JACQLQ subjective symptom questionnaire score and clinical test results for patients with allergic conjunctival disease.

We investigated the relationship between subjective symptoms and objective findings in patients with allergic conjunctival diseases (ACD) and test results for tear total IgE (t-tIgE), conjunctival eosinophils (c-Eo), serum total IgE (s-tIgE), serum-antigen specific IgE (s-sIgE), and serum eosinophils (s-Eo). Subjective symptoms and objective findings of patients with ACD were evaluated using Japanese Allergic Conjunctival Disease Quality of Life Questionnaire (JACQLQ), which described disability score and emotional score written by patient and clinical findings score written by ophthalmologist. We investigated the relationship between questionnaire scores and laboratory data for t-tIgE, c-Eo, s-tIgE, s-sIgE, and s-Eo. Scores of impediments to life and of moods were highest in vernal keratoconjunctivitis among ACD. Cases with positive pollen-sIgE showed significantly more nasal symptom score than those with negative pollen-sIgE (P < 0.05). Cases with positive t-tIgE or c-Eo showed significantly more objective symptoms' JACQLQ score than those with negative t-tIgE or c-Eo (P < 0.05), respectively. Cases positive for house dust/mite-sIgE, showed significantly more objective symptoms' JACQLQ score than those without for house dust/mite-sIgE (P < 0.05). These results indicate that ACD could be analyzed more accurately by the combination of JACQLQ and laboratory data.

Allergic Conjunctivitis Management: Update on Ophthalmic Solutions.

PURPOSE OF REVIEW: The aim of this review, is to present an updated revision of topical management of SAC and PAC, based on the available scientific evidence and focused on the impact of ophthalmic solution formulations on eye surface. RECENT FINDINGS: Physicians treating ocular allergy should be aware of tear film and tear film disruption in SAC and PAC, and how eye drop composition and additives affect the physiology of the allergic eye. Seasonal and perennial allergic conjunctivitis (SAC and PAC) are the most frequent causes of ocular allergy (OA), and both conditions are underdiagnosed and undertreated. SAC and PAC are immunoglobulin E (IgE)-mediated hypersensitivity reactions. The additional tear film disruption caused by the release of inflammatory mediators increases and exacerbates the impact of signs and symptoms and may trigger damage of the ocular surface. Comorbidities are frequent, and dry eye disease in particular must be considered. Clinical guidelines for the management of SAC and PAC recommend topical therapy with antihistamines, mast cells stabilizers or dualaction agents as first-line treatment, but care should be taken, as many medications contain other compounds that may contribute to ocular surface damage.

What's the situation with ocular inflammation? A cross-seasonal investigation of proteomic changes in ocular allergy sufferers' tears in Victoria, Australia.

Background: Ocular allergy (OA) is a localized subset of allergy characterized by ocular surface itchiness, redness and inflammation. Inflammation and eye-rubbing, due to allergy-associated itch, are common in OA sufferers and may trigger changes to the ocular surface biochemistry. The primary aim of this study is to assess the differences in the human tear proteome between OA sufferers and Healthy Controls (HCs) across peak allergy season and off-peak season in Victoria, Australia. Methods: 19 participants (14 OA sufferers, 5 HCs) aged 18-45 were recruited for this study. Participants were grouped based on allergy symptom assessment questionnaire scoring. Proteins were extracted from human tear samples and were run on an Orbitrap Mass Spectrometer. Peaks were matched to a DIA library. Data was analyzed using the software MaxQuant, Perseus and IBM SPSS. Results: 1267 proteins were identified in tear samples of OA sufferers and HCs. 23 proteins were differentially expressed between peak allergy season OA suffers vs HCs, and 21 were differentially expressed in off-peak season. Decreased proteins in OA sufferers related to cell structure regulation, inflammatory regulation and antimicrobial regulation. In both seasons, OA sufferers were shown to have increased expression of proteins relating to inflammation, immune responses and cellular development. Conclusion: Tear protein identification showed dysregulation of proteins involved in inflammation, immunity and cellular structures. Proteins relating to cellular structure may suggest a possible link between OA-associated itch and the subsequent ocular surface damage via eye-rubbing, while inflammatory and immune protein changes highlight potential diagnostic and therapeutic biomarkers of OA.

