Local allergic conjunctivitis: a phenotype of allergic conjunctivitis

Int Ophthalmol. 2019 Nov;39(11):2539-2544. doi: 10.1007/s10792-019-01101-z. Epub 2019 May 15.

Abstract

Purpose: Local allergic rhinitis (LAR) has been reported in the field of otolaryngology; however, the concept of local allergic conjunctivitis (LAC) has not been widely studied in the ophthalmologic community. We routinely examined total IgE levels in tear fluids (t-tIgE) and antigen-specific IgE levels in serum (s-sIgE) in patients with suspected allergic conjunctivitis, on the basis of Japanese guidelines for allergic conjunctival diseases. There are several cases in which the results of t-tIgE and s-sIgE testing are divergent. We suggest that these divergent cases correspond to LAR in otolaryngology.

Methods: The study included 148 patients (33 men and 115 women) with clinical symptoms and signs of allergic conjunctivitis. Allerwatch Tear IgE® was used for measurement of t-tIgE levels. ImmunoCAP Rapid® and View Allergy 39® were used for measurement of s-sIgE levels. Conjunctival cytology using spatula was used to identify eosinophils on the conjunctiva.

Results: A total of 83 patients (56.1%) were positive and 65 patients were negative for t-tIgE in the AW. In the ICR, 97 patients (65.5%) were positive for at least one of the eight allergens, whereas 51 (34.5%) were negative for all allergens. Among 83 patients positive for t-tIgE, 14 (16.9%) had no detectable s-sIgE. Therefore, we considered the possibility of LAC in cases in which only local IgE could be detected. Among 28 cases (18.9%) who were negative for t-tIgE and s-sIgE, 21 underwent conjunctival scraping; eosinophils were found in four cases and eosinophilic granules in two. Accordingly, we considered the possibility of non-IgE-type AC in these six cases.

Conclusions: These results suggest the existence of LAC that is a candidate of a phenotype of AC.

Keywords: Allergic conjunctivitis; Phenotype; Serum total IgE; Specific serum IgE; Total tear IgE.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antibodies, Anti-Idiotypic / blood*
  • Biomarkers / blood
  • Child
  • Child, Preschool
  • Conjunctiva / pathology*
  • Conjunctivitis, Allergic / blood
  • Conjunctivitis, Allergic / diagnosis*
  • Conjunctivitis, Allergic / immunology
  • Female
  • Follow-Up Studies
  • Humans
  • Immunoglobulin E / blood*
  • Immunoglobulin E / immunology
  • Male
  • Middle Aged
  • Phenotype
  • Retrospective Studies
  • Young Adult

Substances

  • Antibodies, Anti-Idiotypic
  • Biomarkers
  • Immunoglobulin E