Prevalence of allergic rhinitis symptoms and positive skin-prick test results in patients with dry eye

Assessment of receptor affinities of ophthalmic and systemic agents in dry eye disease

PURPOSE OF REVIEW

To explore our current understanding of receptor profiles acted upon by medications used to treat dry eye disease (DED).

RECENT FINDINGS

Research into histaminic and muscarinic receptor affinities for drugs targeting the ocular surface has not kept up with bench research pertaining to the receptor profile of the ocular surface. These insights are necessary for better evaluation of medications used in DED and other allergic disorders.

SUMMARY

At the H1 receptor, Ketotifen (pKa = 9.2), pyrilamine (pKa = 9.0), and epinastine (pKa = 8.0) had the highest affinities, whereas ranitidine (pKa = 4.2) and cimetidine (pKa = 4.9) had the lowest. Ketotifen, a second-generation antihistamine, was found to have a pKa of 6.7 at muscarinic receptors which was higher than that of diphenhydramine (pKa = 6.4), a first-generation antihistamine. Additionally, second-generation antihistamines have higher affinity for H3 receptors, which have been linked to urticaria, compared to first-generation. Azelastine, a second-generation, demonstrated significant affinity (pKa = 7.1) at the H3 receptor compared to all other drugs. Antazoline (pKa = 4.4) and diphenhydramine (pKa = 4.6), both first-generation antihistamines, had the lowest affinities for the H3 receptor. These findings raise questions about the use of antihistamines in the treatment of DED and allergic disorders.

Preliminary Study of microRNAs Allele-Specific Targeting in Allergic Rhinitis Patients from Central China

BACKGROUND

Abnormal expression of miRNA is a common feature in many diseases. Some studies have also emphasized that miRNAs play an important role in asthma and allergic rhinitis (AR). This study attempts to reveal the differences between miRNAs expression and normal nasal mucosa in AR patients by microarray method, so as to further understand the molecular mechanism of AR development.

METHOD

MiRNA microrrays were used for analyzing six samples of the nasal mucosa of AR and six samples of nonallergic patients. Quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) of some differentially expressed miRNAs was used to confirm the array results. Furthermore, pathway analysis was carried out.

RESULTS

The microarray identified that 64 miRNAs exhibited altered expression in the nasal mucosa of the AR group when compared with the control group. Moreover, the expression levels of ten miRNAs were significantly altered in the AR group. To verify the results of the microarray, three differentially expressed miRNA were determined by RT-PCR, and the results also confirmed these changes. Ten differentially expressed miRNAs were present in the nasal mucosa of AR patients compared with the control group, and three differentially expressed miRNAs, as miR-1244, miR-4651 and miR-7641, were determined by RT-PCR, indicating that they play important roles in the process of AR.

CONCLUSION

miR-1244, miR-4651 and miR-7641 may play important roles in the process of AR. Sequencing analysis indicated that three kinds of mutations exist in MAPK8 3'UTR, which may play a role in binding with miR-7641, and then influence the AR process. Single miRNA or, more probably, their sets hold the promise for their use as biomarkers of allergic rhinitis. They may also be promising targets in future therapies.

Age-related changes in ocular mucosal tolerance: Lessons learned from gut and respiratory tract immunity

The ocular surface is the part of the visual system directly exposed to the environment, and it comprises the cornea, the first refractive tissue layer and its surrounding structures. The ocular surface has evolved to keep the cornea smooth and wet, a prerequisite for proper sight, and also protected. To this aim, the ocular surface is a bona fide mucosal niche with an immune system capable of fighting against dangerous pathogens. However, due to the potential harmful effects of uncontrolled inflammation, the ocular surface has several mechanisms to keep the immune response in check. Specifically, the ocular surface is maintained inflammation-free and functional by a particular form of peripheral tolerance known as mucosal tolerance, markedly different from the immune privilege of intraocular structures. Remarkably, conjunctival tolerance is akin to the oral and respiratory tolerance mechanisms found in the gut and airways, respectively. And also similarly, this form of immunoregulation in the eye is affected by ageing just as it is in the digestive and respiratory tracts. With ageing comes an increased prevalence of immune-based ocular surface disorders, which could be related to an age-related impairment of conjunctival tolerance. The purpose of this review was to summarize the present knowledge of ocular mucosal tolerance and how it is affected by the ageing process in the light of the current literature on mucosal immunoregulation of the gut and airways.

