Prevalence of dry eye disease in the patients of allergic conjunctivitis: Hospital-based cross-sectional study

Purpose: Allergic conjunctivitis (AC) is commonly associated with dry eye. This study was conducted to assess the prevalence of dry eye in different subsets of AC patients. Methods: This observational, cross?sectional study, conducted in the Department of Ophthalmology of a tertiary center in north India, included 132 patients of AC. The diagnosis of dry eye disease (DED) was made on the basis of Ocular Surface Disease Index (OSDI), Schirmer’s test, and tear film break?up time (TFBUT). Results: The prevalence of dry eye in AC patients was found to range between 31% and 36%. On OSDI scoring, 20.45% of patients had mild, 18.18% moderate, and 31.81% had a severe grade of DED, respectively. The mean OSDI score was noted to be significantly higher in patients with perennial allergic conjunctivitis (PAC) (29.82 ± 12.41), followed by seasonal allergic conjunctivitis (SAC) (25.35 ± 12.88), and least in the patients of vernal keratoconjunctivitis (VKC) (13.60 ± 8.63) (p < 0.0001), respectively. The TFBUT was found to be less than 10 s in 45.45% of PAC, 30.43% of SAC, and 20% of VKC patients, respectively. The difference between the mean TFBUT among the three groups was statistically insignificant (p = 0.683). Schirmer’s test value of <10 mm was observed in 45.45% of PAC, 43.47% of SAC, and 10% of VKC patients, respectively. Conclusion: This study revealed a high prevalence of DED in patients with AC. Among the different types of AC patients, PAC had the highest percentage of DED followed by SAC and least in VKC, respectively.

Alergia ocular: tipos, edad de aparición, prevalencia y morbilidad / Ocular allergy: types, age of onset, prevalence and morbidity

Introducción: La alergia es el desorden más común del sistema inmunitario. En las últimas décadas, la prevalencia de las enfermedades alérgicas ha aumentado de forma considerable en todos los países. Objetivo: Describir el contexto actual de la alergia ocular para la realización de un diagnóstico precoz, una identificación temprana de los subtipos, un adecuado manejo terapéutico y un control de la severidad. Métodos: Se realizó una búsqueda sistemática de la literatura científica de mayor impacto con el uso de las palabras clave. Se limitó la búsqueda por tipo de diseño (revisiones, series de casos, estudios descriptivos, analíticos y experimentales, metaanálisis). No se tuvo en cuenta el idioma de la publicación. Las bases de datos utilizadas fueron: PubMed, Ebsco Host, Lilacs y Science Direct. Se identificaron y se evaluaron 114 artículos, de los cuales se seleccionaron 24 por su pertinencia para el estudio. Conclusiones: La alergia ocular es uno de los trastornos oculares más comunes encontrados en las consultas pediátricas y oftalmológicas. Si bien en la mayoría de los casos se trata de formas leves, estas pueden interferir en la calidad de vida del paciente. Es importante que estos pacientes con manifestaciones oftalmológicas de alergia se remitan al alergólogo para detectar otra patología, que, asociada al padecimiento alérgico, origine los síntomas que suelen ser graves, con una duración y frecuencia importantes(AU)

Introduction: Allergy is the most common disorder of the immune system. In recent decades, the prevalence of allergic diseases has increased considerably in all countries. Objective: To describe the current context of ocular allergy in order to make an early diagnosis, an early identification of subtypes, establish an adequate therapeutic management and control of severity. Methods: A systematic search of the scientific literature with the highest impact was performed using keywords. The search was limited by type of design (reviews, case series, descriptive, analytical and experimental studies, meta-analysis). The language of the publication was not taken into account. The databases used were: PubMed, Ebsco Host, Lilacs and Science Direct. A total of 114 articles were identified and evaluated, of which 24 were selected for their relevance to the study. Conclusions: Ocular allergy is one of the most common ocular disorders encountered in pediatric and ophthalmology consultations. Although in most cases these are mild forms, they can interfere with the patient's quality of life. It is important that these patients with ophthalmologic manifestations of allergy are referred to the Allergist to detect other pathology, which associated with the allergic condition originate the symptoms that are usually severe, with a significant duration and frequency(AU)

"Four Common Characteristics" of Liver and Eyes and Research Ideas Inspired by "Liver Opens at Eyes" / 中国实验方剂学杂志

The theory of "liver opens at the eyes" was first seen in Yellow Emperor's Internal Canon of Medicine， which is the ancient people's summary of the connection between the liver and the eyes. The theory of "liver opens at the eyes" suggests the characteristic of "co-damage and co-recover of liver and eyes". It has been found in clinical practice that liver diseases and eye diseases often occur together， and "liver and eyes co-recover" is an ideal choice. The key to achieving "liver and eyes co-recover" is to analyze its pharmacological material basis and mechanism. With the development of modern medicine， more and more evidence indicates that the liver and eyes have complex and close relationships in physiological and pathological aspects. In a pathological state， there is a phenomenon of "liver and eyes co-damage"， and after the intervention of traditional Chinese medicine， "liver and eyes co-recover" occurs. "Liver and eyes co-damage and co-recover" can be explained through the "co-material basis and co-action mechanism". On this basis， the research group tentatively proposed that the liver and eyes had "four common characteristics" （4CCs）， namely "co-damage， co-recover， co-material basis， and co-action mechanism" from the theoretical connotation of traditional Chinese medicine， clinical practice， and molecular biology. Additionally， the group also took the intervention of Prunella vulgaris， traditional Chinese medicine， for removing liver fire and improving eyesight on immune liver injury （ILI） and allergic conjunctivitis （AC） as examples to analyze 4CCs. This project aims to deeply analyze the scientific connotation of the theory of "liver opens at the eyes"， reveal the common characteristics and biological essence of liver and eyes， explore a new research paradigm of "liver and eyes co-recover"， and provide a reference for the study of common problems of multi-organ associated diseases.

