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Trentalange A, Renzi M, Michelozzi P, Guizzi M, Solimini AG. Association between air pollution and emergency room admission for eye diseases in Rome, Italy: A time-series analysis. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 343:123279. [PMID: 38160774 DOI: 10.1016/j.envpol.2023.123279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/27/2023] [Accepted: 12/29/2023] [Indexed: 01/03/2024]
Abstract
Eye diseases impose a significant burden on health services due to high case numbers. However, exposure to outdoor air pollution is seldom mentioned as potential harmful factor. We conducted a time-series analysis in Rome, Italy, to estimate the association between daily mean concentration of NO2, PM10 and PM2.5 and daily number of emergency room (ER) admissions for a selected cluster of eye diseases from 2006 to 2016. We used Poisson regression adjusted for time trend, population decrease during summer vacations and holidays, day of week, apparent temperature (hot and cold) and daily concentration of nine pollen species. We observed 581,868 ER admissions during the study period. 44.74% of cases were observed in subjects with less than 20 years, 19.50% in 51-65 age category and 13.4% among children (0-14 years). No differences between sexes were recorded. Mean values of pollutant concentrations were 54.75, 31.01 and 18.14 μg/m3 for NO2, PM10 and PM2.5 respectively. The air temperature ranged from -1 °C to 32.5 °C, with a mean value of 16 °C (SD = 6.88). The apparent temperature spaced from -3.58 °C to 34.08 °C (mean = 15.61 °C, SD = 8.5). The highest percent risk increases for 10 μg/m3 increases of the three pollutants were observed at lag0-1 day (1.3%, 0.63-1.98 for PM2.5; 1.03%, 0.56-1.51 for PM10 and 0.6%, 0.13-1.07 for NO2). Risk increased significantly also at lag0 and lag0-5 day for each pollutant. Secondary analyses showed higher effects in the elderly compared to younger subjects. No differences emerged between sexes. The dose response analysis suggested of possible effects on ER admission risk also at low-level concentrations of PM2.5. A strong confounding effect of pollen was not detected. RESULTS: of this study are coherent with previous analyses. Speculation can be done about the biological mechanisms that link air pollution to eye damage.
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Affiliation(s)
| | - Matteo Renzi
- Department of Epidemiology, Health Authority Service, ASL Rome 1, Rome, Italy
| | - Paola Michelozzi
- Department of Epidemiology, Health Authority Service, ASL Rome 1, Rome, Italy
| | - Marco Guizzi
- ASL RM5, UOC Oculistica, Ospedale San Giovanni Evangelista, Tivoli, (RM), Italy
| | - Angelo Giuseppe Solimini
- Department of Public Health and Infectious Diseases, University of Rome "La Sapienza", Rome, Italy
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Yang J, Wang W, Shen Z, Kang W, Zhang P, Chen X, Li H, Shao Y, Liu L, Zhang S, Quan F. Efficacy and safety of Artemisia annua sublingual immunotherapy in patients with seasonal allergic rhinoconjunctivitis over two pollen seasons. Eur Arch Otorhinolaryngol 2023; 280:4939-4947. [PMID: 37365351 DOI: 10.1007/s00405-023-08078-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE This study investigates the efficacy and safety of sublingual immunotherapy (SLIT) with A. annua allergens in patients with seasonal allergic rhinoconjunctivitis over two pollen seasons. METHODS Seventy patients with moderate-severe seasonal allergic rhinoconjunctivitis were divided evenly into the SLIT and control groups. The SLIT last from 3 months before the summer-autumn pollen season in 2021 till the end of the summer-autumn pollen season in 2022. The daily individual symptom score, total rhinoconjunctivitis symptom score (dTRSS), total medication score (dTMS), combined score of medication and rhinoconjunctivitis symptom (dCSMRS), visual analog scale (VAS) score, and adverse events (AEs) were evaluated. RESULTS The average pollen concentration in 2022 was twice that previous two-year during the pollen season. Fifty-six patients completed treatments (SLIT group: 29, control group: 27). Compared with baseline, the individual symptoms, dTRSS, dTMS, dCSMRS, and VAS scores of SLIT group declined in 2021. After 16 months of SLIT, all efficacy indexes in 2022 were still lower than baseline and equivalent to those in 2021. In control group, the efficacy indexes in 2022 were higher than that in 2020 and 2021. The efficacy indexes of SLIT group were lower than those of control group in 2021 and 2022. SLIT is effective for both mono- and poly-sensitized patients. AEs incidence in SLIT group was 82.7% without severe AEs. CONCLUSIONS The A. annua-SLIT can obtain efficacy and safety over two pollen seasons for patients with moderate-severe seasonal allergic rhinoconjunctivitis.