Dry Eye and Dry Nose Caused by the Effect of Allergic Rhinitis on Tear and Nasal Secretion Osmolarity

OBJECTIVE

Allergic rhinitis is a type 1 hypersensitivity reaction of immunoglobulin E in the rhino-ocular mucosa. This study was planned to demonstrate in patients with allergic rhinitis to evaluate changes in tear, nasal secretions, and blood osmolarity compared to healthy individuals.

METHOD

Forty allergic rhinitis patients, 25 patients with acute upper respiratory tract infections, and 26 healthy participants were included in the study. Positive patients with allergic symptoms and skin prick test results were included in the allergic rhinitis group. Tear, nasal secretion, and blood osmolarity values were examined for the 3 groups.

RESULT

In patients with allergic rhinitis, tear and nasal secretion osmolarity values were significantly higher in patients with acute upper respiratory tract infections and those of the healthy participants (P = .001, P = .038). In blood osmolarity measurements, there was no statistical difference between the groups (P = .489). In patients with allergic rhinitis, Schirmer test results were significantly shorter than patients who had acute upper respiratory tract infection and those of the healthy participants (P = .001, P = .001). Patients with allergic rhinitis and acute upper respiratory tract infections had significantly shorter Schirmer test results than in healthy participants (P = .001, P = .001).

CONCLUSION

Tear osmolarity was increased in allergic rhinitis patients, and this was thought to lead to dry eye findings. In the presence of allergic rhinitis, nasal secretions were found more hyperosmolar than tears. Nasal secretion osmolarity was higher in allergic rhinitis patients than in patients with acute upper respiratory tract infections and control group.

Explanatory Model of Dry Eye Disease Using Health and Nutrition Examinations: Machine Learning and Network-Based Factor Analysis From a National Survey

BACKGROUND

Dry eye disease (DED) is a complex disease of the ocular surface, and its associated factors are important for understanding and effectively treating DED.

OBJECTIVE

This study aimed to provide an integrative and personalized model of DED by making an explanatory model of DED using as many factors as possible from the Korea National Health and Nutrition Examination Survey (KNHANES) data.

METHODS

Using KNHANES data for 2012 (4391 sample cases), a point-based scoring system was created for ranking factors associated with DED and assessing patient-specific DED risk. First, decision trees and lasso were used to classify continuous factors and to select important factors, respectively. Next, a survey-weighted multiple logistic regression was trained using these factors, and points were assigned using the regression coefficients. Finally, network graphs of partial correlations between factors were utilized to study the interrelatedness of DED-associated factors.

RESULTS

The point-based model achieved an area under the curve of 0.70 (95% CI 0.61-0.78), and 13 of 78 factors considered were chosen. Important factors included sex (+9 points for women), corneal refractive surgery (+9 points), current depression (+7 points), cataract surgery (+7 points), stress (+6 points), age (54-66 years; +4 points), rhinitis (+4 points), lipid-lowering medication (+4 points), and intake of omega-3 (0.43%-0.65% kcal/day; -4 points). Among these, the age group 54 to 66 years had high centrality in the network, whereas omega-3 had low centrality.

CONCLUSIONS

Integrative understanding of DED was possible using the machine learning-based model and network-based factor analysis. This method for finding important risk factors and identifying patient-specific risk could be applied to other multifactorial diseases.