Evaluation methods using tear volume in a conjunctivitis mice model.

Allergic conjunctival disease is an immune-mediated inflammatory disease of the conjunctiva. To develop clinically useful drugs, it is necessary to develop quantitative evaluation methods that reflect the clinical symptoms in experimental animal models. Allergic conjunctivitis model mice were systemically sensitised with ovalbumin (OVA) administered intraperitoneally and locally sensitised with OVA eye drops between day 14-28. Next, conjunctivitis induced by ocular administration of OVA solution to sensitised mice was evaluated based on tear volume. Additionally, we evaluated increase in tear volume induced by direct ocular instillation of histamine, compound 48/80, and carrageenan. An increase in antigen-induced tear volume was observed in the mice model. Additionally, direct instillation of histamine, compound 48/80, and carrageenan increased tear volume. Furthermore, levocabastine inhibited the increase in tear volume in antigen-induced allergic conjunctivitis and histamine- and compound 48/80-induced conjunctivitis models. In contrast, betamethasone suppressed carrageenan-induced tear volume but not histamine- or compound 48/80-induced tear volume. Histamine may be involved in increased tear volume in allergic conjunctivitis. Betamethasone is not directly involved in the action of histamine and is thought to suppress increase in tear volume. Evaluation of tear volume in a conjunctivitis mice model is highly quantitative; therefore, it is possible to evaluate drug efficacy. This is considered a useful index compared with conventional methods.

Consistent efficacy and safety of sublingual immunotherapy tablets across allergens and geographic regions.

Background: The clinical development program of the SQ grass, ragweed, tree, and house dust mite (HDM) sublingual immunotherapy (SLIT)-tablets for allergic rhinitis/conjunctivitis (AR/C) included clinical trials conducted in North America, Europe, and Japan. Objective: Data from these trials were analyzed to assess efficacy, immunologic mechanisms, and safety outcomes across allergens and geographic regions. Methods: Thirteen phase III, double-blind, placebo controlled trials in the subjects with AR/C were conducted in North America, Europe (including Russia), and Japan (N = 7763 analyzed). Trials were generally similar with respect to medical practice, target population, eligibility criteria, and efficacy and safety monitoring. Data were analyzed for the approved doses in North America and Europe. Four statistical models were used to enhance comparison of the efficacy end points among the trials. Results: The SLIT-tablets demonstrated consistent efficacy across allergens and regions, regardless of the statistical analysis used. Relative improvement in the primary efficacy end point compared with placebo by using the predefined protocol analysis ranged from 17.9% to 32.8%, 17.5% to 19.3%, 20.6% to 38.3%, and 39.6% with the grass, HDM, ragweed, and tree SLIT-tablets, respectively. The kinetics of specific immunoglobulin E (IgE) and IgG4 responses were similar among the allergens and regions. Local application-site reactions were the most common adverse events for all allergens and in all regions. Most treatment-related adverse events for all allergens and in all regions were mild in severity. The rate of systemic allergic reactions was similar across regions (0%-0.54%). Conclusion: Confirmatory phase III trials for SLIT-tablets in the treatment of AR/C showed consistent efficacy, immunologic, and safety outcomes across allergens and geographic regions.

Complement decay-accelerating factor inhibits inflammation-induced myopia development.

Myopia is regarded as a worldwide epidemic ocular disease, has been proved related to inflammation. CD55, also known as decay-accelerating factor (DAF) can modulate the activation of complement through inhibiting the formation of complement 3 convertase and its dysregulation is involved in various inflammatory diseases. To investigate the association between CD55 and myopia, and to test whether CD55 can inhibit myopia development by suppressing inflammation in the eye, we use three different animal models including monocular form-deprivation myopia, myopia induced by TNF-α administration and allergic conjunctivitis animal model to reveal the CD55 in myopia development. The tears of thirty-eight participants with different spherical equivalents were collected and CD55 in the tears were also analyzed. Complement 3 and complement 5 levels increased while CD55 levels decreased in allergic conjunctivitis and myopic eyes. After anti-inflammatory drugs administration, CD55 expression was increased in monocular form-deprivation myopia model. We also found inflammatory cytokines TGF-ß, IL-6, TNF-α, and IL-1ß may enhance complement 3 and complement 5 activation while CD55 level was suppressed contrary. Moreover, lower CD55 levels were found in the tears of patients with myopia with decreased diopter values. Finally, CD55-Fc administration on the eyelids can inhibit the elongation of axial length and change of refractive error. CD55-Fc application also suppress myopia development subsequent to complement 3 and complement 5 reduction and can lower myopia-specific (MMP-2 and TGF-ß) cytokine expression in TNF-α induced myopia animal model. This suggests that CD55 can inhibit myopia development by suppression of complement activation and eventual down-regulation of inflammation.