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Affiliation(s)
- Jiayi Yang
- Department of Otolaryngology Head and Neck Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xian, 710061, China
| | - Weidong Wang
- Department of Otolaryngology Head and Neck Surgery, NO. 215 Hospital of Shaanxi Nuclear Industry, Xianyang, 710054, China
| | - Zhen Shen
- Department of Otolaryngology Head and Neck Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xian, 710061, China
| | - Wei Kang
- Department of Otolaryngology Head and Neck Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xian, 710061, China
| | - Pengfei Zhang
- Department of Otolaryngology Head and Neck Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xian, 710061, China
| | - Xin Chen
- Department of Otolaryngology Head and Neck Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xian, 710061, China
| | - Huajing Li
- Department of Otolaryngology Head and Neck Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xian, 710061, China
| | - Yuan Shao
- Department of Otolaryngology Head and Neck Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xian, 710061, China
| | - Lifeng Liu
- Department of Otolaryngology Head and Neck Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xian, 710061, China
| | - Shaoqiang Zhang
- Department of Otolaryngology Head and Neck Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xian, 710061, China.
| | - Fang Quan
- Department of Otolaryngology Head and Neck Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xian, 710061, China.
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Gherasim A, Bielory L. The use of environmental exposure chambers in studies related to ocular surface effects. Curr Opin Allergy Clin Immunol 2023; 23:409-414. [PMID: 37459277 DOI: 10.1097/aci.0000000000000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE OF REVIEW The potential of allergen challenges using environmental exposure facilities in allergic conjunctivitis drug development and more recently its implication on the diagnosis of the united airways concept have been emphasized in the recent literature. This study aims to present an overview of new and important data in this field. RECENT FINDINGS Standardized methodologies for ocular surface assessment during allergen challenges were described. The Total Ocular Symptom Score (TOSS) is the main validated questionnaire used for the assessment of ocular surface during allergen challenges. It combines patient and investigator assessments for more accurate conjunctival response and was extensively used in clinical research and daily practice. Environmental Exposure Chambers (EECs) studies aim to conduct tight-controlled challenges to a stable and well defined allergen airborne concentration, closer to natural exposure to evaluate the efficacy of nonpharmaceutical and antiallergic treatments. Recent studies showed a good correlation between ocular symptoms elicited by EEC and those assessed during natural exposure. These validated methods allow to investigate the efficacy of novel pharmacotherapies for allergic conjunctivitis and allergen immunotherapy (AIT) in a real-world model of allergen exposure. SUMMARY This study aims to summarize novel data regarding the impact of EECs in studying pathophysiology and drug efficacy in the context of existing clinical protocols related to ocular surface effects. In this regard, studies comparing conjunctival response during natural and EEC exposures in patients with pollen-induced conjunctivitis aimed to demonstrate better outcomes in tight-controlled exposures mimicking natural exposure. Because allergen challenges are widely implemented in allergy treatment, this article will focus on the most important outcomes and the evolution of treatments for allergic conjunctivitis.
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Affiliation(s)
- Alina Gherasim
- ALYATEC Environmental Exposure Chamber, 1 Place de l'Hôpital, Strasbourg, France
| | - Leonard Bielory
- Hackensack Meridian School of Medicine, Department of Medicine and Ophthalmology, Division of Allergy and Immunology
- Kean University, Center for Aerobiological Research, Union
- Rutgers University, Environmental and Occupational Health Science Institute, Piscataway, New Jersey, USA
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Zhang X, Chen H, Liu S, Wang X, Guo B, Liu J, Feng S, Liu F. Allergen Sensitization in Children in Weifang, China: Differences Between Monosensitization and Polysensitization. J Asthma Allergy 2023; 16:397-410. [PMID: 37081905 PMCID: PMC10112473 DOI: 10.2147/jaa.s405549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/03/2023] [Indexed: 04/22/2023] Open
Abstract
Background Children are the age group with the highest prevalence of allergy diseases. There is currently a lack of knowledge regarding monosensitization and polysensitization characteristics in children. In this study, we investigated the characteristics and differences between monosensitization and polysensitization in children in Weifang, eastern China. Objective To demonstrate the basic features of monosensitization and polysensitization in children. To explore the inherent and clinical parameter differences between monosensitized and polysensitized children. Material and Methods A total of 6030 individuals with a physician-determined need for allergy testing were tested for 15 common allergens, including 9 aeroallergens and 6 food allergens. A total of 938 allergen-positive children aged 1 month to 18 years were eventually included in this analysis. Complete blood count results from the same time as the allergen test were derived from the computerized medical records. Intrinsic features such as age, gender, sIgE, T-IgE, and clinical parameters such as eosinophil percentage, eosinophil count, basophil percentage, and basophil count were compared. Results The results showed that dust mite-related allergens, mould-related allergens, and tree and grass pollen-related allergens were the most prevalent allergens among monosensitized children. Additionally, the results of the combined pattern of polysensitive childhood allergens indicate the most common two allergens that were present together included dust mites and mould-related allergens, dust mite and Artemisia pollens, and dust mite and Humulus scandens pollens. Polysensitization can result in higher sIgE, T-IgE and eosinophil levels. Conclusion In conclusion, we provide a basic overview of allergens in monosensitized and polysensitized children. These findings provide new insight into the management of allergic diseases, particularly from the standpoint of polysensitization.