Dermatophagoides farinae induces conjunctival epithelial cell damage to promote neutrophil migration and neutrophil extracellular traps formation / 中国血吸虫病防治杂志

Objective To investigate the mechanisms underlying allergic conjunctivitis caused by conjunctival epithelial cell damage, neutrophil migration and neutrophil extracellular traps (NETs) formation induced by crude extracts of Dermatophagoides farinae mite (CDM). Methods Human conjunctival epithelial cells were stimulated with 500, 1 000, 2 000, 4 000 ng/mL, and the expression levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ) and IL-8 were detected using quantitative real-time PCR (qPCR) assay and enzyme-linked immunosorbent assay (ELISA). The culture supernatant of human conjunctival epithelial cells was collected and co-cultured with neutrophils. Neutrophil migration was measured using Transwell migration assay, and the expression of NETs markers myeloperoxidase (MPO) and citrullinated histone H3 (CitH3) was quantified using immunofluorescence staining. Neutrophils were stimulated with phorbol 12-myristate 13-acetate (PMA), and then NETs were collected for treatment of human conjunctival epithelial cells. Cell apoptosis was detected using flow cytometry, and the levels of IL-6, TNF-α, IFN-γ and IL-8 were measured in the cell culture supernatant using ELISA. Results Treatment with CDM at concentrations of 2 000 ng/mL and 4 000 ng/mL up-regulated IL-6, TNF-α, IFN-γ and IL-8 expression in human conjunctival epithelial cells. Following treatment with CDM at concentrations of 2 000 ng/mL and 4 000 ng/mL, the culture supernatant of human conjunctival epithelial cells promoted neutrophil migration and induced increases in the staining intensity of MPO and CitH3. In addition, increased NETs triggered the apoptosis of human conjunctival epithelial cells and IL-6, TNF-α, IFN-γ and IL-8 secretion in the culture supernatant of human conjunctival epithelial cells. Conclusions CDM induces human conjunctival epithelial cell damages, thereby promoting neutrophil migration and NETs formation, while the release of NETs further aggravates human conjunctival epithelial cell damages.

Dermatophagoides farinae induces conjunctival epithelial cell damage to promote neutrophil migration and neutrophil extracellular traps formation / 中国血吸虫病防治杂志

OBJECTIVE@#To investigate the mechanisms underlying allergic conjunctivitis caused by conjunctival epithelial cell damage, neutrophil migration and neutrophil extracellular traps (NETs) formation induced by crude extracts of Dermatophagoides farinae mite (CDM).@*METHODS@#Human conjunctival epithelial cells were stimulated with 500, 1 000, 2 000, 4 000 ng/mL, and the expression levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ) and IL-8 were detected using quantitative real-time PCR (qPCR) assay and enzyme-linked immunosorbent assay (ELISA). The culture supernatant of human conjunctival epithelial cells was collected and co-cultured with neutrophils. Neutrophil migration was measured using Transwell migration assay, and the expression of NETs markers myeloperoxidase (MPO) and citrullinated histone H3 (CitH3) was quantified using immunofluorescence staining. Neutrophils were stimulated with phorbol 12-myristate 13-acetate (PMA), and then NETs were collected for treatment of human conjunctival epithelial cells. Cell apoptosis was detected using flow cytometry, and the levels of IL-6, TNF-α, IFN-γ and IL-8 were measured in the cell culture supernatant using ELISA.@*RESULTS@#Treatment with CDM at concentrations of 2 000 ng/mL and 4 000 ng/mL up-regulated IL-6, TNF-α, IFN-γ and IL-8 expression in human conjunctival epithelial cells. Following treatment with CDM at concentrations of 2 000 ng/mL and 4 000 ng/mL, the culture supernatant of human conjunctival epithelial cells promoted neutrophil migration and induced increases in the staining intensity of MPO and CitH3. In addition, increased NETs triggered the apoptosis of human conjunctival epithelial cells and IL-6, TNF-α, IFN-γ and IL-8 secretion in the culture supernatant of human conjunctival epithelial cells.@*CONCLUSIONS@#CDM induces human conjunctival epithelial cell damages, thereby promoting neutrophil migration and NETs formation, while the release of NETs further aggravates human conjunctival epithelial cell damages.

