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Expert Opinion on Pharmacotherapy Jun 2015Allergy is the fifth leading group of chronic diseases, affecting as much as 40% of the first-world population. Its pathophysiology has a genetic component, and is... (Review)
Review
INTRODUCTION
Allergy is the fifth leading group of chronic diseases, affecting as much as 40% of the first-world population. Its pathophysiology has a genetic component, and is driven by the immune system's sensitized response to antigens and environmental factors. As research continues to uncover the mediators responsible for ocular allergy, the development of novel drugs should progress.
AREAS COVERED
A literature review of allergic conjunctivitis, ocular allergy and their treatment was performed using PubMed and Medline. Additional information is also included from clinicaltrials.gov and associated web sites for drugs currently in clinical trials.
EXPERT OPINION
The initial step of therapy remains identification and avoidance of allergic triggers. The mainstay of treatment is the new generation of dual-acting antihistamines. Drugs that improve the magnitude and duration of relief, with greater subject responder rates, are gradually making their way into the clinic. Allergic conjunctivitis is a relatively easy disease to study because of the availability of models such as the conjunctival allergen challenge. New classes of drugs that target inflammatory pathways or mediators involved in the early and late-phase allergic response are being screened in these models and we are making progress in identifying the next generation of anti-allergic therapy.
Topics: Adrenal Cortex Hormones; Anti-Allergic Agents; Anti-Inflammatory Agents, Non-Steroidal; Conjunctivitis, Allergic; Histamine Antagonists; Humans; Immunomodulation; Mast Cells
PubMed: 25943976
DOI: 10.1517/14656566.2015.1040760 -
Current Opinion in Allergy and Clinical... Oct 2019Lipids are one of the most important constituents in our body. Advances of lipidomics are elucidating the new roles of various lipid molecules in allergic diseases. For... (Review)
Review
PURPOSE OF REVIEW
Lipids are one of the most important constituents in our body. Advances of lipidomics are elucidating the new roles of various lipid molecules in allergic diseases. For example, some reports showed anti-inflammatory effects of omega-3 fatty acids (FAs), such as docosahexaenoic acid, eicosapentaenoic acid, and their metabolites, on allergic diseases. Here, we introduce the role of lipid mediators in allergic conjunctivitis mouse model.
RECENT FINDINGS
Lipidomics using liquid chromatography-tandem mass spectrometry can profile numerous lipid molecules from small tissue samples such as conjunctival specimens. Lipidomics analysis showed that various inflammatory lipid mediators are produced in the conjunctival tissue of allergic conjunctivitis mouse model. Dietary omega-3 FAs reduced these inflammatory lipid mediators in the conjunctiva and alleviated allergic conjunctivitis symptoms in mouse models. In addition, the roles of specialized proresolving lipid mediators (SPMs) have been reported for allergic inflammation.
SUMMARY
Lipid mediators have important roles for the pathophysiology of the allergic diseases including allergic conjunctivitis. Omega-3 FAs and SPMs are expected as new treatment tools for allergic conjunctivitis.
Topics: Animals; Conjunctiva; Conjunctivitis, Allergic; Disease Models, Animal; Docosahexaenoic Acids; Eicosapentaenoic Acid; Humans; Lipidomics; Mice
PubMed: 31465315
DOI: 10.1097/ACI.0000000000000561 -
Current Allergy and Asthma Reports Mar 2010Although nasal allergy has been prominent in allergy research, ocular allergy is increasingly recognized as a distinct symptom complex that imposes its own disease... (Review)
Review
Although nasal allergy has been prominent in allergy research, ocular allergy is increasingly recognized as a distinct symptom complex that imposes its own disease burden and reduction in patients' quality of life. In the past year, knowledge of the relationships between allergic conjunctivitis and allergic rhinitis has increased. Allergic conjunctivitis is highly prevalent and has a close epidemiologic relationship with allergic rhinitis. Both conditions also exhibit similar pathophysiologic mechanisms. Pathways of communication are thought to increase the likelihood of an inflammatory reaction at both sites following allergen exposure of nasal or ocular tissue. Clinical trials of intranasal therapies have demonstrated efficacy in allergic conjunctivitis and rhinitis. Newer intranasal steroids decrease ocular symptoms, potentially achieving efficacy by suppressing the naso-ocular reflex, downregulation of inflammatory cell expression, or restoration of nasolacrimal duct patency. Proposed pathophysiologic interactions between allergic rhinitis and ocular allergy underscore the need for therapies with efficacy in both symptom sets.