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Affiliation(s)
- Xiyan Zhang
- School of Clinical Medicine, Weifang Medical University, Weifang, People’s Republic of China
- Department of Allergy, Weifang People's Hospital, Weifang, People’s Republic of China
| | - Hui Chen
- School of Clinical Medicine, Weifang Medical University, Weifang, People’s Republic of China
| | - Shengnan Liu
- Department of Blood Transfusion, Affiliated Hospital of Weifang Medical University, Weifang, People’s Republic of China
| | - Xijuan Wang
- Department of Allergy, Weifang People's Hospital, Weifang, People’s Republic of China
| | - Beibei Guo
- Department of Allergy, Weifang People's Hospital, Weifang, People’s Republic of China
| | - Jingjing Liu
- Department of Allergy, Weifang People's Hospital, Weifang, People’s Republic of China
| | - Shaojie Feng
- Department of Allergy, Weifang People's Hospital, Weifang, People’s Republic of China
- Correspondence: Shaojie Feng; Fengxia Liu, Email ;
| | - Fengxia Liu
- Department of Allergy, Weifang People's Hospital, Weifang, People’s Republic of China
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Rusu RN, Ababei DC, Bild W, Stoian I, Macadan I, Stanciu GD, Ciobica A, Bild V. Self-Medication in Rural Northeastern Romania: Patients' Attitudes and Habits. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14949. [PMID: 36429676 PMCID: PMC9690038 DOI: 10.3390/ijerph192214949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 06/16/2023]
Abstract
In recent years, many healthcare systems, along with healthcare professionals, have provided services in a patient-centered manner, in which patients are key actors in the care process. Encouraging self-care creates responsible patients, but it must be practiced responsibly. This study aims to analyze the tendency towards self-medication for patients from a rural area in Northeastern Romania. Data were collected using a questionnaire, which consisted of 25 questions, that has been developed by the research team. Student's T test or one-way ANOVA was used, and the reliability of the questionnaire was calculated using Cronbach's alpha coefficient. Fifty-eight patients agreed to participate and were interviewed. The results of the study suggest that respondents practice self-medication, which they resort to when their condition cannot be treated with natural remedies or herbs and when it impairs their ability to do their daily activities. Self-medication could be explained by the lack of self-care services as well as the trust patients have in the specific treatment. Patients prefer asking the pharmacist for drugs instead of visiting a physician, which could be due to higher accessibility and time-efficiency, while also being prone to stock up on certain medications due to limited access to healthcare.
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Affiliation(s)
- Razvan-Nicolae Rusu
- Department of Pharmacodynamics and Clinical Pharmacy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Daniela-Carmen Ababei
- Department of Pharmacodynamics and Clinical Pharmacy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
- Advanced Research and Development Center for Experimental Medicine (CEMEX), “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Walther Bild
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Center of Biomedical Research of the Romanian Academy, 700506 Iasi, Romania
| | - Ioana Stoian
- Department of Pharmacodynamics and Clinical Pharmacy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Ioana Macadan
- Department of Pharmacodynamics and Clinical Pharmacy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Gabriela Dumitrita Stanciu
- Advanced Research and Development Center for Experimental Medicine (CEMEX), “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Andrei Ciobica
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Veronica Bild
- Department of Pharmacodynamics and Clinical Pharmacy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
- Advanced Research and Development Center for Experimental Medicine (CEMEX), “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
- Center of Biomedical Research of the Romanian Academy, 700506 Iasi, Romania
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Kvedarienė V, Burzdikaitė P, Česnavičiūtė I. mHealth and telemedicine utility in the monitoring of allergic diseases. FRONTIERS IN ALLERGY 2022; 3:919746. [PMID: 36118170 PMCID: PMC9478181 DOI: 10.3389/falgy.2022.919746] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/15/2022] [Indexed: 11/21/2022] Open
Abstract
This literature review discusses the use of mHealth technologies and telemedicine for monitoring various allergic diseases both in everyday life and in the context of COVID-19. Telemedicine, whose popularity, and demand has skyrocketed during the pandemic, rely on mHealth technologies, video calls and websites as a resource-saving and safe way of consulting patients. The incorporation of new mHealth technologies into telemedicine practice may not only be relevant in the context of pandemic restrictions but can also be applied in everyday medical practice as an effective method of patient counseling. The mobile healthcare applications include a wide range of mobile apps for patients' education, monitoring, and disease management. However, applications for the people with food allergies lack relevant information about allergies and, like most other applications, are developed without the contribution of healthcare specialists. During the COVID-19 pandemic, low-risk food-allergic patients were able to rely on telemedicine services where they could get the help, they needed without increasing risk of contracting COVID-19 while saving time. Meanwhile, some applications for allergic rhinitis and asthma patients are showing practical benefits in clinical trials by allowing an efficient assessment of treatment regimens and efficacy. The use of digital symptom diaries further facilitates the implementation of real-life studies. However, for respiratory allergic diseases, the often insufficient quality of pollen prediction needs to be taken into account. Even though studies have shown that asthma is better controlled with mHealth technologies, the quality of mobile apps for asthma patients varies widely, as many products provide information that has not been scientifically proven. Inhaler sensors - have been shown to improve the course of asthma and its monitoring, while push notifications prompting people to take their medication double the likelihood of treatment adherence. Teledermatology has a high level of patient satisfaction - as it is perceived as a more time-saving method of consultation. However, the diagnostic accuracy of contact consultations remains higher. mHealth technologies provide a patient's health data from his/her daily life, which enables insights into behavioral patterns. This closer look at the daily routine can have a significant impact on developing individualized treatment and care guidelines.