Imbalance between myopic shift and the minimum amplitude of accommodation: a hypothesis for the pathogenesis of ocular hypertension secondary to drug-induced bilateral acute ciliochoroidal effusion / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To report 5 cases with drug-induced bilateral acute ciliochoroidal effusion(DBACE)and myopic shift, with or without ocular hypertension(OHT), summarize patients' clinical characteristics and recovery process of DBACE, and investigate the possible pathophysiological mechanism.METHODS:A retrospective observational case study conducted from June 2017 to February 2021. The included patients were subjected to a series of ocular examinations listed as follows: 1)best corrected visual acuity; 2)intraocular pressure(IOP); 3)slit-lamp microscopy; 4)fundus photography; 5)ultrasound biomicroscopy(UBM); 6)subjective optometry; 7)axial length and anterior chamber depth. All patients were followed up every 2d until the diopters were completely restored to the state before the disease onset.RESULTS:In total, 5 patients aged 10-45 years old, including 3 female and 2 male patients, were enrolled in this study. All patients were bilaterally involved(5/5), and had myopic shift(5/5), of whom 3 patients had OHT(3/5). With the increase of age, myopic shift decreased, while OHT increased. Based on OHT, the dynamic aggravation process of DBACE was subdivided into 2 stages, stage 1(myopic shift without OHT)and stage 2(myopic shift with OHT). With the deterioration of DBACE, when myopic shift approached or exceeded the minimum amplitude of accommodation(MAA), IOP gradually rose, and DBACE progressed from stage 1 to stage 2. With the recovery of DBACE after discontinuing the suspicious drugs, DBACE in stage 2 first returned to stage 1, and then returned to normal.CONCLUSION:Pathophysiological mechanism of DBACE was subdivided into 2 stages, including stage 1(myopic shift without OHT)and stage 2(myopic shift with OHT). The transition between the two stages depends on the imbalance between myopic shift and MAA.

Research progress of human surface microbiota and ocular surface diseases / 国际眼科杂志(Guoji Yanke Zazhi)

The ocular surface microbiota is a part of the human ocular surface microenvironment and is critical to its stability. Many studies have explored the composition of the ocular surface microbiota in health and disease, but the research results are different based on internal and external factors, and the relationship between microorganism dysbiosis and diseases also remains unclear. As the research on intestinal microorganisms and systemic diseases has intensified in recent years, ophthalmic researchers have been inspired to further explore the relationship between ocular surface microbiota and non-infectious ocular surface diseases. Therefore, this article will review the core microbiota of the normal ocular surface as well as alterations in ocular surface microbiota in ocular and systemic diseases, and discuss the possible mechanisms of diseases caused by microorganism dysbiosis, hoping to provide a reference for future studies in ocular surface microbiota.

Mudanças na sazonalidade de polens de Poaceae em Curitiba / Seasonal changes in Poaceae pollen counts in Curitiba, south of Brazil

Introdução: Doenças alérgicas afetam de 10 a 30% da população mundial, e polens são frequentes desencadeantes. A polinose é doença decorrente da sensibilização ao pólen e é a forma sazonal da rinite alérgica e/ou asma mediada pela imunoglobulina E (IgE). A família Poaceae tem o maior número de gêneros de plantas que contribuem para a polinose, pois liberam alta quantidade de pólen na atmosfera e são largamente distribuídas. Objetivo: O presente trabalho quantificou a concentração de polens da família Poaceae na atmosfera de Curitiba e comparou a curva de distribuição de polens com os dados das décadas de 1980 e 90. Também classificou a concentração diária de pólen de gramíneas segundo a National Allergy Bureau (NAB). Método: O equipamento de amostragem foi o captador volumétrico Hirst, instalado a uma altura de aproximadamente 25 metros. Resultados: O pico de concentração diária de pólen total ocorreu no começo do mês de agosto, correspondendo a 302 grãos/m3. O mês de agosto também concentrou oito dos maiores picos diários de pólen total, sendo sete deles superiores a 200 grãos/m3. Foi encontrado pólen Poaceae ao longo de todo o ano e o maior pico de concentração foi de 27 grãos/m3 em agosto e setembro. Nas décadas de 80 e 90, os picos de polens foram no mês de novembro e período de polinização entre outubro e abril. Isso não foi observado no ano de 2018, uma vez que a época de polinização das gramíneas se adiantou, com início em agosto, e o pico de concentração foi em de agosto e setembro. Conclusão: Este estudo mostra que houve mudança na estação polínica. Os dois picos de dispersão de polens de Poaceae se repetem ao longo dos anos, mas têm sido encontrados em outros meses. Pacientes com alergia a polens podem ter sintomas por exposição fora das estações determinadas anteriormente.

Background: Allergic diseases affect 10% to 30% of the world population, with pollen as a major trigger. Pollinosis results from sensitization to pollen and is the seasonal form of allergic rhinitis and/or immunoglobulin E (IgE)-mediated allergic asthma. The Poaceae family is distributed worldwide and has the largest number of plant genera contributing to pollinosis, as they release large amounts of pollen into the atmosphere. Objective: To quantify pollen grains from the Poaceae family in the atmosphere of Curitiba, compare the pollen distribution curve with data from the 1980s and 1990s, and classify the daily concentration of grass pollen according to the National Allergy Bureau (NAB). Method: A Hirst-type volumetric sampler was placed at approximately 25 meters from the ground. Results: The peak of daily total pollen concentration occurred in early August, corresponding to 302 grains/m3. August also had 8 of the highest daily total pollen concentrations, 7 of which were greater than 200 grains/m3. Poaceae pollen was found throughout the year, with the highest concentration peak of 27 grains/m3 in August and September. In the 1980s and 1990s, the pollen peaks occurred in November and the pollen season occurred between October and April. In 2018, however, the pollen season started earlier, in August, and the pollen peaks occurred in August and September. Conclusion: This study shows a change in the grass pollen season. Although the 2 peaks of Poaceae pollen dispersion have repeated over the years, grass pollen is currently observed in other months of the year. Patients with pollen allergy may experience symptoms from allergen exposure outside the previously established grass pollen seasons.

