Cellular changes in tears associated with keratoconjunctival responses induced by nasal allergy.

BACKGROUND: Allergic keratoconjunctivitis occurs in a primary form, caused by an allergic reaction localized in the conjunctiva, and in a secondary form, induced by an allergic reaction originating in the nasal mucosa. Various hypersensitivity mechanisms involved in the keratoconjunctivitis forms result in different keratoconjunctival response types. PURPOSE: To investigate the cytologic changes in tears during the secondary immediate (SIKCR), late (SLKCR), and delayed (SDYKCR) keratoconjunctival responses. METHODS: In 61 patients, comprising 20 SIKCRs, 23 SLKCRs, and 18 SDYKCRs, nasal provocation tests (NPTs) with allergens and 61 phosphate-buffered control challenges were repeated and supplemented with cell counting in the tears. RESULTS: The SIKCR (P<0.01), appearing 10-120 min after the NPT, was associated with increased eosinophil and mast cell counts in tears. The SLKCR (P<0.01), appearing 5-12 h after the NPT, was accompanied by increased counts of eosinophils, neutrophils, basophils, and conjunctival epithelial and goblet cells. The SDYKCR (P<0.05), appearing 24-48 h after NPT, was associated with increased counts of lymphocytes, neutrophils, monocytes, basophils, conjunctival epithelial, corneal epithelial and goblet cells. CONCLUSIONS: The SIKCR, SLKCR, and SDYKCR, induced by nasal allergy, were associated with different cellular profiles in the tears. The cells, except mast, epithelial and goblet cells, displaying no intracellular changes, migrated probably from the conjunctival capillaries, in response to the factors released during the primary allergic reaction in the nasal mucosa and subsequently penetrating into the conjunctiva. These results demonstrate a causal role of nasal allergy and diagnostic value of NPT combined with recording of ocular features and cellular profiles in tears in some keratoconjunctivitis patients.

The possible involvement of nasal allergy in allergic keratoconjunctivitis.

PURPOSE: Allergic keratoconjunctivitis coexists regularly with allergic rhinitis. However, little is known about the relationship between these conditions. The purpose of this study was to investigate the possible involvement of nasal allergy in keratoconjunctivitis by means of nasal challenge with allergen (NPT), in combination with recording of the ocular symptoms. METHODS: In 26 patients suffering from atopic (n=15) or vernal (n=11) keratoconjunctivitis showing positive history and skin tests, but responding insufficiently to the local ophthalmologic therapy, 71 NPTs with inhalant allergens were performed and combined with the recording of the ocular response. In 11 control subjects with allergic rhinitis, but without ocular disease history, 11 positive NPTs were repeated and supplemented with the registration of the ocular features. RESULTS: Of the 26 patients, 24 developed 51 positive nasal responses (NRs; P<0.01), 43 of which were accompanied by significant ocular response (P<0.01). No ocular responses were measured during the 26 PBS control challenges (P>0.05) or during 11 repeated NPTs in control subjects (P>0.2). CONCLUSIONS: These results give evidence for possible involvement of nasal allergy in some cases of keratoconjunctivitis. They also show diagnostic value of nasal challenges with allergen in combination with registration of the ocular symptoms in such patients, allowing then consideration of additional therapeutic measures concerning the nasal allergy.

[The role of allergy in interstitial cystitis]. / De rol van allergie bij interstitiële cystitis.

In two women, aged 47 and 58 years, who suffered from longstanding urinary bladder complaints, various urologic treatments had been carried out, which however had had only a partial therapeutic effect. They also suffered from allergic rhinitis and multiple arthralgia. Allergologic investigations including nasal challenges with inhalant allergens and food ingestion challenges revealed the causative participation of the inhalant allergens and the food components in the urinary complaints. The all-round allergologic management, including dietary measures, avoidance of the relevant allergens and nasal as well as oral administration of disodium cromoglycate therapy, led to the almost complete disappearance of the urinary and other complaints. Interstitial cystitis is a regularly appearing urinary disorder, especially in female patients. In practice, the possible causative role of allergy and especially of food allergy is only rarely included in the differential diagnosis of this disorder.

Inhibition of the late asthmatic response by nedocromil sodium administered more than two hours after allergen challenge.

Fourteen adult patients with bronchial asthma who were known late responders to bronchial allergen challenge were entered into a double-blind crossover study to compare the protective effects of nedocromil sodium (3 x 4 mg) and placebo aerosols on the late asthmatic response (LAR). After screening for development of an LAR (fall in forced expiratory volume in 1 second [FEV1] > or = 20% at at least 3 consecutive time points, 4 to 10 hours after challenge), patients were randomized to test treatment on 2 study days, with an interval of at least 3 days. Nine of the patients had a dual late response, which is a combination of an immediate and a late response, and five other patients had an isolated late response only. On each study day the concentration of allergen that previously elicited a response was inhaled for 10 minutes. FEV1 was recorded every 10 or 15 minutes for up to 1 hour after challenge, and then at hourly intervals for 12 hours and every second hour on the next 2 days. Test treatments were administered in three doses at 30-minute intervals, with the first dose given 90 minutes before the expected onset of the LAR for each patient. Compared with placebo, nedocromil sodium significantly inhibited the LAR (p < 0.05) at each time point measured from 6 to 10 hours after challenge and reduced the maximum fall in FEV1 by 21.0% overall (p = 0.003).