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Affiliation(s)
- Violeta Kvedarienė
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Sheng W, Liu A, Peng H, Wang J, Guan L. A time-series analysis on generalized additive model for atmospheric pollen concentration and the number of visits of allergic conjunctivitis, Beijing, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:61522-61533. [PMID: 35445302 DOI: 10.1007/s11356-022-19897-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/21/2022] [Indexed: 06/14/2023]
Abstract
The objective of this study is to investigate the correlation between atmospheric pollen concentration and daily visits for allergic conjunctivitis. Daily counts of outpatient visits for allergic conjunctivitis, atmospheric pollen concentration, and meteorological data during pollen season of 2018 and 2019 were collected from Beijing Shijitan Hospital, China. A time-series analysis on generalized additive model with Poisson distribution was used to estimate the relationship between pollen concentration and visits for allergic conjunctivitis, after controlling for the time trend, weather variables, day of the week, and holiday effect. The RStudio was used to generate Spearman correlation coefficients and then to plot the lag-response curves for specific and incremental cumulative effects of relative risk (RR). There was a moderate positive correlation between pollen concentration and visits for allergic conjunctivitis, and Spearman's correlation coefficient was 0.521 in 2018 and 0.515 in 2019 (P<0.01). The specific cumulative effect peak associated with per 10 grains/kmm2 increases of atmospheric pollen concentration was within 0 day, and the lag time was 8 days(2018, 2019). The incremental cumulative effect peak associated with per 10 grains/kmm2 increases of atmospheric pollen concentration occurred on lag day 10 (2018) and lag day 8 (2019), and the lag time was 14 days (2018) and 20 days (2019). Elevated concentrations of pollen increase the risk of allergic conjunctivitis with a time lag effect.
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Affiliation(s)
- Weixuan Sheng
- Department of Anesthesiology, Capital Medical University Affiliated Beijing Shijitan Hospital, No. 10 Yangfangdian Railway Hospital Road, Haidian District, Beijing, 100038, China
| | - Aizhu Liu
- Department of Otolaryngology Head and Neck Surgery, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, China
| | - Hong Peng
- Department of Otolaryngology Head and Neck Surgery, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, China
| | - Jia Wang
- Department of Otolaryngology Head and Neck Surgery, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, China
| | - Lei Guan
- Department of Anesthesiology, Capital Medical University Affiliated Beijing Shijitan Hospital, No. 10 Yangfangdian Railway Hospital Road, Haidian District, Beijing, 100038, China.
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Ono J, Toshida H. Use of Ketotifen Fumarate-Eluting Daily Disposable Soft Contact Lens in Management of Ocular Allergy: Literature Review and Report of Two Cases. Cureus 2022; 14:e27093. [PMID: 36000122 PMCID: PMC9391663 DOI: 10.7759/cureus.27093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 12/03/2022] Open
Abstract
We present two cases in which the drug-eluting daily disposable soft contact lens (DDSCL) Acuvue® TheravisionTM with Ketotifen (Johnson & Johnson Vision Care, Inc., Jacksonville, Florida, USA) (ATK), which contains the anti-allergic drug ketotifen fumarate, alleviated ocular allergic symptoms. Case 1 was a 57-year-old woman with a history of allergic conjunctivitis in the spring and fall. In the summer and winter, the patient used frequent replacement soft contact lenses, but in the allergy seasons, she used DDSCLs in combination with anti-allergic eye drops. She agreed to start wearing ATK lenses from before the next fall season. The lenses suppressed her allergic signs and symptoms, and she felt comfortable wearing them and continued their use throughout the season. Her symptoms were suppressed, providing her comforts that enabled uses of the CLs for some time. She successfully used the lenses again from the beginning of the next spring season. Case 2 was a 31-year-old woman with a history of cedar pollinosis. The patient previously used DDSCLs and was prescribed ATK lenses at her regular clinic. About one month later, she was referred to our department. With ATK lenses, she did not experience any subjective symptoms during the pollinosis season. At a subsequent visit, hyperemia had decreased compared with the initial visit. In these two cases, the use of ATK lenses from before until the end of both the spring and fall allergy seasons suppressed the symptoms of allergic conjunctivitis, allowing the patients to continue to wear contact lenses.