A quantum dot-based lateral flow immunoassay for the rapid, quantitative, and sensitive detection of specific IgE for mite allergens in sera from patients with allergic rhinitis

The prevalence of allergic rhinitis (AR) is increasing worldwide. However, the current systems used to measure levels of immunoglobulin E (IgE) in sera are associated with several disadvantages that limit their further application. Consequently, there is a need to develop novel highly sensitive strategies that can rapidly detect IgE in a quantitative manner. The development of such systems will significantly enhance our ability to diagnose, treat, and even prevent AR. Herein, we describe our experience of using quantum dot-based lateral flow immunoassay (QD-LFIA), combined with a portable fluorescence immunoassay chip detector (PFICD), to detect serum-specific IgE against Dermatophagoides pteronyssinus (Der-p) and Dermatophagoides farinae (Der-f), two common mite allergens in China. Our data showed that our system could detect serum-specific levels of IgE against Der-p and Der-f as low as 0.093 IU/mL and 0.087 IU/mL, respectively. We also established a standard curve to determine serum-specific IgE concentrations that correlated well with the clinical BioIC microfluidics system. The sensitivity of our assay was 96.7% for Der-p and 95.5% for Der-f, while the specificity was 87.2% for Der-p and 85.3% for Der-f. Collectively, our results demonstrate that QD-LFIA is a reliable system that could be applied to detect serum-specific IgE in accordance with clinical demands. This QD-LFIA strategy can be applied at home, in hospitals, and in pharmacies, with reduced costs and time requirements when compared with existing techniques. In the future, this system could be developed to detect other types of allergens and in different types of samples (for example, whole blood).

Graphical abstract

Estimated Prevalence and Incidence of Dry Eye Disease Based on Coding Analysis of a Large, All-age United States Health Care System

PURPOSE

To assess overall prevalence, annual prevalence, and incidence of dry eye disease (DED) in a large, representative population in the United States.

DESIGN

Prevalence and incidence study.

METHODS

Retrospective analysis using the Department of Defense (DOD) Military Health System (MHS) data on beneficiary medical claims from United States DOD military and civilian facilities, January 1, 2003 through March 31, 2015.

PATIENT POPULATION

Using an algorithm, medical diagnostic codes indicative of DED and prescriptions for cyclosporine ophthalmic emulsion identified a DED population from 9.7 million MHS beneficiaries (DOD service members, retirees, and dependents, aged 2-80+ years).

MAIN OUTCOME MEASURES

DED overall prevalence (2003-2015), annual prevalence (2005-2012), and annual incidence (2008-2012) stratified by sex, age group, and International Statistical Classification of Diseases and Related Health Problems, Ninth Revision diagnosis code grouping.

RESULTS

DED prevalence was 5.28% overall, 7.78% among female beneficiaries, 2.96% among male beneficiaries and increased with age from 0.20% for ages 2-17 years, to 11.66% for individuals aged 50+ years. Annual prevalence increased from 0.8% to 3.0% overall, from 1.4% to 4.5% in female beneficiaries, and from 0.3% to 1.6% in male beneficiaries. Annual prevalence increased across age groups starting at age 18-39, 0.1%-0.6%, to age 50+, 1.8%-6.0%. Annual incidence increased from 0.6% to 0.9% overall, from 0.8% to 1.2% in female beneficiaries, and from 0.3% to 0.6% in male beneficiaries. Across age groups, annual incidence increased starting at age 18-39 (0.2%-0.3%), to age 50+ (1.0%-1.6%).

CONCLUSIONS

DED overall prevalence, annual prevalence, and incidence were found to increase over time for all demographics. These findings highlight the continued importance of research and therapeutic development for this common condition.

Comorbidities and Prescribed Medications in Patients With or Without Dry Eye Disease: A Population-Based Study

PURPOSE

To assess the proportion of comorbidities in patients with dry eye disease (DED) compared with matched patients without DED in a comprehensive US population.

DESIGN

Retrospective case-control study.

METHODS

Healthcare records for insurance claims data, detailing medical services incurred by military personnel and their families and dependents in military and civilian facilities across the United States from January 1, 2003, to March 31, 2015, were obtained from the Department of Defense (DOD) Military Health System (MHS). Diagnostic and procedural codes related to DED from selected International Classification of Diseases, Ninth Revision (ICD-9) Current Procedural Terminology codes and prescriptions for cyclosporine A ophthalmic emulsion were used to identify patients with newly diagnosed and prevalent DED in the MHS database. Age, sex, and geographically matched patients without DED were also identified from healthcare claims records. Medication use and comorbidities in these patient populations were assessed and compared.

