Allergic Conjunctivitis: Update on Its Pathophysiology and Perspectives for Future Treatment

Penyakit alergi okuli adalah penyakit alergi pada konjungtiva atau kulit kelopak mata, berhubungan dengan reaksi inflamasi karena menempelnya immunoglobulin E (IgE) di sel mast. Penatalaksanaan penyakit alergi okuli meliputi meminimalkan kontak dengan alergen dan pemberian obat-obatan (antihistamin, stabilisator sel mast (sodium cromoglycate, pemirolast potassium, lodoxamide, nedocromil sodium), kombinasi antihistamin dan stabilisator sel mast (kortikosteroid, siklosporin). Tujuan penelitian ini adalah untuk mengetahui penurunan konsentrasi IgE dan perbedaan penurunan konsentrasi IgE penderita alergi okuli sesudah diterapi dengan pemirolast potassium 0,1% atau sodium cromoglycate 4%.Penelitian ini merupakan pre and post clinical trial design pada 32 penderita alergi okuli. Sebanyak 16 penderita mendapatkan tetes mata pemirolast potassium 0,1% dan 16 lainnya mendapatkan tetes mata sodium cromoglycate 4%. Air mata penderita diambil saat datang dan satu minggu setelah terapi untuk pemeriksaan konsentrasi IgE dan diperiksa menggunakan ELISA reader. Penurunan konsentrasi IgE sebelum dan setelah terapi pada masing-masing obat diuji menggunakan uji T-test dependent, sedangkan perbandingan penurunan konsentrasi IgE antara kedua obat diuji menggunakan uji T-test independent. Pada kelompok pemirolast potassium 0,1%, konsentrasi IgE awal 730,73 ± SD 40,17 IU/ml dan menurun menjadi 678,61 ± SD 56,20 IU/ml. Kelompok sodium cromoglycate 4%, konsentrasi IgE awal 731,16 ± SD 32,13 IU/ml dan menurun menjadi 686,73 ± SD 43,08 IU/ml(p=0,000). Perbedaan penurunan konsentrasi IgE pada kelompok pemirolast potassium 0,1% sebesar 52,12 ± SD 41,00 IU/ml, kelompok sodium cromoglycate 4% sebesar 44,43 ± SD 32,63 IU/ml. Perbedaan penurunan konsentrasi IgE antara kedua obat tidak bermakna (p=0,561). Dapat disimpulkan tidak didapatkan perbedaan bermakna efek pemirolast potassium 0,1% dan sodium cromoglycate 4% dalam menurunkan konsentrasi IgE air mata penderita alergi okuli.

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“…sebesar 15-20% di dunia. Hampir 80% penderita alergi okuli didapatkan pada usia kurang dari 30 tahun (4).…”

Section: Pendahuluanunclassified

Perbandingan Konsentrasi IgE Air Mata Penderita Alergi Okuli dengan Pemberian Pemirolast Potassium 0,1% dan Sodium Cromoglycate 4%

Moehariadi

Yasmine

2013

JKB

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“…Allergic conjunctivitis is characterized by bilateral itch, burning, redness, tearing and swelling of the conjunctiva and lids. Seasonal allergic conjunctivitis (SAC) and perennial (persistent) forms (PAC) are relatively mild Ag-driven diseases, but atopic keratoconjunctivitis (AKC) and vernal keratoconjunctivitis (VKC) can affect the cornea and vision (Bonini et al 2009). Comorbidity between AKC, allergic rhinitis, atopic dermatitis, urticaria and asthma is common, suggesting shared disease mechanisms in form of sensitization and subsequent challenge phases.…”

Section: Allergic Conjunctivitismentioning

confidence: 99%

“…Although specific allergens cannot be shown in a large proportion of VKCpatients, inflammation is Th2-driven with increased histamine concentrations in tear fluid (Leonardi et al 2011), which may contribute to pathological tissue remodeling and chronicity. As a result, local and peroral H 1 R-antagonists, mast cell-stabilizing drugs (such as cromoglycate and nedochromil) and corticosteroid eye drops form the mainstay of treatment (Bonini et al 2009). In difficult cases, immunosuppressive calcineurin-inhibitors and sometimes desensitization can improve tolerance to allergens.…”

