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Trivedi A, Katelaris C. Presentation, diagnosis, and the role of subcutaneous and sublingual immunotherapy in the management of ocular allergy. Clin Exp Optom 2020; 104:334-349. [PMID: 32944983 DOI: 10.1111/cxo.13129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Allergic eye disease or ocular allergy is a debilitating condition with a significant impact on quality of life and productivity. As atopy continues to be on the rise, primary care providers are likely to encounter increasing numbers of patients with allergic eye disease. This review outlines the classification and pathophysiology of allergic eye disease and its clinical presentation. This paper does not detail traditional first-line therapies of allergic eye disease but describes the interdisciplinary management between the eye-care provider and allergist. It is recommended that patients with ongoing signs and symptoms of ocular allergy despite first-line therapies be referred for allergen immunotherapy, as it is highly effective for treatment of allergic eye disease. Through induction of immune tolerance, allergen immunotherapy is a disease-modifying therapy that can result in long-term improvement of ocular allergy. A thorough literature review was conducted on the efficacy and safety of allergen immunotherapy, including subcutaneous immunotherapy and sublingual immunotherapy, and its role in allergic eye disease.
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Affiliation(s)
- Amruta Trivedi
- Immunology Department, Campbelltown Hospital, Sydney, Australia.,Department of Medicine, Campbelltown Hospital, Sydney, Australia
| | - Constance Katelaris
- Immunology Department, Campbelltown Hospital, Sydney, Australia.,Department of Medicine, Campbelltown Hospital, Sydney, Australia
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Bielory L, Delgado L, Katelaris CH, Leonardi A, Rosario N, Vichyanoud P. ICON: Diagnosis and management of allergic conjunctivitis. Ann Allergy Asthma Immunol 2019; 124:118-134. [PMID: 31759180 DOI: 10.1016/j.anai.2019.11.014] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/08/2019] [Accepted: 11/13/2019] [Indexed: 12/20/2022]
Abstract
Ocular allergy (OA), interchangeably known as allergic conjunctivitis, is a common immunological hypersensitivity disorder affecting up to 40% of the population. Ocular allergy has been increasing in frequency, with symptoms of itching, redness, and swelling that significantly impacts an individual's quality of life (QOL). Ocular allergy is an often underdiagnosed and undertreated health problem, because only 10% of patients with OA symptoms seek medical attention, whereas most patients manage with over-the-counter medications and complementary nonpharmacological remedies. The clinical course, duration, severity, and co-morbidities are varied and depend, in part, on the specific ocular tissues that are affected and on immunologic mechanism(s) involved, both local and systemic. It is frequently associated with allergic rhinitis (commonly recognized as allergic rhino conjunctivitis), and with other allergic comorbidities. The predominance of self-management increases the risk of suboptimal therapy that leads to recurrent exacerbations and the potential for development of more chronic conditions that can lead to corneal complications and interference with the visual axis. Multiple, often co-existing causes are seen, and a broad differential diagnosis for OA, increasing the difficulty of arriving at the correct diagnosis(es). Ocular allergy commonly overlaps with other anterior ocular disease disorders, including infectious disorders and dry eye syndromes. Therefore, successful management includes overcoming the challenges of underdiagnosis and even misdiagnosis by a better understanding of the subtleties of an in-depth patient history, ophthalmologic examination techniques, and diagnostic procedures, which are of paramount importance in making an accurate diagnosis of OA. Appropriate cross-referral between specialists (allergists and eyecare specialists) would maximize patient care and outcomes. This would significantly improve OA management and overcome the unmet needs in global health.
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Affiliation(s)
- Leonard Bielory
- Department of Medicine and Ophthalmology, Hackensack Meridian School of Medicine, Springfield, NJ 07081.