RESULTS

In both the newly diagnosed and prevalent DED samples, the most common comorbidities were hypertension, cataracts, thyroid disease, type 2 diabetes, and glaucoma. All comorbidities were significantly higher in the DED vs non-DED groups (P < .001). Medication use (including, but not limited to, ophthalmic agents and drugs to treat comorbidities) was also significantly higher in the DED than in the non-DED groups (P < .001).

CONCLUSIONS

The high proportions of patients with DED with a range of comorbidities and prescribed medications highlight the need for a multidisciplinary approach to the management of these patients.

Association between dry eye disease and asthma: a nationwide population-based study

BACKGROUND

Dry eye disease (DED), a chronic ocular disease, is associated with numerous medical issues, including asthma. However, studies on these associations are limited. In this study, we investigated the incidence of DED among patients with asthma and its correlation with other allergic comorbidities.

METHODS

We retrospectively analyzed data from the National Health Insurance Research Database of Taiwan. We compared the data of 41,229 patients with asthma with those of 164,916 sex- and age-matched non-asthma controls. We followed up the patient and control groups from 1998 to 2010, and compared the rate of DED in these two groups. We further analyzed the allergic comorbidities and asthma-related medication use among the patients with asthma to verify whether these factors were associated with DED.

RESULTS

The patients in the asthma group were more likely to have DED than were the controls (6.35% vs. 4.92%, p < 0.0001). In the asthma group, female had a higher risk of DED (odds ratio (OR) = 1.70, 95% confidence interval (CI) [1.57-1.85]) than males did. After adjustment for sex, age, income, urbanization, and the other two allergic comorbidities, patients with allergic rhinitis (adjusted OR = 1.58, 95% CI [1.46-1.72]) and urticaria (adjusted OR = 1.25, 95% CI [1.12-1.38]) were more likely to have DED, but not patients with atopic dermatitis (adjusted OR = 1.17, 95% CI [0.98-1.40]). Patients with asthma who had prescriptions of leukotriene receptor antagonists (LTRAs) (adjusted OR = 1.29, 95% CI [1.01-1.64]), oral antihistamines (adjusted OR = 2.02, 95% CI [1.84-2.21]), and inhaled corticosteroids (adjusted OR = 1.19, 95% CI [1.04-1.36]) exhibited association with DED.

DISCUSSION

Our findings reveal that patients with asthma-particularly females-were more likely to have DED, with comorbidities such as allergic rhinitis and urticaria, and prescriptions including LTRAs, antihistamines, and inhaled corticosteroids. The results suggest that in clinical practice, physicians should pay attention to DED, particularly in patients with a high risk of DED.

Association between Dry Eye Disease, Air Pollution and Weather Changes in Taiwan

Dry eye disease (DED) has become a common eye disease in recent years and appears to be influenced by environmental factors. This study aimed to examine the association between the first occurrence of DED, air pollution and weather changes in Taiwan. We used the systematic sampling cohort database containing 1,000,000 insureds of the National Health Insurance of Taiwan from 2004 to 2013, and identified a total of 25,818 eligible DED subjects. Environmental data, including those of air pollutants, temperature and relative humidity, were retrieved from the environmental monitoring stations adjacent to subjects’ locations of clinics as exposure information. We applied the case-crossover design, which used the same subjects experiencing exposures on diagnosis days as cases and those on other days as controls. The descriptive statistics showed that the first occurrences of DED were the most for the elderly by age (53.6%), women by gender (68.9%), and spring by season (25.9%). Multivariate conditional logistic regression analyses indicated that carbon monoxide (CO), nitrogen dioxide (NO₂), and temperature were positively associated with DED (p < 0.05), while relative humidity was negatively related (p < 0.001). Because CO and NO₂ together are considered a surrogate of traffic emission, which is easier to control than the uprising temperature, it is suggested that efficient management and control of traffic emission may lower the probability of DED occurrence.