Twice daily 4% Sodium Cromoglycate vs. 2% Sodium Cromoglycate used four times daily in seasonal (grass pollen) allergic conjunctivitis.

It is well established that 2% Sodium Cromoglycate is an effective treatment for a number of allergic eye diseases. It has been shown to be non-toxic. It can be used longterm and in serious allergic problems it is a useful adjunctive therapy to steroids. The main problem with Sodium Cromoglycate is that the recommended dosage is a four times daily application and patient non-compliance is common. One of the main objectives of any therapy is to reduce the frequency of dosage and the current study has been designed to investigate the efficacy of a 4% solution of Sodium Cromoglycate, used twice daily, versus a 2% solution used four times daily in seasonal allergic conjunctivitis. A multicentre study, therefore, was carried out to assess the efficacy of both drugs and to assess any possibility of side effects. In addition, a unit dose was used, thus eliminating preservatives and it was used specifically in seasonal allergic conjunctivitis in the pollen season. This study showed that 4% Sodium Cromoglycate used twice daily was at least as affective as 2% Sodium Cromoglycate used four times daily.

Role of nasal allergy in chronic maxillary sinusitis--diagnostic value of nasal challenge with allergen.

The role of nasal allergy in chronic maxillary sinusitis without an air-fluid level was studied in 37 patients. Seventy-three nasal provocation tests with various inhalant allergens were performed in 37 patients by means of rhinomanometry, and maxillary sinus radiographs were performed before and repeatedly after the allergen challenge. Forty-one positive nasal responses (NRs) occurred in 29 patients; 13 were immediate only, 18 were late only, and 10 NRs were dual responses. Of these responses, 32 demonstrated radiographic changes, primarily an increase in mucosal edema and/or opacification. These responses were accompanied by increased pressure in the maxillary sinuses, acute headache, and sometimes otalgia. Eight patients did not develop any NRs; however, increased thickening of the mucosal membrane of the maxillary sinuses, accompanied by subjective symptoms, was recorded in three of these nonresponders. These results demonstrate the role of nasal allergy in some patients with chronic maxillary sinusitis, which may affect the diagnostic and therapeutic approaches to this disorder.

[Eosinophilic pulmonary infiltrates or the PIE syndrome]. / Eosinofiele longinfiltraten ofwel het PIE-syndroom.

A 22-year-old male suffering from bronchial obstruction, in whom the usual anti-allergic treatment was almost ineffective, had a high degree of blood eosinophilia and migrating pulmonary infiltrates. These infiltrates were strongly suspected to be of eosinophilic origin, in view of the results of bronchoalveolar lavage. Unfortunately, no clear cause of the disorder was found. Corticosteroid treatment per os and by inhalation clearly improved his condition. However, the treatment with inhalation corticosteroids has to be continued indefinitely.

Effects of oral cromolyn on the nasal response due to foods.

Thirty-eight patients with a perennial allergic rhinitis, who developed a nasal response to ingestion challenge with certain foods, were randomly selected for protection tests with oral cromolyn sodium (Nalcrom). The food challenges were performed in combination with rhinomanometry. The patients were pretreated with cromolyn or placebo by double-blind crossover schedule, in a daily oral dose of 200 mg (four times), starting 3 days before and continuing up to 3 days after the food ingestion challenge. The 38 patients previously developed 25 immediate, 24 late, and 6 delayed nasal responses to food ingestion challenge. Cromolyn fully prevented 15, significantly decreased 9, and was ineffective in 1 case of immediate nasal response. Of the 24 cases of late response, cromolyn fully prevented 10, significantly decreased 12, and was ineffective in 2. Of the 6 cases of delayed response, 2 cases were decreased significantly by cromolyn, while the other 4 cases were not. The protection effects of oral cromolyn were highly significant for the immediate and late nasal responses and nonsignificant for delayed responses. It can be concluded that cromolyn in a daily oral dose of 200 mg four times prevented the immediate and late nasal responses to ingested food.

[Enuresis and encopresis as a reaction to food]. / Enuresis en encopresis als reactie op voedingsmiddelen.

A meanwhile 10-year old girl, suffering from diurnal and nocturnal enuresis and encopresis since she was a baby, had been repeatedly examined and treated by various medical specialists and a homeopathic doctor without any significant improvement. The incontinence persisted. Finally her problem was solved after an allergological examination. The skin tests and specific IgE antibodies were positive for various foods, some of them confirmed later by food ingestion challenge. She was put on a complete elimination diet, combined with oral disodium cromoglycate, and has been free of all complaints since 1 1/2 years.