (0.5%). Central corneal thickness was within the normal range in 33 (27.3%) children, 43 (35.5%) had thin corneas, while 45 (37.2%) had cornea thickness of more than 560 microns. Discussion: Pediatric keratoconus tends to be more aggressive than adult keratoconus with an increased risk of corneal opacities and subsequent keratoplasty. As a result of these negative impacts, early detection and prompt treatment are mandatory. Conclusion: The prevalence of keratoconus was not found to be high in this study population, but with facts emerging between the association of allergic conjunctivitis, and increased prevalence of keratoconus, it is pertinent to integrate keratoconus screening as part of the management of allergic conjunctivitis using an appropriate tool such as video keratography and slit lamp biomicroscope. Abbreviations: KC = Keratoconus, CLEK = Collaborative Longitudinal Evaluation of Keratoconus, SAC = Seasonal Allergic Conjunctivitis, PAC = Perennial Allergic Conjunctivitis, VKC = Vernal Keratoconjunctivitis, IOP = Intraocular Pressure, CCT = Central Corneal Thickness, TNF-α = Tumor Necrosis Factor-Alpha, IL = Interleukin.

Prevalence of dry eye disease in the patients of allergic conjunctivitis: Hospital-based cross-sectional study.

Allergic conjunctivitis (AC) is commonly associated with dry eye. This study was conducted to assess the prevalence of dry eye in different subsets of AC patients. This observational, cross-sectional study, conducted in the Department of Ophthalmology of a tertiary center in north India, included 132 patients of AC. The diagnosis of dry eye disease (DED) was made on the basis of Ocular Surface Disease Index (OSDI), Schirmer's test, and tear film break-up time (TFBUT). The prevalence of dry eye in AC patients was found to range between 31% and 36%. On OSDI scoring, 20.45% of patients had mild, 18.18% moderate, and 31.81% had a severe grade of DED, respectively. The mean OSDI score was noted to be significantly higher in patients with perennial allergic conjunctivitis (PAC) (29.82 ± 12.41), followed by seasonal allergic conjunctivitis (SAC) (25.35 ± 12.88), and least in the patients of vernal keratoconjunctivitis (VKC) (13.60 ± 8.63) (p < 0.0001), respectively. The TFBUT was found to be less than 10 s in 45.45% of PAC, 30.43% of SAC, and 20% of VKC patients, respectively. The difference between the mean TFBUT among the three groups was statistically insignificant (p = 0.683). Schirmer's test value of <10 mm was observed in 45.45% of PAC, 43.47% of SAC, and 10% of VKC patients, respectively. This study revealed a high prevalence of DED in patients with AC. Among the different types of AC patients, PAC had the highest percentage of DED followed by SAC and least in VKC, respectively.

Safety and Tolerability of Bilastine 0.6% Ophthalmic Solution: An 8-Weeks Phase III Study.

The objective of this study was to assess the safety and tolerability of preservative-free bilastine 0.6% ophthalmic solution after 8 weeks of once-daily administration in patients with allergic conjunctivitis (AC). Multi-center, international, randomized, double blind, placebo-controlled, parallel-group, phase III study of adult patients with seasonal or perennial AC. The study was conducted in 26 centers of 5 European countries. Duration of daily treatment with bilastine 0.6% ophthalmic solution or placebo was 8 weeks. Safety was evaluated by analyzing incidence of ocular treatment-emergent adverse events (TEAEs); additionally, and as secondary parameters, ocular tolerability was assessed, in addition efficacy was also assessed by the average daily total eye symptoms score (TESS). A total of 333 randomized patients with AC were included (bilastine, N=218; placebo, N=115). Mean (SD) age of the patients was 39.9 (13.7) and were 63.7% female. Overall, the percentage of ocular related TEAEs was low, and the percentage of patients with ocular related TEAEs was lower in the bilastine ophthalmic solution group (2.8%) than in the placebo group (4.3%). No severe TEAEs were reported. The ocular symptoms and TESS improved during the trial in both treatment groups. Statistically significant treatment differences were observed at Week 8 for the TESS and all individual ocular symptoms, being significantly better in the bilastine ophthalmic solution group than in placebo group. Bilastine 0.6% ophthalmic solution revealed no safety concerns in patients with AC after 8 weeks of once-daily administration. Bilastine was effective in reducing ocular symptoms associated with AC in response to both seasonal and perennial allergens.