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Effects of rAmb a 1-Loaded PLGA-PEG Nanoparticles in a Murine Model of Allergic Conjunctivitis. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27030598. [PMID: 35163859 PMCID: PMC8837990 DOI: 10.3390/molecules27030598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/09/2022] [Accepted: 01/13/2022] [Indexed: 11/17/2022]
Abstract
Ambrosia artemisiifolia (Amb a) contains many allergens. Allergic conjunctivitis caused by Ambrosia artemisiifolia and its related allergen-specific immunotherapy (AIT) are seldom studied at present. poly(DL-lactide-co-glycolide)-polyethylene glycol (PLGA-PEG) is a very good nano-carrier, which has been applied in the medical field. In this context, we studied the immunotherapy effect and potential mechanism of recombinant Amb a 1 (rAmb a 1)-loaded PLGA-PEG nanoparticles. A mouse allergic conjunctivitis model was established with Ambrosia artemisiifolia crude extract, and the nanoparticles were used for AIT through direct observation of conjunctival tissue, degranulation of mast cells in conjunctival tissue, serum-specific antibodies, cytokines and other assessment models. The treatment of nanoparticles enhanced the secretion of T-helper 1 (Th1) cytokine Interferon-gama (IFN-γ) and the production of immunoglobulin G (IgG)2a (IgG2a), inhibited the secretion of T-helper 2 (Th2) cytokine Interleukin (IL)-13 and IL-4 and the level of IgE. Especially, degranulation of mast cells and expression of mast cell protease-1 (MCP-1) in conjunctival tissue was reduced significantly. In this study, we proved that the nanoparticles prepared by rAmb a 1 and PLGA-PEG have an immunotherapy effect on allergic conjunctivitis in mice.
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Gherasim A, Fauquert J, Domis N, Siomboing X, de Blay F. Birch allergen challenges in allergic conjunctivitis using standard conjunctival allergen challenge and environmental exposure chamber. Clin Transl Allergy 2021; 11:e12053. [PMID: 34429874 PMCID: PMC8369317 DOI: 10.1002/clt2.12053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/28/2021] [Accepted: 07/30/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Environmental exposure chambers (EECs) have been used extensively to study allergic rhinoconjunctivitis. Few studies have been published using EECs in conjunctivitis only, and none have used conjunctival allergen challenge as a selection criterion. The present study validated ALYATEC EEC in allergic conjunctivitis to birch pollen. METHODS Sixteen patients with a positive conjunctival allergen challenge (CAC) were exposed to 60 ng/m3 of Bet v 1 in an EEC on two consecutive days for a maximum of 4 h to validate EEC exposure to birch. Reproducibility was tested among seven of the patients. A conjunctival positive scoring during the CAC and the EEC exposure was defined as a Total Ocular Symptom Score (TOSS) ≥ 5. RESULTS Fifty percent of patients had a conjunctival positive scoring during first exposure and 75% during second exposure. The mean time to a conjunctival response was 81.2 ± 33.9 min and 101.6 ± 57 (P > 0.05) during first and second exposure, respectively. No difference in TOSS occurred between the two exposures. The time necessary to obtain a positive response during the CAC was significantly shorter than with the EEC. The estimated quantity of Bet v 1 inducing a positive response was 0.07 ± 0.03 ng (exposure 1), 0.07 ± 0.07 ng (exposure 2), 980 ± 784 ng (CAC). Conjunctival positive scoring and quantity of Bet v 1 was reproducible in all six EEC exposures. CONCLUSIONS Early conjunctival responses induced by birch allergen exposures in EEC were different than from those identified with direct instillation during CAC. EEC appears to be closer to natural exposure than CAC.
