Adverse reactions to the allergen conjunctival provocation test

Mourão, Elizabeth Maria Mercer

doi:10.1016/j.anai.2011.07.015

Cited by 5 publications

(6 citation statements)

References 6 publications

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“…A study realized in Singapore with nasal challenges with Bt provoked late-phase reaction wheezing in patients with allergic rhinitis and a history of asthma ( 21 ). Even though most adverse reactions of CPT are mild, there is potential for more severe/systemic responses and it should preferably be performed in centers where side effects can be handled ( 22 ).…”

Section: Discussionmentioning

confidence: 99%

Conjunctival Provocation Test With Blomia tropicalis

Mourão

2021

Front.Allergy

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Background: Conjunctival provocation test (CPT) is used to demonstrate clinical relevance to a specific allergen. Blomia tropicalis (Bt) is a prevalent allergen in tropical regions. Its major allergen Blo t 5 is commonly detected in house dust in Brazil. Patients with allergic rhinoconjunctivitis (ARC) have IgE antibodies to Bt although it may not indicate clinical allergy.Objective: The purpose of this study is to demonstrate the role of CPT in clinical allergy to Bt in allergic conjunctivitis (AC).Methods: CPT was performed in asymptomatic subjects with ARC (n = 26) outside the grass pollen season. They had positive skin prick tests (SPT) to Bt and other common inhalant allergens and they were off topical or systemic antihistamines. Standardized allergens were used for CPT (Blo t 5 462.5 ng/mL in 1:1 solution, Alk Abelló). CPT was conducted on a control group of subjects (n = 29) without symptoms of ARC and with negative SPT. CPT was performed with progressive doses of allergen solutions in normal saline (1:32, 1:16, 1:8, 1:4, 1:2). CPT with the same allergen dose that elicited a positive reaction was repeated one week later. The protocol was approved by the local Ethics Board and signed informed consent was obtained from all participants.Results: There were 92% (24/26) of positive CPT in subjects sensitized to Bt. Significant association was found between SPT and CPT results with Bt (p < 0.0001). CPT had 92% sensitivity and 100% specificity when compared to SPT results. Positive reactions with the same dose or one immediately higher occurred in 21 out of 22 subjects who repeated TPC 1 week later. Mild transient nasal symptoms (21/24) were the major side effects of positive CPT followed by moderate periorbital edema which occurred in 41% (10/24). One controlled asthmatic BT-sensitized subject developed wheezing and dyspnea during a positive CPT with Bt that cleared with inhaled albuterol (400 mcg). There were no reactions whatsoever of CPT in non-allergic subjects.Conclusion: This study demonstrated that Bt may cause allergic conjunctivitis in our population. In addition, CPT is a safe and reproducible test if standardized allergens are used.

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Section: Discussionmentioning

confidence: 99%

Conjunctival Provocation Test With Blomia tropicalis

Mourão

2021

Front.Allergy

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“…97 In a series of 77 CAPT positive with standardized extracts (Alk Abelló) of Dermatophagoides pteronyssinus (83.8 μg/mL of Der p 1), Blomia tropicalis (42.4 ng/mL of Blo t 5) and Lolium perenne (399, 2 μg/mL of Phl p 5), 88% of the individuals presented nasal itching, sneezing, nasal obstruction and coryza with spontaneous resolution within 1 hour. 113 This occurs by direct drainage of allergens into the nose through the nasolacrimal duct. To minimize allergen absorption and reduce the risk of adverse events, Anderson et al recommend occlusion of the nasolacrimal duct during CAPT.…”

Section: Safety and Adverse Effectsmentioning

confidence: 99%

“…Also in our study, a controlled asthmatic individual, sensitive to Blomia tropicalis (papule diameter ≥ 8 mm on TCA), presented an episode of bronchospasm and shortness of breath with a dose of 28.9 ng/mL of Blo t 5), being treated with aerosol beta 2-agonist, corticosteroid and oral H1 antihistamine. 113 Although it is considered safe even with high doses of allergens, a potential risk of serious and life-threatening reactions may occur, which justifies the performance of CAPT by a team trained in the method, in a hospital environment or equipped for the treatment of anaphylaxis. 99,100,113 In conclusion, CAPT is a simple, fast and safe method to evaluate IgE-mediated allergic ocular diseases, especially in cases of perennial allergic conjunctivitis, in polysensitized individuals or when there is no agreement between symptoms and the suspected allergen.…”

Section: Safety and Adverse Effectsmentioning

confidence: 99%

“…113 Although it is considered safe even with high doses of allergens, a potential risk of serious and life-threatening reactions may occur, which justifies the performance of CAPT by a team trained in the method, in a hospital environment or equipped for the treatment of anaphylaxis. 99,100,113 In conclusion, CAPT is a simple, fast and safe method to evaluate IgE-mediated allergic ocular diseases, especially in cases of perennial allergic conjunctivitis, in polysensitized individuals or when there is no agreement between symptoms and the suspected allergen. With this, we suggest a protocol for carrying out the CAPT, as shown in Figure 6.…”

Section: Safety and Adverse Effectsmentioning

confidence: 99%

See 1 more Smart Citation

Latin American Guideline on the Diagnosis and Treatment of Ocular Allergy - On behalf of the Latin American Society of Allergy, Asthma and Immunology (SLAAI)

Chong-Neto¹,

Cepeda²,

Moreira³

et al. 2022

AAAI

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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.Descritores: Alergia ocular, conjuntivite alérgica, rinoconjuntivite.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.

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“…18 Even the presence of one eosinophil or eosinophilic granules is consistent with a diagnosis of allergy. 19,20 There is also a possible involvement of nasal allergy in some patients with allergic conjunctivitis, such as SAC and PAC, and therefore, there may be value to a nasal challenge with allergen combined with registration of the ocular features. 8 The diagnosis can also be made by performing the conjunctival provocation tests, which consist of instilling offending pollen into the conjunctival sac, producing the typical symptoms of SAC.…”

Section: Diagnosis Of Sac and Pacmentioning

confidence: 99%

Seasonal and Perennial Allergic Conjunctivitis

Freitas¹

2013

Ocular Surface Disease: Cornea, Conjunctiva and Tear Film

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Adverse reactions to the allergen conjunctival provocation test

Cited by 5 publications

References 6 publications

Conjunctival Provocation Test With Blomia tropicalis

Conjunctival Provocation Test With Blomia tropicalis

Latin American Guideline on the Diagnosis and Treatment of Ocular Allergy - On behalf of the Latin American Society of Allergy, Asthma and Immunology (SLAAI)

Seasonal and Perennial Allergic Conjunctivitis

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