Allergen Immunotherapy: The Evidence Supporting the Efficacy and Safety of Subcutaneous Immunotherapy and Sublingual Forms of Immunotherapy for Allergic Rhinitis/Conjunctivitis and Asthma.

Allergen immunotherapy (AIT) is a recognized key therapeutic modality for the treatment of allergic respiratory disease. Definitive studies have provided evidence-based data to demonstrate its effectiveness in allergic rhinitis and asthma due to the inhalation of proteinaceous allergic substances from specific seasonal pollens, dust mites, animal allergens, and certain mold spores. Over the ensuing decades, laboratory investigations have provided objective evidence to demonstrate immunologic changes, including production of protective IgG antibody, suppression of IgE antibody, upregulation of regulatory T cells, and induction of a state of immune tolerance to the offending allergen(s). Tangential to this work were carefully designed clinical studies that defined allergen dose and duration of treatment, established the importance of preparing extracts with standardized allergens (or well-defined extracts) based on major protein moieties, and used allergen provocation models to demonstrate efficacy superior to placebo. In the United States, the use of subcutaneous immunotherapy extracts for AIT was grandfathered in by the Food and Drug Administration based on expert literature review. In contrast, sublingual tablet immunotherapy underwent formal clinical development programs (phase I-III clinical trials) that provided the necessary clinical evidence for safety and efficacy that led to regulatory agency approvals for the treatment of allergic rhinitis in properly characterized patients with allergy. The allergy specialist's treatment options currently include traditional subcutaneous AIT and specific sublingual tablets approved for grass, ragweed, house dust mites, trees belonging to the birch-homologous group, and Japanese cedar. Tangential to this are sublingual drops that are increasingly being used off-label (albeit not approved by the Food and Drug Administration) in the United States. This article will review the evidence-based literature supporting the use of these forms of AIT, as well as focus on several current controversies and gaps in our knowledge base that have relevance for the appropriate selection of patients for treatment with specific AIT.

Rhinoconjunctivitis severity induced by cat exposure influences early and late asthmatic responses: Evidence from an environmental exposure chamber.

BACKGROUND: The impact of allergic rhinoconjunctivitis on the early (EAR) and late asthmatic response (LAR) has yet to be assessed during optimal allergen exposure conditions. OBJECTIVE: We aimed to assess predictive factors of the EAR and LAR and to evaluate the relation between rhinitis, conjunctivitis and asthma induced by cat allergen exposure in an environmental exposure chamber (EEC). METHODS: Data from two cohort studies involving asthmatic patients with cat allergy who performed a cat allergen exposure challenge in ALYATEC EEC were analysed. Spirometry, visual analogue scale (VAS) for asthma, VAS for rhinitis, Total Nasal Symptoms Score, Total Ocular Symptoms Score (TOSS), Rhinoconjunctivitis Total Symptoms Score and Abelson score were used to assess asthma, rhinitis and conjunctivitis during and after exposure. RESULTS: An EAR occurred in 65.1% of patients, 32.1% of whom had a LAR. The diameter of the prick test to cat allergens and non-specific bronchial hypersensitivity level were independent risk factors for EAR (p < .05). No independent risk factors for LAR were identified. Rhinoconjunctivitis severity during exposure correlated with the asthma VAS during EAR and LAR (p < .05). Allergen exposure time needed to trigger an EAR correlated with the Abelson score during exposure (p < .05). The asthma VAS and TOSS during exposure correlated with faster LAR occurrence (p < .05). CONCLUSION: Prick test size and non-specific bronchial hypersensitivity level were confirmed as independent predictive factors of EAR during allergen exposure in an EEC. This study demonstrated the relation between the severity of rhinitis, conjunctivitis and asthma induced by allergen exposure for both EAR and LAR.