Intense Pulsed Light Attenuates Oxidative Stress in Perennial Allergic Conjunctivitis.

Objective: To assess the effects of intense pulsed light (IPL) on oxidative stress (OS) in perennial allergic conjunctivitis (PAC). Background: IPL treatment has been proven effective for dry eye disease (DED). However, we have observed that, after IPL treatment, some patients with DED combined with allergic conjunctivitis (AC), an immune response condition in which excessive OS causes and exacerbates inflammatory damage, not only show an improvement in eye dryness, but also their AC-related eye itching is relieved. The mechanism by which IPL inhibits allergic reactions is not clear. Methods: Five patients with moderate-to-severe PAC were given two IPL treatments on the periorbital skin with a 2-week interval. Visual analog scale (VAS) scores and signs of AC, including eye redness and conjunctival follicles, were assessed before the first treatment (day 1) and 2 weeks after the second treatment (day 30). Tears were also collected at the same time, and lipid oxidation (LPO) metabolite analysis was performed using liquid chromatography tandem mass spectrometry (LC-MS/MS) to investigate the effects of IPL on OS response. Results: The average VAS score significantly decreased with treatment (30.2 for day 1, 10.6 for day 30; p < 0.001). The general signs of PAC showed no difference (p > 0.05). LPO metabolite analysis revealed that 17,18-diHETE, which is an oxidation product of eicosapentaenoic acid, and 13-OXoODE, which is an oxidation product of linoleic acid, are significantly downregulated after IPL treatment. Conclusions: The photothermal effect of IPL attenuates OS in PAC, and this seems to be one of the mechanisms by which IPL treatment improves PAC. Clinical Trial Registration number: ChiCTR1900022202.

Topical cyclosporine versus allergen specific immunotherapy in perennial allergic conjunctivitis.

Symptom control in the long-term with less side effects is important in perennial allergic conjunctivitis, since would improve quality of life. This study aimed to assess the clinical efficacies of topical cyclosporin A and subcutaneous allergen immunotherapy (SCIT) in terms of sign control in perennial allergic conjunctivitis. This retrospective study included 20 adult patients with perennial allergic conjunctivitis and confirmed sensitization to house dust mites with skin prick test. Patients were assigned to either topical cyclosporine A treatment or SCIT. The participants were followed for 6months, and signs scores were recorded at 1, 3 and 6months. Overall, both cyclosporine and immunotherapy groups showed significant improvements in papillary reaction (p = 0.011 and 0.003, respectively), limbal involvement (p = 0.031 and 0.001), and conjunctival hyperemia (p = 0.001 and p < 0.001) scores during the 6-month follow-up. However, only cyclosporine group showed a significant improvement in corneal involvement scores (p = 0.015) during the study period. When scores at different time points were compared, significant improvement in conjunctival hyperemia was evident at 6months in both groups when compared to baseline (cyclosporine group, 0.7 ± 0.68 vs. 2.4 ± 0.84, 70.8% decrease, p = 0.01; immunotherapy group, 0.3 ± 0.48 vs. 2.3 ± 0.95, 87.0% decrease, p = 0.004), whereas for limbal involvement such an improvement was only evident in the immunotherapy group (0.1 ± 0.32 vs. 1.3 ± 0.95, 92.3% decrease, p = 0.01). Allergen immunotherapy and cyclosporin A treatment may provide effective sign relief in perennial allergic conjunctivitis. It may represent an encouraging treatment option particularly for cases with perennial allergic conjunctivitis refractive to other treatments and positive skin prick test to a specific allergen (house dust in the present study). Long-term relief by SCIT would reduce the side effects of polypharmacotherapy. Larger studies with longer follow-up are warranted to confirm our findings.

Clinical characteristics and outcomes of ocular allergy in Thai children.