| | - Luis Delgado
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, and CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Constance H Katelaris
- Western Sydney University, Campbelltown Hospital, Clinical Immunology and Allergy, Sydney, New South Wales, Australia
| | - Andrea Leonardi
- Department of Neurosciences & Ophthalmology, University of Padua, Padua, Italy
| | - Nelson Rosario
- Division of Pediatric Allergy, Immunology and Pneumology, Hospital de Clinicas, UFPR Professor of Pediatrics Federal University of Parana, Curitiba, Brazil
| | - Pakit Vichyanoud
- Emeritus Faculty of Medicine, Pediatric Allergy and Immunology Chulalongkorn, University Bangkok, Thailand
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Elieh Ali Komi D, Rambasek T, Bielory L. Clinical implications of mast cell involvement in allergic conjunctivitis. Allergy 2018; 73:528-539. [PMID: 29105783 DOI: 10.1111/all.13334] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2017] [Indexed: 01/27/2023]
Abstract
The conjunctiva is a common site for the allergic inflammatory response due to it being highly vascularized, having constant exposure to environmental pollutants and allergenic pollens and having a unique conjunctival associated lymphoid tissue. The primary morbidity of anterior surface conjunctival disorders that include allergic conjunctivitis and tear film disorders is associated with its high frequency of involvement rather than its severity, although the more chronic forms can involve the cornea and lead to sight-threatening conditions. Ocular allergy is associated with IgE-mediated mast cell activation in conjunctival tissue leading to the release of preformed mediators including histamine and proteases and subsequent de novo formation of lipid-derived mediators and cytokines that trigger a cascade of cellular and molecular events leading to extensive migration and infiltration of inflammatory cells to the ocular surface. The trafficking of neutrophils, eosinophils, and lymphocytes to the ocular surface is due to establishing various chemokine gradients (mainly CCL11, CCL24, CCL5, MCP-3, and MCP-4), cell surface expression of adhesion molecules (such as VCAM-1 the ligand for VLA-4), and leukocyte adhesion to vascular endothelium. The release of preformed mediators underlies the acute ocular surface response while the secondary influx of inflammatory cells leading to the recruitment and activation of eosinophils and the subsequent activation of Th2 and Th1 lymphocytes at the level of the conjunctiva reflects the late-phase reaction.
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Affiliation(s)
- D. Elieh Ali Komi
- Immunology Research Center; Tabriz University of Medical Sciences; Tabriz Iran
- Department of Immunology; Tabriz University of Medical Sciences; Tabriz Iran
| | - T. Rambasek
- Ohio University Heritage College of Osteopathic Medicine; Athens OH USA
| | - L. Bielory
- Rutgers University Center for Environmental Prediction; New Brunswick NJ USA
- Thomas Jefferson University The Sidney Kimmel Medical College Philadelphia; Philadelphia PA USA
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Jauhonen HM, Laihia J, Oksala O, Viiri J, Sironen R, Alajuuma P, Kaarniranta K, Leino L. Topical cis-urocanic acid prevents ocular surface irritation in both IgE -independent and -mediated rat model. Graefes Arch Clin Exp Ophthalmol 2017; 255:2357-2362. [PMID: 28840310 DOI: 10.1007/s00417-017-3781-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 08/07/2017] [Accepted: 08/14/2017] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Our purpose was to investigate the effect of locally administered cis-urocanic (cis-UCA) in two experimental models of allergic conjunctivitis. METHODS The compound 48/80 (C48/80)-induced ocular irritation model (IgE-independent) and the ovalbumin (OA)-induced ocular allergy model (IgE-mediated) were used to test and compare the effect of cis-UCA on dexamethasone, ketotifen and olopatadine. In the C48/80 model, clinical severity scoring from photographs, immunohistochemical analysis of nuclear Ki-67 antigen to quantify actively proliferating epithelial cells and of caspase-3 enzyme to identify apoptotic activity in the conjunctival tissue were used. In the OA model, an Evans Blue stain concentration of conjunctival tissue was used to evaluate vascular leakage due to allergic reaction. RESULTS The cis-UCA was well tolerated and effective in both the IgE-independent and -mediated rat models. Treatment with C48/80 caused conjunctival hyperaemia, which was significantly inhibited by ketotifen at the 6 h time point (p = 0.014) and by dexamethasone and cis-UCA 0.5% at 12 (p = 0.004) and 24 (p = 0.004) hour time points. In a comparison between the active drug treatments, only ketotifen showed a significant difference (p = 0.023) to cis-UCA treatment at the 1 h time point, otherwise there were no statistically significant differences between the active drugs. Ketotifen, dexamethasone and cis-UCA 0.5% significantly inhibited the C48/80-induced nuclear accumulation of Ki-67, without differences between the active treatment groups. In the OA model, cis-UCA 0.5% did not inhibit the vascular leakage of conjunctiva, whereas cis-UCA 2.5% of was at least equally effective compared to olopatadine, abolishing the allergic vascular leakage response almost completely. CONCLUSIONS The present findings in the two AC models suggest that cis-UCA might have anti-allergic potency both in immediate and delayed-type allergic reactions in the eye.