Combined treatment modality including topical 20% fluorescein dye in the management of phthiriasis palpebrarum � A case series

Purpose: To study the clinical presentations and outcomes of phthiriasis palpebrarum (PP) managed with combined treatment modality comprising of 20% fluorescein dye, mechanical removal of the ectoparasites, and topical application of antibiotic eye ointment with paraffin base. Methods: This is a prospective interventional noncomparative hospital?based series of 13 patients of PP. All the patients underwent local application of 20% fluorescein dye over the eyelashes and eyebrows of both the eyes followed by the mechanical removal of all the ectoparasites and trimming of the eyelashes from the base followed by application of ophthalmic ointment. Results: Mean age of the patients was 28 � 22 years (range 3� Years). Out of the total of 13 patients, 11 patients (85%) were having bilateral involvement. The mean duration of symptoms in 11 patients (rest 2 were accidental findings) was 4 � 3 weeks (range 1� weeks). Three patients (23%) had a history of sexual contact with possible parasite?infested partners. Four patients (31%) had additional parasites in the pubic area or torso. All the patients were completely parasite free at the end of 1 month. There was no infestation of the treating medical personnel from the patient. The average follow?up was 8 � 5 months (range 3� months). Conclusion: Itching and irritation of the eyes were the most common presentations of PP. Combined treatment modality comprising of 20% fluorescein dye, mechanical removal of ectoparasites, and topical application of antibiotic eye ointment with paraffin base is effective in the management of PP

Diretriz Latino-americana sobre o Diagnóstico e Tratamento da Alergia Ocular ­ Em nome da Sociedade Latinoamericana de Alergia, Asma e Imunologia (SLAAI) / Latin American Guideline on the Diagnosis and Treatment of Ocular Allergy ­ On behalf of the Latin American Society of Allergy, Asthma and Immunology (SLAAI)

A alergia ocular, também conhecida como conjuntivite alérgica (CA), é uma reação de hipersensibilidade mediada por imunoglobulina E (IgE) do olho desencadeada por aeroalérgenos, principalmente ácaros da poeira doméstica e pólen de gramíneas. Os sintomas geralmente consistem em prurido ocular ou periocular, lacrimejamento e olhos vermelhos que podem estar presentes durante todo o ano ou sazonalmente. A alergia ocular tem frequência elevada, é subdiagnosticada e pode ser debilitante para o paciente. É potencialmente danosa para a visão, nos casos em que ocasiona cicatrização corneana grave, e na maioria dos pacientes associa-se a outros quadros alérgicos, principalmente rinite, asma e dermatite atópica. É classificada em conjuntivite alérgica perene, conjuntivite alérgica sazonal, ceratoconjuntivite atópica e ceratoconjuntivite vernal. O diagnóstico procura evidenciar o agente etiológico e a confirmação se dá pela realização do teste de provocação conjuntival. O tratamento baseia-se em evitar o contato com os desencadeantes, lubrificação, anti-histamínicos tópicos, estabilizadores de mastócitos, imunossupressores e imunoterapia específica com o objetivo de obter o controle e prevenir as complicações da doença.

Ocular allergy, also known as allergic conjunctivitis, is an immunoglobulin E-mediated hypersensitivity reaction of the eye triggered by airborne allergens, primarily house dust mites and grass pollen. Symptoms usually consist of ocular or periocular itching, watery eyes, and red eyes that may be present year-round or seasonally. Ocular allergy has a high frequency, is underdiagnosed, and can be debilitating for the patient. It is potentially harmful to vision in cases of severe corneal scarring, and in most patients, it is associated with other allergic conditions, especially rhinitis, asthma, and atopic dermatitis. It is classified as perennial allergic conjunctivitis, seasonal allergic conjunctivitis, atopic keratoconjunctivitis, and vernal keratoconjunctivitis. Diagnosis seeks to identify the etiologic agent, and confirmation is given by conjunctival provocation testing. Treatment is based on avoiding contact with triggers, lubrication, topical antihistamines, mast cell stabilizers, immunosuppressants, and specific immunotherapy with the aim of achieving control and preventing disease complications.

Observation on the curative effect of Tiaoti Tuomin Decoction on allergic conjunctivitis and the changes of immunologic function / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To observe the curative effect of take oral and cold-wet compress on eyes with Tiaoti Tuomin Decoction and the changes of immunologic function in patients with allergic conjunctivitis. METHODS:Totally 160 patients 320 eyes with allergic conjunctivitis were randomly divided into observation group and control group. The 80 patients(160 eyes)in the observation group were treated with Tiaoti Tuomin Decoction take oral and cold-wet compress on eyes. The 80 patients(160 eyes)in the control group were treated with 0.05% Azelastine Hydrochloride Eye Drops. After 14d of continuous treatment, the symptom and sign scores, quality of life questionnaire scores of allergic conjunctivitis, and the levels of serum immunoglobulin IgG, IgA, IgE of the two groups were compared and analyzed.RESULTS:After treatment, the scores of symptom and sign, quality of life questionnaire of allergic conjunctivitis in both groups were better than those before treatment(<i>P</i><0.05), and the improvement degree of which in the observation group was better than that in the control group(<i>P</i><0.05). After treatment, the levels of serum immunoglobulin IgG, IgA in the two groups were not significant improvement than before treatment(<i>P</i> >0.05), the level of serum immunoglobulin IgE in the observation group were significantly improved than before treatment(<i>P</i><0.05). CONCLUSION: Treatment of take oral and cold-wet compress on eyes with Tiaoti Tuomin Decoction can improve clinical symptoms of allergic conjunctivitis patients, help relieve allergic reaction and improve the quality of life.

