Allergic Conjunctivitis and the Impact of Allergic Rhinitis

Abstract

Although nasal allergy has been prominent in allergy research, ocular allergy is increasingly recognized as a distinct symptom complex that imposes its own disease burden and reduction in patients' quality of life. In the past year, knowledge of the relationships between allergic conjunctivitis and allergic rhinitis has increased. Allergic conjunctivitis is highly prevalent and has a close epidemiologic relationship with allergic rhinitis. Both conditions also exhibit similar pathophysiologic mechanisms. Pathways of communication are thought to increase the likelihood of an inflammatory reaction at both sites following allergen exposure of nasal or ocular tissue. Clinical trials of intranasal therapies have demonstrated efficacy in allergic conjunctivitis and rhinitis. Newer intranasal steroids decrease ocular symptoms, potentially achieving efficacy by suppressing the naso-ocular reflex, downregulation of inflammatory cell expression, or restoration of nasolacrimal duct patency. Proposed pathophysiologic interactions between allergic rhinitis and ocular allergy underscore the need for therapies with efficacy in both symptom sets.

Epidemiology of allergic conjunctivitis

“…Although the ARIA initiative recognized conjunctivitis as a frequent comorbidity of allergic rhinitis [1], ocular symptoms are often under-diagnosed and are increasingly recognized as a distinct disorder that imposes its own burden on medical costs and patient's QoL, especially in those with persistent moderate/severe eye symptoms [27].…”

The Burden Associated with Ocular Symptoms in Allergic Rhinitis

“…Allergic rhinitis (AR) is a prevalent and bothersome inflammatory condition affecting the upper airways, nose and eyes [1,2,3,4]. Ocular symptoms are common in AR patients and are known to be underappreciated [1,4].…”

“…Ocular symptoms are common in AR patients and are known to be underappreciated [1,4]. In fact, the association of nasal and ocular symptoms has been scarcely explored, with most studies reporting on either the proportion of AR patients suffering from ocular symptoms or the associated burden [5].…”

A Prospective Study of the Prevalence of Allergic Conjunctivitis in Allergic Rhinitis

“…Pathways of communication are thought to increase the likelihood of an inflammatory reaction at both sites following allergen exposure of nasal or ocular tissue. Proposed pathophysiologic interactions between allergic rhinitis and ocular allergy underscore the need for therapies with efficacy in both symptom sets [7] .…”