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Affiliation(s)
| | | | | | | | - Frederic de Blay
- ALYATEC Environmental Exposure ChamberStrasbourgFrance
- Chest Diseases DepartmentStrasbourg University HospitalStrasbourgFrance
- University of StrasbourgStrasbourgFrance
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Seth D, Bielory L. Allergenic Pollen Season Variations in the Past Two Decades Under Changing Climate in the United States. Immunol Allergy Clin North Am 2020; 41:17-31. [PMID: 33228870 DOI: 10.1016/j.iac.2020.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Prevalence of allergic diseases has been increasing due to multiple factors, among which climate change has had the most impact. Climate factors increase production of pollen, which also exhibits increased allergenicity. Also, as a result of climate change, there has been a shift in flowering phenology and pollen initiation causing prolonged pollen exposure. Various numerical models have been developed to understand the effect of climate change on pollen emission and transport and the impact on allergic airway diseases.
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Affiliation(s)
- Divya Seth
- Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, 3950 Beaubien, 4th Floor, Pediatric Specialty Building, Detroit, MI 48201, USA.
| | - Leonard Bielory
- Center of Environmental Prediction, Rutgers University; Allergy, Immunology, and Ophthalmology, Hackensack Meridian School of Medicine at Seton Hall University, 400 Mountain Avenue, Springfield, NJ 07081, USA
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12
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Use of allergen immunotherapy for treatment of allergic conjunctivitis. Curr Opin Allergy Clin Immunol 2020; 20:609-615. [DOI: 10.1097/aci.0000000000000692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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: 57] [Impact Index Per Article: 11.4] [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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14
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Bousquet J, Ansotegui IJ, Anto JM, Arnavielhe S, Bachert C, Basagaña X, Bédard A, Bedbrook A, Bonini M, Bosnic-Anticevich S, Braido F, Cardona V, Czarlewski W, Cruz AA, Demoly P, De Vries G, Dramburg S, Mathieu-Dupas E, Erhola M, Fokkens WJ, Fonseca JA, Haahtela T, Hellings PW, Illario M, Ivancevich JC, Jormanainen V, Klimek L, Kuna P, Kvedariene V, Laune D, Larenas-Linnemann D, Lourenço O, Onorato GL, Matricardi PM, Melén E, Mullol J, Papadopoulos NG, Pfaar O, Pham-Thi N, Sheikh A, Tan R, To T, Tomazic PV, Toppila-Salmi S, Tripodi S, Wallace D, Valiulis A, van Eerd M, Ventura MT, Yorgancioglu A, Zuberbier T. Mobile Technology in Allergic Rhinitis: Evolution in Management or Revolution in Health and Care? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2019; 7:2511-2523. [PMID: 31445223 DOI: 10.1016/j.jaip.2019.07.044] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/02/2019] [Accepted: 07/25/2019] [Indexed: 01/08/2023]
Abstract
Smart devices and Internet-based applications (apps) are largely used in allergic rhinitis and may help to address some unmet needs. However, these new tools need to first of all be tested for privacy rules, acceptability, usability, and cost-effectiveness. Second, they should be evaluated in the frame of the digital transformation of health, their impact on health care delivery, and health outcomes. This review (1) summarizes some existing mobile health apps for allergic rhinitis and reviews those in which testing has been published, (2) discusses apps that include risk factors of allergic rhinitis, (3) examines the impact of mobile health apps in phenotype discovery, (4) provides real-world evidence for care pathways, and finally (5) discusses mobile health tools enabling the digital transformation of health and care, empowering citizens, and building a healthier society.
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Affiliation(s)
- Jean Bousquet
- University Hospital, Montpellier, France; MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France; VIMA, INSERM U 1168, VIMA: Ageing and chronic diseases Epidemiological and public health approaches, Villejuif, Université Versailles St-Quentin-en-Yvelines, Montigny le Bretonneux, France; Euforea, Brussels, Belgium; Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Department of Dermatology and Allergy, Berlin Institute of Health, Comprehensive Allergy Center, Berlin, Germany.