Allergic conjunctivitis (AC) is the most common ocular condition in allergic children. In tropical countries, the study about the clinical features and outcome of treatment is very limited. To review clinical characteristics and outcomes of treatment in children with ocular allergy. Children with history of AC were classified to seasonal allergic conjunctivitis (SAC), perennial allergic conjunctivitis (PAC), vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC). The clinical history and outcome of treatment were recorded. One hundred and sixty-four children were recruited. PAC was the most common type (61.6%), followed by SAC (21.3%), VKC (12.2%), and AKC (4.9%). Male preponderance was found in all groups. Mean age of onset was 6.8 ? 2.8 years. Allergic rhinitis was the most common co-morbidity (97.6%). The common sensitized allergen is house-dust mites (86.1%). Standard treatments in all groups were natural tear and topical olopatadine. Add-on medications were usually needed in severe types of AC (VKC, AKC). History of topical corticosteroid use was 68.8% and 12.5% in VKC and AKC, respectively. All of them can discontinue topical corticosteroid when topical tacrolimus was applied. The overall remission was found 35% in VKC group and 63% in AKC group. The median duration of treatment was 20.5 months in VKC group and 11 months in AKC group. most Thai children with AC sensitized to house-dust mites. In severe forms of AC, most patients needed addon medication. The use of topical calcineurin inhibitor as an add-on therapy can decrease the use of topical corticosteroid.

Major considerations and clinical findings on the allergic conjunctivitis: a narrative and systematic review

Introduction: Allergic conjunctivitis (AC) is a disease of increasing prevalence, affecting children and adults, with progressive loss of quality of life. It has been reported that about 20 % of the entire human population undergoes a form of allergy. The prevalence of allergic conjunctivitis (AC) varies around the world, usually ranging from 15 to 40 %. In Japan, the prevalence of allergic diseases is the conjunctiva is estimated to be as high as 15% -20% of the population is on the rise. Objective: the present objective was to carry out a narrative and systematic review of the major clinical considerations of allergic conjunctivitis, as well as the main treatments, immunological aspects, and allergic conjunctivitis classification. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from May to June 2022 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. Scientific articles from the last 20 years were selected. The quality of the studies was based on the GRADE instrument. The risk of bias was analyzed according to the Cochrane instrument. Results: A total of 512 articles were found, and 35 articles were included in the systematic review. Allergic conjunctivitis (AC) is an inflammation of the conjunctiva secondary to an immune response to foreign antigens, usually called allergens. This inflammation can be mediated or non-IgE and atopy could play a significant role in the outcome. These forms include seasonal and perennial allergic conjunctivitis, vernal keratoconjunctivitis and atopic keratoconjunctivitis. Giant papillary conjunctivitis and contact or induced by dermatoconjunctivitis drugs are considered to be allergic conjunctivitis subtypes. Conclusion: It was concluded that allergic conjunctivitis is a frequent comorbid with many undiagnosed patients. Then, an additional specific questioning and a therapeutic challenge in suspected patients may help identify patients who may benefit from treatment of Allergic conjunctivitis.

Conjunctival Intraepithelial Lymphocytes, Lacrimal Cytokines and Ocular Commensal Microbiota: Analysis of the Three Main Players in Allergic Conjunctivitis.

Conjunctival intraepithelial lymphocytes, tear soluble molecules and commensal microbiota have important roles in the ocular mucosal immune response in healthy and diseased subjects. For the purpose of this study, the cellular and microbial populations of the conjunctiva and the lacrimal soluble molecules were analyzed to find the main biomarkers in allergic conjunctivitis. A total of 35 healthy subjects, 28 subjects with seasonal allergic conjunctivitis and 32 subjects with perennial allergic conjunctivitis were recruited to obtain peripheral blood, conjunctival brush cytology, tear fluid and microbiota samples. Flow cytometry for lymphocytes, multiplex bead assays for cytokines and high-throughput DNA sequencing for microbiome analysis were used. For perennial allergic conjunctivitis, an increased proportion of Th2 and NKT lymphocytes was found, while CD3+TCRγδ+ lymphocytes and double negative MAIT cells were decreased. In contrast, seasonal allergic conjunctivitis was distinguished by an increase in Th17 and Th22 cell proportions, while the Th1 cell proportion decreased. Among tear fluid, the vast majority of pro-inflammatory cytokines (especially Th2 and Th17 cytokines) in perennial allergies and MMP-9 together with IgA in seasonal allergies were increased. In contrast, TGF-β2 was decreased in both forms of conjunctivitis. Finally, fungal (Malassezia species) and bacterial (Kocuria and Propionobacterium acnes species) colonization were observed in the perennial allergic conjunctivitis group. These results provide the basis for the development of a disease profile for perennial allergic conjunctivitis and open the door to new therapeutic and diagnostic strategies.