Comparative study on establishing an immune tolerance model for allergic conjunctivitis in mice with different methods / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To establish an immune tolerance model for allergic conjunctivitis in newborn mice with different methods and observe the impact of environmental factors on allergic conjunctivitis in early life.METHOD: A total of 50 Balb/c newborn mice were randomly divided into blank control group, ovalbumin(OVA)+subcutaneous injection group, OVA+nebulized inhalation group, OVA+gastric group, ragweed pollen(RW)+subcutaneous injection group, RW+nebulized inhalation group, RW+gastric group, house dust mite(HDM)+subcutaneous injection group, HDM+nebulized inhalation group, HDM+intragastric group(n=5 animals/group). Except for the blank control group, mice in each group were individually exposed to the corresponding antigens to induce immune tolerance early in life and stimulated with the corresponding antigens in adulthood. The ocular surface was visualized by anterior segment photography. The relative expression level of conjunctival RANTES and IL-17 mRNA was measured by RT-qPCR and serum IL-17 concentration was measured by ELISA.RESULTS: Compared with the blank control group, the relative expression level of conjunctiva IL-17 mRNA in RW+gastric group was the highest, and it was the lowest in RW+subcutaneous group(all P&#x003C;0.05). The relative expression level of conjunctiva RANTES mRNA was the highest in RW+gastric group(P&#x003C;0.001). Compared with the blank control group, the serum concentration of IL-17 was increased in all treatment groups except OVA+nebulizer group and RW+subcutaneous group(P&#x003C;0.05).CONCLUSION: The immune tolerance of allergic conjunctivitis induced by subcutaneous injection of antigen was the most suitable method in the early life of mice.

Analyze on the value of conjunctival impression cytology in the diagnosis of allergic conjunctivitis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the value of conjunctival impression cytology(CIC)in the diagnosis of allergic conjunctivitis(AC). <p>METHODS: A case-control study. Forty patients(80 eyes)who were clinically diagnosed with AC in our department from January to February 2021 were included in the study,and 40 normal controls(80 eyes)were enrolled too. All subjects underwent double upper palpebral CIC examinations. Observed the morphology and number of conjunctival eosinophils and carried out Tseng classification in each group. To Compare the differences between the results of the two groups and analyze the effects of gender, age and course of disease on the results of CIC eosinophil examination in AC group.<p>RESULTS: The positive rate of eosinophils in the upper palpebral CIC examination of AC patients was significantly higher than that of the normal control group(χ²=57.744, <i>P</i><0.001); The Tseng grade of AC patients was also higher than that of the normal control group(<i>Z</i>=-2.453, <i>P</i><0.05). Gender, age and course of disease had no significant effect on the results of CIC eosinophils in AC group(all <i>P</i> >0.05).<p>CONCLUSION: CIC examination is simple, and the result is objective and accurate. It has good application value in the diagnosis of AC.

Meta-analysis of clinical effect and safety of Loratadine combined with Diclofenac sodium eye drops on allergic conjunctivitis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the clinical effects and safety of Loratadine combined with Diclofenac sodium eye drops in the treatment of allergic conjunctivitis by system review.METHODS:Using “Loratadine” “Diclofenac sodium” and “allergic conjunctivitis” as keywords, a randomized controlled trial of Loratadine combined with diclofenac sodium in the treatment of allergic conjunctivitis was searched in Embase, Cochrane library, Pubmed, CNKI, Wanfang database, VIP and SionMed. The retrieval time is from the establishment of the database to July 2021. The risk bias tool provided by the Cochrane cooperation scale was used to assess the risk bias of included studies of RCTs. The publication bias of the included studies was assessed by the Egger's test. Meta-analysis of clinical efficiency, incidence of adverse effects, ocular itch score, and discharge score were using RevMan 5.3. Descriptive analysis were performed on the results with high heterogeneity.RESULTS:A total of 19 articles were included, all of which were Chinese literatures, including 1 931 patients(2 044 eyes). The control group was treated with Loratadine, and the experimental group was treated with Loratadine combined with Diclofenac sodium eye drops. The Meta-analysis showed that the clinical effect of experimental group was better than control group(<i>OR</i>=4.43, 95%<i>CI</i>:3.26-6.03,<i>P</i><0.00001).The incidence of adverse reaction was lower than control group(<i>OR</i>=0.32, 95%<i>CI</i>:0.2-0.52,<i>P</i><0.00001). The Score of ocular itching(<i>MD</i>=-0.36, 95%<i>CI</i>:-0.39 to -0.33,<i>P</i><0.00001)and discharge(<i>MD</i>=-0.24,95%<i>CI</i>: -0.31 to -0.18,<i>P</i><0.00001)in experimental group was lower than control group. All the studies on hyperemia and edema of conjunctiva, conjunctival papilla or follicle proliferation and foreign body sensation in patients with allergic conjunctivitis showed that the experimental group could significantly reduce the above symptoms(all <i>P</i><0.05). Egger's test was performed on the total effective rate, the incidence of adverse reaction. The results showed that there was publication bias in the total effective. Trim and fill method showed that the publication bias did not affect the results.CONCLUSION: On the basis of the oral Loratadine, combined with Diclofenac sodium eye drops has a certain clinical efficacy in the treatment of allergic conjunctivitis, which can improve the clinical symptoms such as ocular itching, foreign body sensation, hyperemia and edema of conjunctiva, and the incidence of adverse reactions is low, which can provide evidence-based basis for the drug treatment of allergic conjunctivitis in the future. However, due to the low intensity of the included research evidence, more multicenter, randomized double-blind clinical trials are needed in the future, so that to improve the evidence intensity.