Topics: Administration, Intranasal; Allergens; Clinical Trials as Topic; Comorbidity; Conjunctivitis, Allergic; Eye; Humans; Inflammation; Nasolacrimal Duct; Nose; Rhinitis; Steroids; Treatment Outcome
PubMed: 20425504
DOI: 10.1007/s11882-010-0087-1 -
The Journal of Allergy and Clinical... Jan 2005Allergic conjunctivitis is in actuality a group of diseases affecting the ocular surface and is usually associated with type 1 hypersensitivity reactions. Two acute... (Review)
Review
Allergic conjunctivitis is in actuality a group of diseases affecting the ocular surface and is usually associated with type 1 hypersensitivity reactions. Two acute disorders, seasonal allergic conjunctivitis and perennial allergic conjunctivitis, exist, as do 3 chronic diseases, vernal keratoconjunctivitis, atopic keratoconjunctivitis, and giant papillary conjunctivitis. The ocular surface inflammation (usually mast cell driven) results in itching, tearing, lid and conjunctival edema-redness, and photophobia during the acute phase and can lead to a classic late-phase response (with associated eosinophilia and neutrophilia) in a subset of individuals. As is the case in other allergic diseases, a chronic disease can also develop, accompanied by remodeling of the ocular surface tissues. In severe cases the patient experiences extreme discomfort and sustains damage to the ocular surface. For such cases, there is no highly effective and safe treatment regimen. Topical administration of corticosteroids is used in severe cases but is associated with an increased risk for the development of cataracts and glaucoma. Thus there is a worldwide search for new biotargets for the treatment of these diseases. Here we provide a brief update of the clinical symptoms associated with these diseases, the rationale for disease classification, recent advances in our understanding of the pathogenesis of the diseases, and an update on both preclinical and clinical advances toward refined therapies for these diseases.
Topics: Administration, Topical; Animals; Conjunctiva; Conjunctivitis, Allergic; Edema; Eyelids; Humans; Hydroxycorticosteroids; Photophobia; Pruritus; Seasons; Tears
PubMed: 15637556
DOI: 10.1016/j.jaci.2004.10.042 -
Current Opinion in Allergy and Clinical... Dec 2020The purpose of this article is to provide an overview of the literature pertaining to the use of allergen immunotherapy for treatment of allergic conjunctivitis with an... (Review)
Review
PURPOSE OF REVIEW
The purpose of this article is to provide an overview of the literature pertaining to the use of allergen immunotherapy for treatment of allergic conjunctivitis with an emphasis on recent developments.
RECENT FINDINGS
Both subcutaneous (SCIT) and sublingual (SLIT) immunotherapy continue to show efficacy in treating allergic conjunctival disease, subcutaneous more than sublingual. Adverse effects of sublingual therapy continue to be reported since the FDA's approval of SLIT tablets in 2014. Initial SLIT studies reported high rates of adherence, while real use reports identify rates of nonadherence/discontinuation ranging between 50 and 80%. Studies in polyallergic patients evaluating the efficacy of SLIT combination therapy report encouraging results.
SUMMARY
Both SCIT and SLIT offers improvement in allergic conjunctival symptom scores and decrease medication utilization. Although SCIT has a higher likelihood of systemic reaction, SLIT has a very high rate of mild-to-moderate adverse events - especially in the first month. Cost-benefit analyses tend to favor SCIT (greater efficacy and less impacted by discontinuation rates).
Topics: Administration, Sublingual; Allergens; Conjunctivitis, Allergic; Cost-Benefit Analysis; Desensitization, Immunologic; Humans; Injections, Subcutaneous; Patient Compliance
PubMed: 33044339
DOI: 10.1097/ACI.0000000000000692 -
Journal of Pharmacological and... 2022Allergic conjunctivitis is an immune-mediated inflammatory disease of the conjunctiva that is induced by antigens. Allergic conjunctivitis can cause various symptoms...
INTRODUCTION
Allergic conjunctivitis is an immune-mediated inflammatory disease of the conjunctiva that is induced by antigens. Allergic conjunctivitis can cause various symptoms such as ocular itching, hyperemia and edema. Developing experimental animal models that show clinical symptoms and methods for quantitative and objective evaluation is important for understanding allergic conjunctivitis. Therefore, this study aimed to develop an ovalbumin (OVA)-induced mouse model of allergic conjunctivitis and a useful method for evaluating symptoms of allergic conjunctivitis.
METHODS
ICR mice were sensitized by an intraperitoneal injection of OVA in PBS containing alum on days 0 and 5. Subsequently, local sensitization was then performed once daily from days 14 to 28, by instilling OVA in PBS into the both eyes. Drug treatment was administered once daily from days 14 to 28. Mice were randomly assigned topical treatment groups: Group 1, 0.1% betamethasone; Group 2, 0.025% levocabastine; Group 3 PBS (control).
RESULTS
Mice showed marked eye scratching behavior, hyperemia, edema, infiltration of eosinophils into tears and increased antigen-specific immunoglobulin E antibody levels in tears and the serum. These symptoms were inhibited by instillation of levocabastine and betamethasone, which are used clinically for the treatment of allergic conjunctivitis.
DISCUSSION
This method may be useful for evaluation of the symptoms of allergic conjunctivitis in experimental and clinical settings. In particular, the developed method, which measures the number of eosinophils in tears collected with phenol red threads, may enable the quantitative, objective, and noninvasive evaluation of the severity of allergic conjunctivitis.