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Affiliation(s)
- Hanna-Mari Jauhonen
- Department of Ophthalmology, Kuopio University Hospital, Kuopio, Finland. .,Institute of Clinical Medicine, Department of Ophthalmology, University of Eastern Finland, Kuopio, Finland. .,Department of Ophthalmology, University of Eastern Finland and Kuopio University Hospital, Finland, P.O. Box 1627, FIN-70211, Kuopio, Finland.
| | | | | | - Johanna Viiri
- Institute of Clinical Medicine, Department of Ophthalmology, University of Eastern Finland, Kuopio, Finland
| | - Reijo Sironen
- Institute of Clinical Medicine, Department of Pathology and Forensic Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Pathology, Kuopio University Hospital, Kuopio, Finland
| | | | - Kai Kaarniranta
- Department of Ophthalmology, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, Department of Ophthalmology, University of Eastern Finland, Kuopio, Finland
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Xia Y, Zhao G, Lin J, Li C, Cong L, Jiang N, Xu Q, Wang Q. 1,25(OH)2D3 and VDR Signaling Pathways Regulate the Inhibition of Dectin-1 Caused by Cyclosporine A in Response to Aspergillus Fumigatus in Human Corneal Epithelial Cells. PLoS One 2016; 11:e0164717. [PMID: 27755569 PMCID: PMC5068748 DOI: 10.1371/journal.pone.0164717] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 09/29/2016] [Indexed: 01/24/2023] Open
Abstract
Background The objective of this study is to observe whether cyclosporine A (CsA) inhibits the expression of dectin-1 in human corneal epithelial cells infected with Aspergillus fumigatus (A. fumigatus) and to investigate the molecular mechanisms of the inhibition. Methods Immortalized human corneal epithelial cells (HCECs) were pretreated with 1,25(OH)2D3 and VDR inhibitor for 1 h, and then they were pretreated with CsA for 12h. After these pretreatments, the HCECs were stimulated with A. fumigatus and curdlan respectively, and the expression of dectin-1 and proinflammatory cytokines (IL-1β and TNF-α) were detected by RT-PCR, western blot and ELISA. Results Dectin-1 mRNA and dectin-1 protein expression increased when HCECs were stimulated with A. fumigatus or curdlan, and CsA inhibited the dectin-1 expression both in mRNA and protein levels specifically. Dectin-1 and proinflammatory cytokine expression levels were higher when HCECs were pretreated with VDR inhibitor and CsA compared to pretreatment with CsA alone, while dectin-1 and proinflammatory cytokine levels were lower when HCECs were pretreated with 1,25(OH)2D3 and CsA compared to pretreatment with CsA alone. Conclusions These data provide evidence that CsA can inhibit the expression of dectin-1 and proinflammatory cytokines through dectin-1 when HCECs are stimulated by A. fumigatus or curdlan. The active form of vitamin D, 1,25(OH)2D3, and VDR signaling pathway regulate the inhibition of CsA. The inhibition is enhanced by 1,25(OH)2D3, and the VDR inhibitor suppresses the inhibition.
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MESH Headings
- Antigens, Bacterial/immunology
- Antigens, Bacterial/pharmacology
- Aspergillus fumigatus/metabolism
- Calcitriol/antagonists & inhibitors
- Calcitriol/metabolism
- Cells, Cultured
- Cyclosporine/pharmacology
- Enzyme-Linked Immunosorbent Assay
- Epithelium, Corneal/cytology
- Epithelium, Corneal/drug effects
- Epithelium, Corneal/metabolism
- Gene Expression/drug effects
- Humans
- Interleukin-1beta/analysis
- Interleukin-1beta/genetics
- Interleukin-1beta/metabolism
- Lectins, C-Type/antagonists & inhibitors
- Lectins, C-Type/genetics
- Lectins, C-Type/metabolism
- RNA, Messenger/metabolism
- Receptors, Calcitriol/antagonists & inhibitors
- Receptors, Calcitriol/metabolism
- Signal Transduction/drug effects
- Tumor Necrosis Factor-alpha/analysis
- Tumor Necrosis Factor-alpha/genetics
- Tumor Necrosis Factor-alpha/metabolism
- beta-Glucans/pharmacology
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Affiliation(s)
- Yiping Xia
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Guiqiu Zhao
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- * E-mail:
| | - Jing Lin
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Cui Li
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Lin Cong
- Shandong Eye Institute, Qingdao, Shandong, China
| | - Nan Jiang
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Qiang Xu
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Qian Wang
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Ao J, Goldblatt F, Casson RJ. Review of the ophthalmic manifestations of gout and uric acid crystal deposition. Clin Exp Ophthalmol 2016; 45:73-80. [DOI: 10.1111/ceo.12749] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 03/03/2016] [Accepted: 03/18/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Jack Ao
- South Australian Institute of Ophthalmology; University of Adelaide; Adelaide South Australia Australia
| | - Fiona Goldblatt
- Department of Rheumatology; The Repatriation General Hospital; Adelaide South Australia Australia
- Flinders Medical Centre; Adelaide South Australia Australia
| | - Robert J Casson
- South Australian Institute of Ophthalmology; University of Adelaide; Adelaide South Australia Australia
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