Role of Vitamin D &amp; Immunoglobulins E in patients of Seasonal Allergic Conjunctivitis

Introduction: Allergic conjunctivitis is in fact a bunch of diseases affecting the visual surface and is usually related with type1 hypersensitivity reactions. Two acute disorders, seasonal allergic conjunctivitis and perennial allergic conjunctivitis, exist, as do 3 chronic illnesses, vernal keratoconjunctivitis, atopic keratoconjunctivitis, and giant papillary conjunctivitis. Seasonal allergic conjunctivitis is related with seasonal hypersensitivities that ordinarily happen amid the spring and summer months, and in some cases amid the fall. Exposure to dust, grass and other airborne allergens causes seasonal allergic conjunctivitis. Low levels of vitamin D somewhat related to allergic disorders. This study show a relationship between Serum vitamin D and Immunoglobulin’s E in patients of seasonal allergic conjunctivitis Objective: To evaluate serum vitamin D and serum total immunoglobulin E levels in patients with seasonal allergic conjunctivitis (SAC). Material and Methods Study design: quantitative cross sectional Duration: Six months i.e. 1st September 2021 to 28th February 2022 Data Collection procedure: A cross sectional study was conducted on 100 patients. The study was conducted in Holy Family Hospital Rawalpindi. Ethical approval was taken from ethical committee. An educated consent was taken from the participants. 60 patients in this study presented with seasonal allergic conjunctivitis and 40 healthy normal persons were included. Serum vitamin D and serum total IgE levels were calculated. Results: The average age of the participant in this study was in between 30-50 years of age. In SAC group 40 were males and 20 females. Group two healthy normal consist of 25 males and 15 females. There is a significant decrease of vitamin D level in patients who were diagnosed seasonal allergic conjunctivitis and IgE levels were high when compared to normal healthy group Conclusion: In conclusion, we demonstrated lower plasma vitamin D levels in patients with SAC compared with the control bunch. To conclude a certain association between vitamin D status and allergic conjunctivitis, both multicenter larger case arrangement and further studies examining the impacts of vitamin D supplementation ought to be performed in the long run. Keywords: Vitamin D, seasonal allergic conjunctivitis, IgE, Allergy

Ocular allergy in children and adolescents.

The association between symptoms of asthma, rhinoconjunctivitis (RC) and allergic conjunctivitis (AC) is frequent, and AC is considered a comorbidity of asthma and allergic rhinitis (AR). Ocular symptoms are often underestimated and undertreated.Differences according to gender were reported, because girls present symptoms more frequently. The development of RC depends on genetic and environmental factors, and recent studies have indicated that gender, family history of atopy, early sensitization, food allergy, and atopic dermatitis are risk factors for allergic RC. There are six well-defined clinical forms of ocular allergy: seasonal AC, perennial AC, vernal keratoconjunctivitis, atopic keratoconjunctivitis, and contact blepharoconjunctivitis.

Efficacy of N-acetyl aspartyl glutamic acid versus fluorometholone for treating allergic conjunctivitis in an environmental exposure chamber.