Analysis of Animal Models of Allergic Conjunctivitis Based on Characteristics of Clinical Symptoms in Chinese and Western Medicine / 中国实验方剂学杂志

Allergic conjunctivitis （AC） is one of the most common eye diseases in ophthalmology， including type I allergies and type Ⅳallergies， which seriously affect the quality of life of patients. This article analyzes the current models of allergic conjunctivitis based on the characteristics of clinical symptoms of Chinese and Western medicine， including the types of animals selected， the characteristics of the models， and the analysis of the degree of agreement with the clinical symptoms of Chinese and Western medicine. It is concluded that most of the current AC model replication uses ovalbumin （OVA） induction method， ragweed pollen induction method. In recent years， animal models of fungal-inducible， compound 48/80-inducible， and murine allergic conjunctivitis have appeared， which are sensitized by the "systemic first and then local" method. Most of them have a high degree of coincidence with the characteristics of Western medicine symptoms， but there are certain gaps in the indicators of Chinese medicine， and there are also inconsistencies between the existing observation indicators and the diagnostic standards of Chinese medicine， resulting in unclear symptoms of Chinese medicine and irregular classification judgments. Therefore， To replicate the animal model with high clinical anastomosis of Chinese and Western medicine， further discussion and research are needed to better promote the research of allergic conjunctivitis.

Clinical value of Loratadine combined with Diclofenac sodium eye drops in the treatment of allergic conjunctivitis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the therapeutic effect of loratadine combined with diclofenac sodium eye drops in the treatment of allergic conjunctivitis, and the influence on tear film stability and tear-related indexes.<p>METHODS: A prospective study was conducted among 93 patients(186 eyes)with allergic conjunctivitis admitted to the hospital between January 2019 and January 2020. They were randomly divided into observation group(<i>n</i>=47, 94 eyes, treated with loratadine and diclofenac sodium eye drops)and control group(<i>n</i>=46, 48 eyes, treated with loratadine). All patients received 2wk of treatment. The improvement of ocular symptoms and signs after treatment was evaluated. Schirmer I test(SⅠt)and break up time(BUT)were used to evaluate the tear film stability. The height, depth and cross-sectional area of lacrimal rivus were measured by anterior segment related optical coherence tomography. Tear specimens were collected to detect changes in tear hyaluronic acid(HA), group ⅡA secretory phospholipase A2(sPLA2-Ⅱa and eosinophil cationic protein(ECP). The occurrence of adverse reactions was counted.<p>RESULTS: After 2wk of treatment, the scores of main symptoms and signs were reduced in the two groups(<i>P</i><0.05), and the observation group had lower scores than the control group(<i>P</i><0.05). SⅠt and BUT were increased in the two groups(<i>P</i><0.05), which were longer in the observation group than in the control group(<i>P</i><0.05). The height of lacrimal rivus increased, depth increased, and cross-sectional area were increased in the two groups(<i>P</i><0.05). Besides, the above indexes in observation group were higher than those in the control group(<i>P</i><0.05). Meanwhile, HA, ECP and sPLA2-Ⅱa were decreased in the two groups(<i>P</i><0.05), which were lower in the observation group than in the control group(<i>P</i><0.05). No significant differences were found between the 2 groups in the incidence of adverse reactions(12.8% <i>vs</i> 10.9%, <i>P</i>>0.05).<p>CONCLUSION: The overall effect of loratadine combined with diclofenac sodium eye drops is better than that of loratadine alone in the treatment of allergic conjunctivitis. The combined treatment can improve symptoms, signs and tear film stability, reduce inflammatory mediators in tears, and promote recovery of tear film function. Besides, it is safe and feasible.

Demografía e inmunología de variantes fenotípicas de la alergia en pacientes atópicos de 1-5 años. Granma. 2012-2018 / Demography and immunology of phenotypic variants of allergy in atopic patients aged 1-5 years. Granma. 2012-2018 / Demografia e imunologia de variantes fenotípicas da alergia em pacientes atópicos com idade entre 1 e 5 anos. Granma. 2012-2018

RESUMEN Se realizó un estudio analítico, en el Servicio de Alergia del Centro Médico Ambulatorio de Granma, en el periodo 2012-2018, con el objetivo de caracterizar demográfica e inmunológicamente las variantes fenotípicas de alergia en 224 pacientes de 1 a 5 años de edad. Se estudiaron: edad, sexo, valor de IgA, IgG e IgE, componentes C3 y C4 del complemento, valor de leucograma total, y eosinófilos en sangre y en mucosa nasal, así como el diagnóstico clínico de cada variante fenotípica de alergia. El procesamiento estadístico incluyó estadística descriptiva. Además, se empleó estadística inferencial en la realización de análisis bivariables a través de CHI2 para identificar asociación con p< 0,05. No existieron diferencias en cuanto a sexo y predominaron los niños de 4 y 5 años de edad. El orden de frecuencia de los diferentes fenotipos de enfermedades alérgicas fue, de mayor a menor, rinitis alérgica, asma bronquial, conjuntivitis alérgica y dermatitis atópica. En los pacientes estudiados predominaron los valores elevados de IgE y de eosinófilos en citología nasal y en sangre y normales de IgA, IgG, C3, C4 y la cuenta leucocitaria total.

