Atopic Dermatitis and Keratoconjunctivitis

Bielory, Brett P.; Bielory, Leonard

doi:10.1016/j.iac.2010.06.004

Cited by 86 publications

(82 citation statements)

References 86 publications

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“…Patients with severe ocular allergy present with similar clinical manifestations (13, 14); however, more chronic symptoms exist (15). These symptoms include thickening of the lid, blepharitis, and meibomian gland obstruction, among others (3, 5, 16–18). The massive infiltration of eosinophils and the chronic exposure to inflammatory mediators can cause signs of keratopathy (15, 19).…”

Section: Ocular Allergy Backgroundmentioning

confidence: 99%

“…The massive infiltration of eosinophils and the chronic exposure to inflammatory mediators can cause signs of keratopathy (15, 19). Additionally, anterior subcapsular cataracts can develop due to the steroid treatment required for this disease (16). Similarly, VKC patients experience more severe symptoms that include giant papillae, trantas dots, and corneal epitheliopathy that develop into shield ulcers (20–23), compromising vision in these patients as well.…”

Section: Ocular Allergy Backgroundmentioning

confidence: 99%

“…In severe ocular allergy such as VKC, IL-13 is involved in giant papillae formation through conjunctival fibroblast activity (61–63). Similarly, AKC is attributed to Th2 cytokines that include: IL-2, IL-4, and IL-5(16, 18, 64, 65), where IL-5levels have been shown to correlate with disease severity (66). …”

Section: T Helper Cells In Ocular Allergymentioning

confidence: 99%

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T helper subsets in allergic eye disease

Reyes

Saban²

2014

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of review Ocular allergy is an IgE-mediated disease that results in inflammation of the conjunctiva and, in more severe cases, the cornea. This is driven by an immediate hypersensitivity response via mast cells, followed by a late phase response mediated by eosinophils—both of which are indeed dependent on T helper (Th) lymphocyte activity. Here we provide an update on Th subsets (Th1, Th2, Th17, T regulatory (Treg) and their relevance in ocular allergy. Recent findings Recent evidence in ocular allergy points to an involvement of other Th subsets, in addition to Th2. However, how these subsets are respectively activated and their role in mediating the different clinical forms is poorly understood. Novel mouse models may facilitate addressing such unknowns, and future challenges will involve how to translate such findings into more effective and “patho-specific” treatments. Summary Ocular allergy, especially in severe forms, involves subsets other than Th2. Th1 cells have been detected in mild and severe forms, and recent evidence points to a possible role for IL-17 in severe disease. Tregs, on the other hand, dampen pathogenic Th cell function and allergy immunotherapy is associated with Treg augmentation in disease management. Further understanding of Th biology is warranted and may lead to better therapies.

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Section: Ocular Allergy Backgroundmentioning

confidence: 99%

Section: Ocular Allergy Backgroundmentioning

confidence: 99%

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T helper subsets in allergic eye disease

Reyes

Saban²

2014

Current Opinion in Allergy &Amp; Clinical Immunology

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“…75 Keratoconus is a progressive noninflammatory corneal ectasia that occurs in a small percentage of patients with atopic dermatitis. 77,78 Progressive thinning and ectasia occurs in the corneal stroma that is mainly composed of collagen. 79 Conjunctival mast cell hyperplasia with release of proteolytic enzymes may play a role in the pathogenesis of this complication.…”

Section: Complications Of Akcmentioning

confidence: 99%

Atopic keratoconjunctivitis

Bielory²

2013

allergy asthma proc

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Atopic keratoconjunctivitis (AKC) is a chronic allergic inflammatory disease that is at the severe end of a spectrum of allergic conjunctival diseases. AKC can involve the cornea and conjunctiva bilaterally, and at times can lead to visual loss from corneal complications. The classification, histology, ocular examination findings and complications of AKC are described herein, as well as the roles and interactions of inflammatory cells involved. Finally, current treatment options for AKC is reviewed and presented as a stepwise, multidisciplinary approach that involves the allergist/immunologist's medical interventions of topical and systemic immunomodulating agents, as well as the surgical skills of the ophthalmologist.

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“…The eyelid skin may have a fine sandpaper-like texture. There may be mild, or severe, conjunctival injection and chemosis [9]. Giant papillae may, or may not, be present.…”

Section: Atopic Keratoconjunctivitismentioning

confidence: 99%