Clinical signs and symptoms are not enough for the correct diagnosis of allergic conjunctivitis.

BACKGROUND: Allergic Conjunctivitis (AC) has a high incidence in the general population and sometimes it is difficult to make a correct diagnosis, distinguish among the different subtypes of AC, and therefore, to indicate the suitable therapy. OBJECTIVE: To determine the best way to carry out an appropriate diagnosis of AC. METHODS: Thirty-one patients with clinical manifestations of AC and eleven controls were studied by measuring allergic and immunologic parameters. Only those patients confirmed as having AC were treated with ketotifen fumarate and further evaluated. RESULTS: According to allergic and immunological parameters, patients were divided into two groups. Group I patients had positive prick test toward at least one allergen, 60% exhibited high levels of tear-IgE, and only 36% conjunctival eosinophils. By contrast, patients from Group II had negative prick tests and laboratory findings similar to the control group. In group I there was a good correlation between levels of tear-IgE and eosinophils (r = 0.55; p = 0.009); key symptoms and signs and prick test (r = 0.52; p = 0.015), and prick test and eosinophils (r = 0.50 p = 0.022). The cardinal signs and symptoms scores dropped significantly in Group I as a consequence of the treatment (p < 0.0001). CONCLUSION: In order to have a reliable AC diagnosis, allergen-skin prick test, IgE in tears, and conjunctival eosinophils must be studied. Serum IgE is less important.

Expression of CS-1 fibronectin precedes monocyte chemoattractant protein-1 production during elicitation of allergic contact dermatitis.

BACKGROUND: Leucocyte migration within inflammatory skin compartments in allergic contact dermatitis (ACD) is the result of a sophisticated multi-step event where multiple molecules are involved. OBJECTIVE: Since non-antigen-specific mechanisms have been described as an early participant in elicitation of ACD, we investigated the kinetics of the expression of monocyte chemoattractant protein-1 (MCP-1/CCL2) and the type of infiltrating cells. We compared the time course production of MCP-1/CCL2 with connecting segment-1 (CS-1) fibronectin and thymus and activation-regulated chemokine (TARC/ CCL17) expression. METHODS: Biopsies from 10 individuals challenged in their back with the antigen responsible for their contact dermatitis and an irrelevant antigen were taken at different times and histology, immunohistochemistry for CS-1 fibronectin, TARC/CCL17, CD3, CD68, CXCR3, CCR4 and in situ hybridization for MCP-1/CCL2 were performed. RESULTS: At positive antigen stimulated sites expression of MCP-1/CCL2 by basal keratinocytes and isolated cells in dermis started at 10 h. CS-1 fibronectin and TARC/CCL17 expression by blood endothelial cells was found at 2 and 10 h, respectively. This was followed by dermal accumulation of mononuclear cells with a significant increase of CD3+ and CD68+cells. At 48 h, approximately 58% of infiltrating cells were CXCR3+, and 35% CCR4+. CONCLUSIONS: We showed evidence of the fact that CS-1 fibronectin expression precedes the production of MCP-1/CCL2 and TARC/CCL17 in the skin of patients with ACD, suggesting that these molecules participate in the early complex process of migrating mononuclear cells during elicitation of ACD.

Hacia un mejor diagnóstico de conjuntivitis alérgica / Towards the best diagnosis of allergic conjunctivitis

Antecedentes: la conjuntivitis alérgica (CA) tiene una elevada incidencia en la población general y el diagnóstico es realizado por oftalmólogos a través de síntomas y signos oculares característicos. Objetivo: determinar la mejor manera de realizar un diagnóstico preciso de CA. Materiales y métodos: se estudiaron veintidós pacientes con síntomas de CA en el nivel clínico, alergológico e inmunológico antes y después del tratamiento con fumarato de ketoifeno 0,05 por ciento tópico. Resultados: el 83 por ciento de la población estudiada tenía antecedentes familiares de alergia y el 100 por ciento tuvo pruebas cutáneas positivas hacia diferentes alergenos. El 30 por ciento presentó niveles de IgA sérica elevados y el 60 por ciento en lágrimas. Todos los pacientes tuvieron niveles normales de IgA secretoria y lisozima A y valores no detectables de VCAM-1s. El estudio de las moléculas CD29 y HLA-DR sobre células epiteliales conjuntivales antes del tratamiento mostró un marcado incremento en el porcentaje de las mismas con respecto a valores normales. Encontramos correlación entre valores de IgE en lágrimas y eosinófilos (r=0,56; p=0,007); índice de síntomas y signos cardinales e índice de pruebas cutáneas (r=0,50; p=0,032); índice de pruebas cutáneas y eosinófilos conjuntivales (r=0,48; p=0,024); e índice de síntomas y signos cardinales y niveles de IgE sérica (r=0,45; p=0,018). El porcentaje de células CD29+ disminuyó significativamente como consecuencia del tratamiento (p=0,03) mientras que el porcentaje de células HLA-DR+ solo disminuyó en el 41 por ciento de pacientes. Conclusiones: en el diagnóstico de la CA son parámetros críticos los signos y síntomas cardinales, pruebas cutáneas, eosinófilos conjuntivales e IgE en lágrimas