ABSTRACT An analytical study was carried out in the Allergy Service of the Ambulatory Medical Center of Granma, in the period 2012-2018, with the aim of demographically and immunologically characterizing the phenotypic variants of allergy in 224 patients from 1 to 5 years of age. Age, sex, IgA, IgG and IgE value, complement components C3 and C4, total leukogram value, and eosinophils in blood and nasal mucosa were studied, as well as the clinical diagnosis of each phenotypic variant of allergy. Statistical processing included descriptive statistics. In addition, inferential statistics was used in the performance of bivariate analyzes through CHI 2 to identify an association with p <0.05. There were no differences in terms of sex and children of 4 and 5 years of age predominated. The order of frequency of the different phenotypes of allergic diseases was, from highest to lowest, allergic rhinitis, bronchial asthma, allergic conjunctivitis and atopic dermatitis. In the patients studied, elevated IgE and eosinophil values ​​predominated in nasal and blood cytology and normal IgA, IgG, C3, C4 and total leukocyte count.

RESUMO Foi realizado um estudo analítico no Serviço de Alergia do Centro Médico Ambulatorial de Granma, no período 2012-2018, com o objetivo de caracterizar demograficamente e imunologicamente as variantes fenotípicas da alergia em 224 pacientes de 1 a 5 anos de idade. Foram estudados idade, sexo, valor de IgA, IgG e IgE, componentes do complemento C3 e C4, valor total de leucograma e eosinófilos no sangue e mucosa nasal, além do diagnóstico clínico de cada variante fenotípica da alergia. O processamento estatístico incluiu estatística descritiva. Além disso, a estatística inferencial foi utilizada na realização de análises bivariadas através do CHI 2 para identificar uma associação com p <0,05. Não houve diferenças quanto ao sexo e predominaram crianças de 4 e 5 anos. A ordem de frequência dos diferentes fenótipos de doenças alérgicas foi, da mais alta à mais baixa, rinite alérgica, asma brônquica, conjuntivite alérgica e dermatite atópica. Nos pacientes estudados, os valores elevados de IgE e eosinófilos predominaram na citologia nasal e sanguínea e em IgA normal, IgG, C3, C4 e contagem total de leucócitos.

Entendendo a alergia ocular / Understanding eye allergy

A associação entre sintomas de asma, rinoconjuntivite (RCA) e conjuntivite alérgica (CA) é frequente, e sintomas oculares podem afetar 75% dos pacientes com rinite, e 20% dos asmáticos. Embora asma e RCA sejam comumente associadas, a prevalência desta em crianças e os fatores de risco para seu desenvolvimento têm sido estudados com menor frequência. A CA é um espectro de condições clínicas que varia de formas agudas a formas crônicas e graves. A CA é frequentemente subdiagnosticada em pacientes com RA e asma, pois os sintomas são pouco valorizados. O desenvolvimento de RCA depende de fatores genéticos e ambientais, e estudos indicam que sexo, história familiar de atopia, sensibilização precoce, alergia alimentar e dermatite atópica são fatores de risco. Existem seis formas clínicas de alergia ocular: conjuntivite alérgica sazonal, conjuntivite alérgica perene, ceratoconjuntivite vernal, conjuntivite papilar gigante, ceratoconjuntivite atópica e blefaroconjuntivite de contato. As diferentes formas clínicas envolvem diferentes mecanismos imunológicos, principalmente reações de hipersensibilidade Tipo 1 e Tipo 4. Os principais sintomas são prurido ocular, hiperemia conjuntival, secreção ocular e lacrimejamento, sendo o prurido o sintoma cardinal. A avaliação do especialista em alergia é importante para a identificação de possíveis agentes desencadeantes, e do oftalmologista para avaliar possíveis complicações. A maioria dos pacientes com alergia ocular inicia o tratamento com automedicação, geralmente com colírios não específicos. Anti-histamínicos são os principais medicamentos utilizados. Corticoides tópicos são reservados para casos graves. Imunomoduladores podem beneficiar esses pacientes, bem como imunoterapia. Imunobiológicos têm sido estudados para casos refratários.