BackgroundTopical mast cell stabilizers were previously shown to treat the signs and symptoms of seasonal and perennial allergic conjunctivitis safely and effectively in active and placebo‐controlled trials. However, mast cell stabilizers have not been compared to topical corticosteroids for efficacy. We tested the non‐inferiority of a topical mast cell stabilizer, N‐acetyl aspartyl glutamic acid (4.9%, NAAGA), compared to fluorometholone (0.1%, FM) during controlled exposures to the airborne birch pollen allergen, Bet v 1, in an environmental exposure chamber (EEC).MethodsThis randomized, cross‐over, investigator‐blinded study included 24 patients with a history of birch pollen allergic conjunctivitis. Patients were randomized to 5 days of treatment with NAAGA, then FM (n = 12) or FM, then NAAGA (n = 12). After each treatment, patients were exposed to a fixed airborne concentration of Bet v 1 in ALYATEC EEC. The primary endpoint was the amount of allergen required to trigger a conjunctival response (Abelson score ≥5). Groups were compared with a linear model for cross‐over studies. Non‐inferiority was assumed, when the lower bound of the risk ratio confidence interval (CI) was >0.5.ResultsAt screening, the mean time‐to‐conjunctival response was 72.5 ± 35.9 min. NAAGA and FM extended the response time to 114.8 ± 55.0 and 116.6 ± 51.5 min respectively. The mean amounts of allergen required to trigger a conjunctival response were 1.165 ng after NAAGA and 1.193 ng after FM treatment. The risk ratio for the conjunctival response was 0.977 (95% CI: 0.812; 1.174), which indicated non‐inferiority. Adverse events occurred less frequently with NAAGA (29.2%) than with FM (58.3%).ConclusionIn patients with allergic conjunctivitis to birch pollen, NAAGA was non‐inferior to FM in exposures to airborne Bet v 1. The EEC was a good model for simulating real‐life airborne allergen exposure and for demonstrating the efficacy and safety of eye drops for treating allergic conjunctivitis.Trial registrationNot registered.

Lirentelimab for severe and chronic forms of allergic conjunctivitis

Allergic conjunctivitis (AC) is an ocular inflammatory disease with symptoms driven by eosinophils and mast cells. Allergic comorbidities are common. Current treatments are often ineffective in severe AC and limited by potential side effects. Lirentelimab is an anti-sialic acid-binding immunoglobulin-like lectin-8 mAb that depletes eosinophils and inhibits mast cells. We sought to determine safety and preliminary efficacy of lirentelimab in an open-label, phase 1b study. Patients with chronic, severely symptomatic atopic keratoconjunctivitis, vernal keratoconjunctivitis, and perennial AC, and who had history of topical or systemic corticosteroid use, were enrolled to receive up to 6 monthly lirentelimab infusions (dose 1: 0.3 mg/kg, dose 2: 1 mg/kg, subsequent doses: 1 or 3 mg/kg). Changes from baseline in peripheral blood eosinophils, changes in patient-reported symptoms (measured by daily Allergic Conjunctivitis Symptom Questionnaire, including atopic comorbidities), changes in investigator-reported ocular signs and symptoms (Ocular Symptom Scores), changes in quality of life, and changes in tear cytokine and chemokine levels were assessed. Thirty patients were enrolled (atopic keratoconjunctivitis n= 13, vernal keratoconjunctivitis n= 1, perennial AC n= 16), 87% of whom had atopic comorbidities. After lirentelimab treatment, mean improvement was observed in Allergic Conjunctivitis Symptom Questionnaire score (-61%; 95% CI, -75% to -48%) and Ocular Symptom Scores (-53%; 95% CI, -76% to -31%), consistent across atopic keratoconjunctivitis, vernal keratoconjunctivitis, and perennial AC groups. There was substantial improvement in atopic comorbidities, with -55% (95% CI, -78% to -31%), -50% (95% CI, -82% to -19%), and -63% (95% CI, -87% and -38%) reduction in symptoms of atopic dermatitis, asthma, and rhinitis, respectively. Levels of key mediators of inflammation were reduced in patient tears after lirentelimab treatment. The most common adverse effects were mild to moderate infusion-related reactions. Lirentelimab was well tolerated, improved severe AC and concomitant atopic symptoms, and reduced inflammatory mediators in patient tears.

Psychosocial impact of ocular surface allergic inflammatory disorders.