A Pilot Study Investigating the Impact of Topical Nasal Steroid Spray in Allergic Rhinitis Patients with Dry Eye

OBJECTIVE

The aim of this study is to demonstrate the effect of nasal steroid treatment on intraocular pressure and dry eye in allergic rhinitis patients with dry eye.

MATERIALS AND METHODS

Twenty-nine patients with a diagnosis of allergic rhinitis and dry eye were included. Symptoms and findings of patients before and after nasal steroid therapy were compared.

RESULT

Ocular Surface Disease Index scores for dry eye symptoms showed significant improvement after nasal steroid treatment (p = 0.003). In the Schirmer test, no significant change was observed in the right or left eye (p = 0.167 and p = 0.489). For the tear film break-up time, no significant change was observed in the right or left eye (p = 0.076 and (p = 0.170). No significant change was observed in the right eye or the left eye in an intraocular pressure test (p = 0.893 and p = 0.495).

CONCLUSION

In our study, symptoms of dry eye with allergic rhinitis were significantly improved with nasal steroid therapy, without affecting the intraocular pressure.

Dry eye disease and allergic conditions: A Korean nationwide population-based study

BACKGROUND

Dry eye disease (DED) is a multifactorial disease of the tears and ocular surface. No epidemiologic reports have yet been published about the relationship between DED and allergic rhinitis or sensitization to allergens.

OBJECTIVE

To investigate the association between DED and allergic conditions in the general adult Korean population.

METHODS

This population-based cross-sectional study included 17,542 individuals (ages ≥ 19 years) who participated in the Korea National Health and Nutrition Examination Survey (KNHANES) from 2010 to 2012. Data for total serum immunoglobulin E (IgE) and allergen-specific IgE levels were available for 1857 subjects. Data were analyzed by using logistic regression to determine the association of DED with allergy or allergic conditions, including allergic rhinitis, atopic dermatitis, asthma, increased total serum IgE, and sensitization to house-dust mite (Dermatophagoides farinae), dog, and cockroach allergens.

RESULTS

The prevalence of DED, allergic rhinitis, atopic dermatitis, and asthma was 10.4, 13.1, 2.2, and 3.3%, respectively. The prevalence of the increased total serum IgE level and sensitization to D. farinae, dog, and cockroach allergens was 34.6, 15.7, 1.0, and 2.8%, respectively. After adjusting for general characteristics, DED was significantly associated with allergic rhinitis (odds ratio 1.58 [95% confidence interval, 1.38-1.81]) and D. farinae sensitization (odds ratio 1.80 [95% confidence interval, 1.17-2.79]).

CONCLUSION

This study demonstrated a close association between DED and both allergic rhinitis and D. farinae sensitization in Korean adults. Further studies are warranted to establish temporal relationships between DED and allergic rhinitis.

Vitamin D3 inhibits micro RNA-17-92 to promote specific immunotherapy in allergic rhinitis

It is recognized that T helper 2 (Th2) polarization plays a critical role in a large number of immune disorders. Yet, the remedies for reconciling the established Th2 polarization are still limited currently. Published data indicate that micro RNA-17-92 cluster is associated with the skewed immune response; 25 vitamin D3 (VD3) can regulate multiple bioactivities in the body. This study tests a hypothesis that VD3 facilitates the effect of specific immunotherapy (SIT) on Th2 response. We observed that treatment with either SIT or VD3 alleviated AR symptoms as well as reduced serum levels of specific IgE and T helper (Th) 2 cytokines, suppressed miR-19a (one of the members of the miR-17-92 cluster) and increased IL-10 in peripheral B cells, which was further improved in those AR patients treated with both SIT and VD3. The expression of miR-19a and IL-10 was significantly negatively correlated with each other in peripheral B cells of AR patients. Metabolites of VD3 formed a complex with retinoid acid receptor to repress the expression of miR-19a in B cells. We conclude that administration with VD3 promotes the effect of SIT on suppression of AR via repressing the expression of miR-19a in peripheral B cells.