Conjunctival allergen provocation test (CAPT) reproduces the events occurring by instilling an allergen on the ocular surface. This paper is the compilation of a task force focussed on practical aspects of this technique based on the analysis of 131 papers. Main mechanisms involved are reviewed. Indications are diagnosing the allergen(s)-triggering symptoms in IgE-mediated ocular allergy in seasonal, acute or perennial forms of allergic conjunctivitis, especially when the relevance of the allergen is not obvious or in polysensitized patients. Contraindications are limited to ongoing systemic severe pathology, asthma and eye diseases. CAPT should be delayed if receiving systemic steroids or antihistamines. Local treatment should be interrupted according to the half-life of each drug. Prerequisites are as follows: obtaining informed consent; evidencing of an allergen by skin prick tests and/or serum-specific IgE dosages; being able to deal with an unlikely event such as acute asthma exacerbation, urticaria or anaphylaxis, or an exacerbation of allergic conjunctivitis. Allergen extracts should be diluted locally prior to administration. Positive criteria are based on itching or quoted according to a composite score. An alternative scoring is based on itching. CAPT remains underused in daily practice, although it is a safe and simple procedure which can provide valuable clinical information.The conjunctival allergen provocation test (CAPT), also known as conjunctival allergen challenge (CAC), is a conjunctival provocation test (CPT) used to evaluate the inflammatory effects on the external ocular surface after the topical application of an allergen in a presumed sensitized patient. The aim was to objectively evaluate the reactivity to specific allergens at the mucosal surface (1).As stated in a recent Position Paper on Ocular Allergy, CAPT is a method for investigating the ocular surface IgE-mediated hypersensitivity disorders. It is used to determine or confirm which allergen(s) triggers the ocular symptoms, using the eye as a model to evidence a specific reactivity to allergen(s) (2). Conjunctival allergen provocation test is also a tool for investigating allergic inflammation mechanisms and biomarkers of the ocular surface, as well as its treatments. Recently, it has been used as a surrogate test of mucosal reactivity in other allergic diseases, namely rhinitis, asthma, food and latex allergy (3-5).Allergy 72 (2017) 43-54

Funding informationThis work was done under the approval of EAACI with a TF budget 2015-18. AbstractThe treatment and management of ocular allergy (OA) remain a major concern for different specialties, including allergists, ophthalmologists, primary care physicians, rhinologists, pediatricians, dermatologists, clinical immunologists, and pharmacists.We performed a systematic review of all relevant publications in MEDLINE, Scopus, and Web Science including systematic reviews and meta-analysis. Publications were considered relevant if they addressed treatments, or management strategies of OA.A further wider systematic literature search was performed if no evidence or good quality evidence was found. There are effective drugs for the treatment of OA; however, there is a lack an optimal treatment for the perennial and severe forms. Topical antihistamines, mast cell stabilizers, or double-action drugs are the first choice of treatment. All of them are effective in reducing signs and symptoms of OA. The safety and optimal dosing regimen of the most effective topical anti-inflammatory drugs, corticosteroids, are still a major concern. Topical calcineurin inhibitors may be used in steroid-dependent/resistant cases of severe allergic keratoconjunctivitis.Allergen-specific immunotherapy may be considered in cases of failure of first-line treatments or to modify the natural course of OA disease. Based on the current wealth of publications and on the collective experience, recommendations on management of OA have been proposed.