Allergic rhinoconjunctivitis is one of the most common ocular surface allergic inflammatory conditions seen in primary care that impacts patient's quality of life. Allergic conjunctivitis is increasingly being recognized as its own symptom complex that negatively impacts patient's quality of life separate from allergic rhinitis. This article reviews the psychosocial impact of ocular surface allergic inflammatory disorders (namely seasonal allergic conjunctivitis, ocular allergy, perennial allergic conjunctivitis, and atopic keratoconjunctivitis) on adult and pediatric populations. Despite the perception that allergic conjunctivitis is a trivial condition, it imposes a burden on numerous psychosocial aspects of life for adolescents and adults. Several questionnaires specific to rhinoconjunctivitis have been found to be effective tools at gauging quality of life (QoL) and communicating impairments in specific behavioral domains for adult and pediatric populations. An emerging focus on the role of hormone fluctuations and age on ocular surface allergic inflammation underscores the importance of nuancing the physiologic effects on ocular allergy and QoL at every decade of life. Further exploration and research of symptoms by age would greatly improve our understanding of age's impact on QoL in these patients and contribute to improved management of allergic conjunctivitis.

Association of Allergic Conjunctivitis With Health-Related Quality of Life in Children and Their Parents

Allergic conjunctivitis (AC) is one of the most common allergic diseases and is especially problematic in children and adolescents. The course of AC is generally prolonged and often recurs. Understanding the health-related quality of life (QOL) of both children with AC and their parents would be useful. To evaluate the association between AC and health-related QOL in children and their parents. A prospective case-control study was conducted at Zhongshan Ophthalmic Center, a single tertiary referral center, from November 16, 2019, through January 20, 2020. Participants comprised 92 children aged 5 to 18 years with AC and their parents and 96 healthy, age-matched children who served as controls and their parents. The 92 children in the AC group were subdivided into cohorts with vernal keratoconjunctivitis (VKC) (23 [25.0%]) or atopic keratoconjunctivitis (AKC) (7 [7.6%]) and seasonal allergic conjunctivitis (SAC) (26 [28.3%]) or perennial allergic conjunctivitis (PAC) (36 [39.1%]). Allergic conjunctivitis. Pediatric Quality of Life Inventory, version 4.0 (PedsQL), scores for children and their parents. Scores range from 0 to 100, with higher scores indicating better health-related QOL and fewer negative aspects. In the AC group, 77 of 92 (83.7%) participants were boys, and 67 (72.8%) of the parents were women. Of the individuals in the control group, 55 of 96 (57.3%) of the children were girls and 76 (79.2%) of the parents were women. Median total PedsQL scores were reduced in both children with AC (69.6 [interquartile range [IQR], 66.3-72.8 vs 96.7; IQR, 92.7-98.9; P < .001) and their parents (68.8; IQR, 63.9-71.4 vs 96.5; IQR, 95.1-97.9; P < .001). The reduction in health-related QOL was more severe in children with VKC/AKC than in those with SAC/PAC (difference, -3.3; 95% CI, -5.4 to -1.1; P = .004) and their parents (difference, -4.3; 95% CI, -7.1 to -2.1; P < .001). In the AC group, a higher corneal fluorescein staining score was associated with lower QOL in children (β, -1.16; 95% CI, -1.80 to -0.52; P = .001); higher corneal fluorescein staining scores (β, -1.12; 95% CI, -1.74 to -0.50; P = .001) and multiple clinical consultations (β, -3.96; 95% CI, -7.34 to -0.57; P = .02) were associated with lower QOL in parents. The parents' QOL scores were correlated with their children's QOL scores (correlation coefficient, r = 0.59; P < .001). These findings suggest AC has a negative association with health-related QOL for children and their parents, especially in children with VKC/AKC or higher corneal fluorescein staining scores.

Current Knowledge in Allergic Conjunctivitis.

Allergic conjunctivitis is a disease of increasing prevalence that affects both children and adults and causes significant deterioration of their quality of life and sometimes irreversible visual damage. There are various forms of the disease, some are allergen-induced such as seasonal and perennial allergic conjunctivitis, giant papillary conjunctivitis, and contact allergic blepharoconjunctivitis, whereas others are not always explained by allergen exposure, such as vernal keratoconjunctivitis and atopic keratoconjunctivitis. We review their clinical course, characteristics, and differential diagnosis, and highlight recent advances in their pathophysiology and treatment.