Section: Allergic Conjunctivitismentioning

confidence: 99%

Chapter 7 Non-professional Histamine Producing Cells, Immune Responses and Autoimmunity

Konttinen¹,

Husu

Han

et al. 2013

Histamine H₄ Receptor: A Novel Drug Target in Immunoregulation and Inflammation

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Histamine is a monovalent cationic biological amine synthesized by professional and non-professional histamine producing cells, which form two distinct cell categories. Professional cells produce, store and burst release their histamine from storage granules so that locally and temporarily for short periods high micromolar histamine concentrations are achieved. Non-professional cells generally produce and release histamine into the cytoplasm continuously without intermediated storage, to release it along its concentration gradient via histamine channels. These channels might play an important role in balancing, maintaining and regulating low-level histamine fluctuations, which tend to occur due to variation in the histamine content of the food, histamine production by microflora, histamine release from professional cells and enzymatic degradation and reuptake of histamine. Effects of the professionally-produced high histamine levels are mediated via two low-affinity histamine receptors, H 1 R and H 2 R. In contrast, the nonprofessionally-produced, low nascent histamine levels are only able to activate two novel high-affinity histamine receptors, H 3 R and H 4 R. The former are active during short-term emergency "on-state" whereas the latter are active during a basic or long term homeostatic "off-state". Micromolar histamine/H 1 R/H 2 R amplifies expulsion of irritants (e.g. pollen, helminths) by adding to a direct irritant-induced

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“…Ocular allergic symptoms are estimated to be present in 40%–80% of the affected individuals [ 1 , 2 ]. Allergic eye diseases include a collection of clinical entities with variable presentation [ 3 ]. The most characteristic symptom of allergic conjunctivitis is itching, which is caused by the release of histamine and other mediators from specifically activated mast cells after allergen exposure [ 2 , 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Hydrocortisone concentration influences time to clinically significant healing of acute inflammation of the ocular surface and adnexa – results from a double-blind randomized controlled trial

Sergiyenko

Sukhina²,

Бездетко

et al. 2014

BMC Ophthalmol

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BackgroundThe efficacy of topical ophthalmic corticosteroids depends upon small modifications in preparations, such as drug concentration.The aim of this study was to confirm that hydrocortisone acetate (HC-ac) ophthalmic ointments of 2.5% and 1% are more effective than a 0.5% eye ointment.MethodsIn this randomized, double-blind, placebo-controlled, parallel-group clinical study, the change of signs and symptoms of acute inflammation of the ocular surface and adnexa was evaluated in 411 subjects.ResultsMedian time to clinically relevant response as estimated by 50% reduction in clinical signs and symptoms (CSS) total score over the entire trial was similar for subjects treated with HC-ac 2.5% (73.5 h) and for subjects treated with HC-ac 1.0% (67.7 h) and was considerably and significantly longer for subjects treated with HC-ac 0.5% (111.8 h) [p < 0.001 for both dosages]. All trial medications were safe and well tolerated.ConclusionHydrocortisone acetate 2.5% and Hydrocortisone acetate 1% eye ointments are efficacious and safe treatments for acute inflammations of the ocular surface or adnexa, and showed significantly better efficacy than a control group treated with Hydrocortisone acetate 0.5% therapy.Trial registrationCurrent Controlled Trials ISRCTN15464650.

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Allergic Conjunctivitis: Update on Its Pathophysiology and Perspectives for Future Treatment

Cited by 10 publications

References 135 publications

Perbandingan Konsentrasi IgE Air Mata Penderita Alergi Okuli dengan Pemberian Pemirolast Potassium 0,1% dan Sodium Cromoglycate 4%

Perbandingan Konsentrasi IgE Air Mata Penderita Alergi Okuli dengan Pemberian Pemirolast Potassium 0,1% dan Sodium Cromoglycate 4%

Chapter 7 Non-professional Histamine Producing Cells, Immune Responses and Autoimmunity

Hydrocortisone concentration influences time to clinically significant healing of acute inflammation of the ocular surface and adnexa – results from a double-blind randomized controlled trial

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