| | - Ignacio J Ansotegui
- Department of Allergy and Immunology, Hospital Quirónsalud Bizkaia, Erandio, Spain
| | - Josep M Anto
- ISGlobAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Hospital del Mar Research Institute, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | | | - Claus Bachert
- Upper Airways Research Laboratory, ENT Department, Ghent University Hospital, Ghent, Belgium
| | - Xavier Basagaña
- ISGlobAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Annabelle Bédard
- ISGlobAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Anna Bedbrook
- MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France
| | - Matteo Bonini
- UOC Pneumologia, Istituto di Medicina Interna, F Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy; National Heart and Lung Institute, Royal Brompton Hospital & Imperial College London, London, United Kingdom
| | - Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW, Australia; Woolcock Emphysema Centre and Sydney Local Health District, Glebe, NSW, Australia
| | - Fulvio Braido
- Department of Internal Medicine (DiMI), University of Genoa, Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Vicky Cardona
- Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron & ARADyAL Research Network, Barcelona, Spain
| | | | - Alvaro A Cruz
- ProAR-Nucleo de Excelencia em Asma, Federal University of Bahia, Salvador, Brazil; WHO GARD Planning Group, Salvador, Brazil
| | - Pascal Demoly
- Department of Pulmonology, Division of Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France; Equipe EPAR-IPLESP, Sorbonne Université, Paris, France
| | | | - Stephanie Dramburg
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité-University Medicine Berlin, Berlin, Germany
| | | | - Marina Erhola
- National Institute for Health and Welfare, Helsinki, Finland
| | - Wytske J Fokkens
- Euforea, Brussels, Belgium; Department of Otorhinolaryngology, Amsterdam University Medical Centres, AMC, Amsterdam, the Netherlands
| | - Joao A Fonseca
- CINTESIS, Center for Research in Health Technology and Information Systems, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Medida, Lda, Porto, Portugal
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | - Peter W Hellings
- Euforea, Brussels, Belgium; Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium; Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Maddalena Illario
- Division for Health Innovation, Campania Region and Federico II University Hospital Naples (R&D and DISMET), Naples, Italy
| | | | | | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - Violeta Kvedariene
- Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Désirée Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico
| | - Olga Lourenço
- Faculty of Health Sciences and CICS-UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | | | - Paolo M Matricardi
- AG Molecular Allergology and Immunomodulation, Department of Pediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany
| | - Erik Melén
- E. Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, Barcelona, Spain; Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain
| | - Nikos G Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine, Royal Manchester Children's Hospital, University of Manchester, Manchester, United Kingdom; Allergy Department, 2nd Pediatric Clinic, Athens General Children's Hospital "P&A Kyriakou", University of Athens, Athens, Greece
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Phillipps-Universität Marburg, Marburg, Germany
| | - Nhân Pham-Thi
- Allergy Department, Pasteur Institute, Paris, France
| | - Aziz Sheikh
- The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, United Kingdom
| | - Rachel Tan
- Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW, Australia; Woolcock Emphysema Centre and Sydney Local Health District, Glebe, NSW, Australia
| | - Teresa To
- Sidkkids Hospital and Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada
| | | | - Sanna Toppila-Salmi
- Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | | | - Dana Wallace
- Nova Southeastern University, Fort Lauderdale, Fla
| | - Arunas Valiulis
- Institute of Clinical Medicine, Clinic of Children's Diseases, Vilnius University, Vilnius, Lithuania; Institute of Health Sciences, Department of Public Health, Vilnius University, Vilnius, Lithuania; European Academy of Paediatrics (EAP/UEMS-SP), Brussels, Belgium
| | | | - Maria Teresa Ventura
- University of Bari Medical School, Unit of Geriatric Immunoallergology, Bari, Italy
| | - Arzu Yorgancioglu
- Department of Pulmonary Diseases, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Torsten Zuberbier
- Charité-Universitätsmedizin Berlin, Berlin, Germany; Corporate member of Freie Universität Berlin, Humboldt-Uniersität zu Berlin, and Berlin Institute of Health, Comprehensive Allergy-Centre, Department of Dermatology and Allergy, Berlin, Germany; Member of GA(2)LEN, Berlin, Germany
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15
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Zielen S, Kuna P, Aberer W, Lassmann S, Pfaar O, Klimek L, Wade A, Kluehr K, Raab J, Wessiepe D, Lee D, Kramer M, Gunawardena K, Higenbottam T, Heath M, Skinner M, de Kam P. Strong dose response after immunotherapy with PQ grass using conjunctival provocation testing. World Allergy Organ J 2019; 12:100075. [PMID: 31709029 PMCID: PMC6831906 DOI: 10.1016/j.waojou.2019.100075] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 09/19/2019] [Accepted: 09/24/2019] [Indexed: 12/24/2022] Open
Abstract
Background Pollinex Quattro Grass (PQ Grass) is an effective, well-tolerated, short pre-seasonal subcutaneous immunotherapy to treat seasonal allergic rhinoconjunctivitis (SAR) due to grass pollen. In this Phase II study, 4 cumulative doses of PQ Grass and placebo were evaluated to determine its optimal cumulative dose. Methods Patients with grass pollen-induced SAR were randomised to either a cumulative dose of PQ Grass (5100, 14400, 27600 and 35600 SU) or placebo, administered as 6 weekly subcutaneous injections over 31-41 days (EudraCT number 2017-000333-31). Standardized conjunctival provocation tests (CPT) using grass pollen allergen extract were performed at screening, baseline and post-treatment to determine the total symptom score (TSS) assessed approximately 4 weeks after dosing. Three models were pre-defined (Emax, logistic, and linear in log-dose model) to evaluate a dose response relationship. Results In total, 95.5% of the 447 randomized patients received all 6 injections. A highly statistically significant (p < 0.0001), monotonic dose response was observed for all three pre-specified models. All treatment groups showed a statistically significant decrease from baseline in TSS compared to placebo, with the largest decrease observed after 27600 SU (p < 0.0001). The full course of 6 injections was completed by 95.5% of patients. Treatment-emergent adverse events were similar across PQ Grass groups, and mostly mild and transient in nature. Conclusions PQ Grass demonstrated a strong curvilinear dose response in TSS following CPT without compromising its safety profile.