Association between asthma, allergic rhinoconjunctivitis (ARC) and allergic conjunctivitis (AC) is frequent, and ocular symptoms may affect 75% of patients with rhinitis and 20% of those with asthma. Although asthma and ARC are commonly associated, the prevalence of eye allergy in children and the risk factors for its development are not well established. AC is a spectrum of clinical conditions ranging from acute to severe chronic cases. It is frequently underdiagnosed in patients with asthma and rhinitis because symptoms are underestimated. ARC development depends on genetic and environmental factors, and studies indicate that sex, family history of atopy, early sensitization, food allergy and atopic dermatitis are risk factors. There are six clinical forms of eye allergy: seasonal allergic conjunctivitis, perennial allergic conjunctivitis, vernal keratoconjunctivitis, giant papillary conjunctivitis, atopic keratoconjunctivitis and contact blepharoconjunctivitis. Different clinical aspects involve different immunologic mechanisms, especially type 1 and type 4 hypersensitivity reactions. The most common symptoms are itchy eyes, conjunctival hyperemia, ocular discharge and watering. The evaluation of an allergy specialist is important to identify possible triggering factors, and an ophthalmologist is able to evaluate possible complications. Most patients with eye allergy start treatment with self-medication, generally non-specific eye drops. Anti-histamines are the most commonly used medications. Topical corticosteroids are reserved for severe cases. Immunomodulators may benefit such patients, as well as immunotherapy. Biologics are being studied for refractory cases.

Evaluation of 0.1% Olopatadine Hydrochloride versus 0.5% Ketorolac Tromethamine Solution in the Management of Allergic Conjunctivitis

Introduction: The term “allergic conjunctivitis” refers to a group of hypersensitivity disorders of eye. This is a commonocular condition which presents with itching, redness, tearing, swelling, burning, fullness in the eye, leading to rubbing ofthe eye, and blurred vision. Histamine, prostaglandins, and mast cell degranulation are important mediators responsiblefor the signs and symptoms of seasonal and perennial allergic conjunctivitis. Olopatadine is a novel drug with dual actionof mast cell stabilizer with blocking of histamine H1 receptors. Ketorolac tromethamine 0.5% ophthalmic solution is a verypotent nonsteroidal anti-inflammatory drug (NSAID) that inhibits the enzyme cyclooxygenase and decreases the synthesisof prostaglandins.Objectives: The objectives of the study were to compare the clinical efficacy and therapeutic effects of 0.1% olopatadinehydrochloride to that of 0.5% ketorolac tromethamine ophthalmic solution with different pharmacological mechanisms in themanagement of seasonal allergic conjunctivitis.Materials and Methods: This was a comparative study that was conducted on patients with allergic conjunctivitis attendingophthalmology outpatient department in a tertiary health-care center during the study period of 1 year. A total of 100 patientswere chosen by purposive sampling method and randomized into two groups. Group A patients were treated with olopatadineand Group B patients were treated with ketorolac and the drugs were instilled twice daily. Patients were evaluated for clinicalsigns and symptoms at baseline and at 30 min, 2 days, 7 days, and 14 days of application of eye drops.Results: The mean age in our study was 27.81 years and had male predominance. There was a significant reduction in thefrequency of all ocular signs and symptoms of hyperemia and itching following initiation of medication. The percentage of nonresponders was comparable between both the groups. Three patients showed increase in hyperemia signs at 30 min postapplication of ketorolac. Adverse reaction was observed in three patients in the ketorolac group.Conclusion: The topical dual-action drug-olopatadine and NSAID-ketorolac both have an attenuating and equivocal effect onthe clinical signs and symptoms of allergic conjunctivitis.

Azelastine hydrochloride combined with Praprofen in the treatment of allergic conjunctivitis in children / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To study azelastine hydrochloride combined with praprofen for the treatment of allergic conjunctivitis in children.<p>METHODS: Totally 80 children with allergic conjunctivitis who were admitted to our hospital from May 2016 to June 2018, they were randomly divided into the control group and the observation group, 40 cases in each group. The control group was given pranoprofen eye drops, on the basis of the control group, the observation group was combined with azelastine hydrochloride eye drops for adjuvant treatment. The two groups children were treated continuously for 1wk. The clinical efficacy, the changes of the clinical symptoms, tear film stability, inflammatory factors and adverse reactions were compared between the two groups.<p>RESULTS: After 1wk of treatment, the clinical efficacy of the observation group was 95.0%, higher than that of the control group, 85.0%(<i>P</i>=0.035); the itching, tearing, foreign body sensation and photophobia scores in the observation group were lower than that of the control group \〖(1.13±0.36)<i>vs </i>(2.28±0.41)scores,(1.05±0.33)<i>vs </i>(2.14±0.49)scores,(1.17±0.46)<i>vs </i>(2.28±0.59)scores(1.29±0.37)<i>vs </i>(1.84±0.55)scores\〗(<i>P</i><0.05); the tear film rupture time(BUT)in the observation group was significantly higher than that of the control group, and the corneal fluorescein staining test(FL)was significantly lower than that of the control group \〖(11.96±1.14)<i>vs </i>(5.85±0.92)s,(2.85±0.33)<i>vs </i>(6.21±0.68)scores\〗(<i>P</i><0.05); the tears histamine(HA), eosinophilic cationic protein(ECP)and immunoglobulin E(IgE)in the observation group were lower than that of the control group \〖(31.62±4.51)<i>vs </i>(65.03±6.48)μg/L,(2.20±0.28)<i>vs </i>(7.26±0.72)μg/L,(0.06±0.01)<i>vs </i>(0.18±0.04)mg/L\〗(<i>P</i><0.05); there was no significant difference in the overall incidence of adverse reactions between the two groups during treatment(χχ2=1.897, <i>P</i>=0.168).<p>CONCLUSION: The clinical efficacy of azelastine hydrochloride combined with pranoprofen in the treatment of allergic conjunctivitis in children is significant, which can effectively improve the level of inflammatory factors, promote the tear film stability recovery, and have good safety, the clinical value is high.