The possible involvement of nasal allergy in allergic keratoconjunctivitis

Abstract

Purpose Allergic keratoconjunctivitis coexists regularly with allergic rhinitis. However, little is known about the relationship between these conditions. The purpose of this study was to investigate the possible involvement of nasal allergy in keratoconjunctivitis by means of nasal challenge with allergen (NPT), in combination with recording of the ocular symptoms. Methods In 26 patients suffering from atopic (n ¼ 15) or vernal (n ¼ 11) keratoconjunctivitis showing positive history and skin tests, but responding insufficiently to the local ophthalmologic therapy, 71 NPTs with inhalant allergens were performed and combined with the recording of the ocular response. In 11 control subjects with allergic rhinitis, but without ocular disease history, 11 positive NPTs were repeated and supplemented with the registration of the ocular features. Results Of the 26 patients, 24 developed 51 positive nasal responses (NRs; Po0.01), 43 of which were accompanied by significant ocular response (Po0.01). No ocular responses were measured during the 26 PBS control challenges (P40.05) or during 11 repeated NPTs in control subjects (P40.2). Conclusions These results give evidence for possible involvement of nasal allergy in some cases of keratoconjunctivitis. They also show diagnostic value of nasal challenges with allergen in combination with registration of the ocular symptoms in such patients, allowing then consideration of additional therapeutic measures concerning the nasal allergy.

Cellular changes in tears associated with keratoconjunctival responses induced by nasal allergy

“…These parameters were evaluated by means of the modified Pelikan's grading system (Supplementary Table 1S). [8][9][10]26,27 Collection and processing of tears…”

“…[7][8][9][10]26,27 The patients were investigated in a period without acute ocular and nasal complaints and outside the allergen-relevant season. Long-acting H1-receptor antagonists and topical glucocorticosteroids were withdrawn 6 weeks before, whereas other treatments 48 h before each of the NPTs.…”

“…In these 61 patients, 94 NPTs with inhalant allergens (Supplementary Table 2S), with respect to the positive skin tests and/or suspect disease history, and 61 phosphate-buffered saline (PBS) control tests were performed by means of rhinomanometry [7][8][9][10]26,29,30 combined with the recording of ocular signs and symptoms. [7][8][9][10]26,27 The patients were investigated in a period without acute ocular and nasal complaints and outside the allergen-relevant season.…”

“…The secondary keratoconjunctivitis form is induced by the allergic reaction taking place in the nasal mucosa due to the exposure of nasal mucosa to an inhalant allergen. [7][8][9][10] Various hypersensitivity mechanisms, such as immediate (IgE-mediated) type, late type (type III), or delayed type (cell-mediated), can underlie the primary as well as the secondary form of keratoconjunctivitis, which may then result in the development of three basic keratoconjunctival response types, an immediate, a late, or a delayed type. There is a dearth of data demonstrating the role of a nasal allergy in the conjunctiva, cornea and in the possible induction of the secondary keratoconjunctival response (SKCR).…”

“…[7][8][9][10]16,23,26 Moreover, little data are available to illustrate the cytologic changes in tears during the particular types of SKCR. [7][8][9][10] The purpose of this study, which is a continuation of our earlier work, [7][8][9][10]27 was (1) to investigate the cytologic profiles and changes in the counts of individual cell lineages in tears during the particular types of SKCR, (2) to evaluate the significance of cytologic changes in tears for the possible role of various immunologic mechanism(s) underlying the particular types of SKCR.…”