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Key Words
- ADRs, adverse drug reactions
- AE, adverse events
- AIT, allergen immunotherapy
- ANCOVA, analysis of covariance
- ARC, adverse reaction complexes
- Allergen immunotherapy
- Allergoid
- CIA-CPT, Culture – Independent Assessment of the Conjunctival Provocation Test
- CPT, conjunctival provocation test
- Cumulative dose
- Curvilinear dose response
- EAACI, European Academy of Allergy and Clinical Immunology
- EMA, European Medicine Agency
- FAS, Full Analysis Set
- FEV, forced expiratory volume
- FVC, forced vital capacity
- Grass pollen
- HEP, Histamine Equivalent Potency
- LPS, lipopolysaccharide
- MCP-Mod, Multiple Comparison Procedure and Modelling
- MCT, microcrystalline tyrosine
- MPL, Monophosphoryl Lipid A
- MedDRA, Medical Dictionary for Regulatory Activities
- PPS, Per Protocol Set
- SAEs, serious adverse events
- SAF, safety set
- SAR, seasonal allergic rhinoconjunctivitis
- SD, standard deviation
- SU, standardized units
- TEAEs, treatment-emergent adverse events
- TLR, Toll-like receptor
- TSS, Total Symptom Score
- mFAS, Modified Full Analysis Set
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Affiliation(s)
- S. Zielen
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Goethe University, Frankfurt, Germany
| | - P. Kuna
- Poradnia Alergologii i Chorób Płuc Lodz, Poland
| | - W. Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - S. Lassmann
- Specialist in Otolaryngology, Saalfeld, Germany
| | - O. Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Germany
| | - L. Klimek
- Centre for Rhinology and Allergology, Wiesbaden, Germany
| | - A. Wade
- Allergy Therapeutics Ltd., Worthing, UK
| | - K. Kluehr
- Allergy Therapeutics Ltd., Worthing, UK
| | - J. Raab
- Allergy Therapeutics Ltd., Worthing, UK
| | - D. Wessiepe
- Metronomia Clinical Research GmbH, Munich, Germany
| | - D. Lee
- Allergy Therapeutics Ltd., Worthing, UK
| | | | | | | | | | | | - P.J. de Kam
- Allergy Therapeutics Ltd., Worthing, UK
- Corresponding author. Allergy Therapeutics (UK) Ltd, Dominion Way Worthing, West Sussex BN14 8SA, UK
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16
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Fauquert JL. Diagnosing and managing allergic conjunctivitis in childhood: The allergist's perspective. Pediatr Allergy Immunol 2019; 30:405-414. [PMID: 30742722 DOI: 10.1111/pai.13035] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/23/2019] [Accepted: 01/24/2019] [Indexed: 12/26/2022]
Abstract
Allergic conjunctivitis in childhood often poses problems of diagnosis and management for the allergist. We present the salient points concerning the diagnosis and treatment of ocular allergy emerging from a large cohort survey conducted jointly in the departments of ophthalmology and paediatric allergy in a French teaching hospital. Seasonal acute conjunctivitis is a common disorder and not overly difficult to diagnose and treat when associated with rhinitis leading to allergic rhinoconjunctivitis. An ophthalmologist should be consulted when conjunctivitis occurs alone and if another form of conjunctivitis is suspected, such as perennial allergic conjunctivitis, vernal keratoconjunctivitis or atopic keratoconjunctivitis. When IgE-mediated hypersensitivity assessment does not establish aetiological diagnosis, a conjunctival allergen provocation test can be performed. The principal non-IgE-mediated allergy is chronic blepharoconjunctivitis. The main problem for differential diagnosis is the presence of signs suggestive of dry eye. Management includes non-pharmacological treatments, such as lacrimal substitutes, avoidance measures and protection of the ocular surface. Second-line treatment consists of eye drops, preferably single dose or without additives and with dual local action, mast cell stabilizer action and antihistaminic action. Third-line treatment is reserved for severe forms. Short-lasting local steroid therapy can control flare-ups of allergic keratoconjunctivitis, which should have specialized follow-up. Cyclosporine is a disease-modifying treatment, which is both effective and well tolerated.
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Affiliation(s)
- Jean-Luc Fauquert
- CHU Clermont-Ferrand, Consultation d'Ophtalmologie et Allergologie de l'enfant, Unité d'Allergologie de l'enfant, CHU Estaing, Clermont-Ferrand Cedex1, France
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