Topics: Mice; Animals; Conjunctivitis, Allergic; Eosinophils; Hyperemia; Mice, Inbred ICR; Disease Models, Animal; Ovalbumin; Immunoglobulin E; Edema; Betamethasone
PubMed: 36130665
DOI: 10.1016/j.vascn.2022.107225 -
Current Opinion in Allergy and Clinical... Oct 2015To analyse the most recently published studies on the prevalence of allergic conjunctivitis alone or in association with allergic rhinitis, and the clinical and... (Review)
Review
PURPOSE OF REVIEW
To analyse the most recently published studies on the prevalence of allergic conjunctivitis alone or in association with allergic rhinitis, and the clinical and demographic aspects of the disease.
RECENT FINDINGS
Allergic conjunctivitis or conjunctival symptoms are present in 30-71% of patients with allergic rhinitis. Allergic conjunctivitis alone has been estimated in 6-30% of the general population and in up to 30% in children alone or in association with allergic rhinitis. Seasonal allergic conjunctivitis is the most frequent form; however, studies from tertiary, ophthalmology referral centers report that the chronic forms, such as vernal and atopic keratoconjunctivitis, are the most frequently seen by ophthalmologists. A recent large survey performed at a national level involving 304 ophthalmologists showed that the majority of patients with allergic conjunctivitis suffer annually of few episodes of mild ,intermittent conjunctivitis. However, 30% of patients are affected by frequent episodes with intense and persistent symptoms. Treatment is frequently not appropriate.
SUMMARY
Even though allergic conjunctivitis is often associated to allergic rhinitis, epidemiology studies frequently do not include specific ophthalmological evaluations. An understanding of allergic conjunctivitis disease, its prevalence, demographics and treatment paradigms will provide important information towards understanding its pharmacoeconomics and burden on the national health systems.
Topics: Animals; Child; Conjunctivitis, Allergic; Economics, Pharmaceutical; Humans; Population Groups; Practice Guidelines as Topic; Prevalence; Rhinitis, Allergic; Seasons
PubMed: 26258920
DOI: 10.1097/ACI.0000000000000204 -
Canadian Journal of Ophthalmology.... Feb 2023
Topics: Humans; Conjunctivitis, Allergic; Silicones; Dermatitis, Contact; Intubation, Intratracheal; Intubation; Dermatitis, Allergic Contact; Conjunctivitis
PubMed: 35868439
DOI: 10.1016/j.jcjo.2022.06.017 -
Current Allergy and Asthma Reports Nov 2001The clinical presentation of the various forms of allergic conjunctivitis varies greatly from mild symptoms to severe disease with vision-threatening complications.... (Review)
Review
The clinical presentation of the various forms of allergic conjunctivitis varies greatly from mild symptoms to severe disease with vision-threatening complications. Although an IgE-mediated type-1 hypersensitivity reaction has been demonstrated or postulated in many types of allergic eye disease, the pathophysiology underlying the allergic conjunctivitides is not fully understood. The variety of currently available treatment options underscores the complexity of the chemical reactions associated with mast cell degranulation and mediator release causing the onset of allergic signs and symptoms. Many of these treatments are merely palliative and do not eliminate the complex immune response initiating the symptoms, so there is a recurrence of disease as soon as the therapy is discontinued. Models of allergic eye disease have significantly aided the discovery of new anti-allergic and anti-inflammatory compounds that can be used safely in the eye.
Topics: Acute Disease; Anti-Allergic Agents; Anti-Inflammatory Agents; Cell Degranulation; Conjunctivitis, Allergic; Humans; Mast Cells; Models, Biological
PubMed: 11892084
DOI: 10.1007/s11882-001-0064-9 -
Recent Patents on Inflammation &... Jun 2009Seasonal and perennial allergic conjunctivitis are IgE-mediated, hypersensitivity ophthalmic conditions characterized by ocular pruritus, epiphora, and hyperemia. Proper... (Review)
Review
Seasonal and perennial allergic conjunctivitis are IgE-mediated, hypersensitivity ophthalmic conditions characterized by ocular pruritus, epiphora, and hyperemia. Proper diagnosis is usually made clinically based on history and physical examination. Diagnostic procedures are rarely necessary. Non-pharmacological measures, such as environmental modification and proper eye care, should be considered for all patients with allergic conjunctivitis. Pharmacological interventions may also be required. Milder cases can be treated with short-term topical ophthalmic therapy such as a decongestant/antihistamine combination, a mast cell stabilizer, or a multi-action agent. Moderate to severe cases may require longer usage of the above agents or the addition of an oral antihistamine. Refractory cases may necessitate the use of topical ophthalmic corticosteroids and/or immunotherapy. Despite all the available therapeutic agents, there continues to be a constant need to discover more effective ways to treat seasonal and perennial allergic conjunctivitis. This review article also discusses recent patents related to the field.
Topics: Allergens; Anti-Allergic Agents; Conjunctivitis, Allergic; Diagnosis, Differential; Humans; Immunologic Factors; Immunotherapy
PubMed: 19519588
DOI: 10.2174/187221309788489733