Updates in the treatment of ocular allergies

Abstract

Allergic diseases have greatly increased in industrialized countries. About 30% of people suffer from allergic symptoms and 40%–80% of them have symptoms in the eyes. Atopic conjunctivitis can be divided into seasonal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC). The treatment of SAC is simple; antihistamines, anti-inflammatory agents, or chromoglycate. In severe cases of SAC, subcutaneous or sublingual immunotherapy is helpful. PAC needs longer therapy, often year round, with mast cell stabilizers, antihistamines, and sometimes local steroids. Atopic keratoconjunctivitis is a more severe disease showing chronic blepharitis often connected with severe keratitis. It needs, in many cases, continuous treatment of the lid eczema and keratoconjunctivitis. Blepharitis is treated with tacrolimus or pimecrolimus ointment. Conjunctivitis additionally needs corticosteroids and, if needed, cyclosporine A (CsA) drops are administered for longer periods. Basic conjunctival treatment is with mast cell-stabilizing agents and in addition, antihistamines are administered. Vernal keratoconjunctivitis is another chronic and serious allergic disease that mainly affects children and young people. It is a long-lasting disease which commonly subsides in puberty. It demands intensive therapy often for many years to avoid serious complicating corneal ulcers. Treatment is mast cell-stabilizing drops and additionally antihistamines. In relapses, corticosteroids are needed. When the use of corticosteroids is continuous, CsA drops should be used, and in relapses, corticosteroids should be used additionally. Nonallergic eosinophilic conjunctivitis (NAEC) is a less known, but rather common, ocular disease. It affects mostly middle-aged and older women. The eye symptoms of NAEC are largely similar to those seen in chronic allergic conjunctivitis. Basic therapy is mast cell-stabilizing drops. Eosinophilic inflammation needs additional corticosteroids. In severe cases, CsA drops are recommended. Antihistamines should be avoided. It is important to recognize the different forms of allergic ocular diseases and to start the treatment early and intensively enough to avoid chronicity of the disease and accompanying tissue destruction.

Sublingual Immunotherapy for Experimental Allergic Conjunctivitis in a Murine Model Induced by Dermatophagoides farinae Allergen

“…The clinical symptoms and histopathological changes in the BALB/c mice model corresponded to the immediate and late phases of the allergic process, as described in humans [18,19]. In addition to ocular disease, there was also a systemic immune response induced by the mite, characterized by an increase in both total serum and Der f -specific IgE and IgG levels and in the ratio of Th2 cytokine IL-4/Th1 cytokine IFN-γ, which parallels findings in humans [5]. The present model, as a good mimic of human AC, indicates that it is an accurate instrument for studying the pathogenesis of ocular allergy and for testing therapies for AC.…”

“…Chemotactic factors released by mast cells are responsible for accumulation of eosinophils and neutrophils at the site of allergic inflammation. Eosinophils contain granules in which preformed cytokines are rapidly secreted depending on the cytokine stimuli, T helper cell 1 [Th1; interleukin (IL)-12, IL-27 and interferon (IFN)-γ] and Th2 (IL-4 and IL-13) [5]. …”

“…Sublingual immunotherapy (SLIT) is recommended as a new promising and safe method of allergen-specific immunotherapy [6,7]. In the past, the efficacy of SLIT in both house dust mite-induced asthma or conjunctivitis and pollen-induced rhinoconjunctivitis has been documented clinically [5,8,9,10]. However, studies resolving the efficacy and underlying mechanisms of action of SLIT in mite-induced AC patients are rare.…”

The Role of Anemia Management in Improving Outcomes for African-Americans with Chronic Kidney Disease

“…Although these patients often receive higher ESA doses [90,91,92], it is difficult to distinguish the effects of nutritional deficiency, lower pretreatment Hb levels, and delayed ESA initiation from possible racial-specific biological effects on ESA responsiveness [1, 93]. In the Procrit® Dosed Once Weekly in the Patients with Anemia due to Early Renal Insufficiency (POWER) study [94], a post-hoc analysis reported that African-American nonsmokers demonstrated a statistically significant decreased response to epoetin alfa compared with nonsmokers of other races (mean Hb at week 16: 11.61 vs. 11.86 g/dl, p = 0.02); however, whether this was a clinically significant difference in response is not known.…”

“…Once dialysis is initiated, African-Americans receive higher ESA doses [90,91,92]; however, it is difficult to distinguish the effects of nutritional deficiency, lower pretreatment Hb levels, and delayed ESA initiation from possible racial-specific biological effects on ESA responsiveness. Awareness of racial-specific challenges in anemia management in addition to CKD risk factors, progression, complications, and treatment responses will help physicians serve African-American kidney patients more effectively.…”