Sublingual Tablet Immunotherapy Improves Quality of Life in Adults With Allergic Rhinoconjunctivitis.

BACKGROUND: Allergic rhinitis with or without conjunctivitis can negatively impact many aspects of quality of life (QoL). The efficacy and safety of standardized quality (SQ) sublingual immunotherapy (SLIT) tablets have been confirmed across large clinical trials in adults with grass, tree, ragweed, and house dust mite (HDM) allergic rhinitis with or without conjunctivitis. OBJECTIVE: This pooled analysis investigates whether the reduction in symptom burden found across the clinical trials is supported by improvements in QoL. METHODS: A total of 11 phase II/III randomized placebo-controlled trials across the SQ grass, tree, ragweed, and HDM SLIT tablets (grass: N = 3179; ragweed: N = 767; tree: N = 634; HDM: N = 2221) were included. QoL was assessed using the standardized Rhinitis Quality of Life Questionnaire (RQLQ), with the exception of 3 grass trials, which used the nonstandardized version. The overall RQLQ scores were expressed as a mean of 7 domains. In the pooled analysis, treatment was used as fixed effect; and the trial, and the interaction between region/country and trial as random effects. RESULTS: The pooled analysis showed consistent and statistically significant improvements in overall RQLQ scores across all 4 SQ SLIT tablets versus placebo (pooled estimate [95% CI], P value-grass: -0.20 [-0.28 to -0.12], P < .001; tree: -0.42 [-0.58 to -0.26], P < .001; ragweed: -0.36 [-0.55 to -0.17], P < .001; HDM: -0.28 [-0.39 to -0.17], P < .001). Furthermore, significant improvements versus placebo for all 4 SQ SLIT tablets were seen across the 7 individual domains. CONCLUSIONS: The proven efficacy of SQ SLIT tablets to reduce symptoms across 4 of the most common respiratory allergens is supported by concurrent significant improvements in RQLQ scores overall and for all 7 domains.

The Rediscovery of Hydroxychloroquine in Allergic Diseases in the COVID-19 Era

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A possible new mushroom allergen in a case of occupational asthma

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Allergic rhinoconjunctivitis due to pediculus humanus capitis

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Tear osteopontin level and its relationship with local Th1/Th2/Th17/Treg cytokines in children with allergic conjunctivitis

Background: Allergic conjunctivitis (AC) is one of the most common allergic ocular diseases worldwide. Osteopontin (OPN), as a recently described Th2 inflammation related protein, may play a role in the pathogenesis of AC. The aim of this study was to identify the expression of OPN in children with AC. Methods: Eighty AC children (seasonal and perennial AC) and twenty controls were enrolled in this study. Serum and tears of different time points (during and out of the pollen season) were collected and used for enzyme-linked immunosorbent assay (ELISA) of OPN and T-help cell related cytokines, respectively. The relationship between serum and tears OPN and Th1/2/17Treg related cytokines as well as disease severity were analysed. Results: Our results showed that expression of tear OPN protein by perennial AC patients increased significantly compared with controls or seasonal AC patients out of the pollen season. Tear OPN expression was positively related to local Th2/17 cytokines and negatively related to IL-10 and TGF-Beta expression. The tear OPN expression was also significantly related to disease severity. Conclusion: Tear OPN reflects the local clinical status of ocular allergy and might play an important pathophysiological role in local Th2/17/Treg inflammation in children with AC (AU)

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Does the profile of sensitization to grass pollen allergens have clinical relevance?

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Clinical characteristics of patients sensitized to Siberian Hamster

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A Multicenter Study of Sensitization Profiles in an Allergic Pediatric Population in an Area With High Allergen Exposure

Antecedentes y objetivo: En áreas geográficas donde el paciente está expuesto a un elevado número y altas concentraciones de alérgenos, es importante identificar los principales causantes de la enfermedad alérgica, especialmente en pacientes pediátricos. El presente estudio se ha realizado en pacientes alérgicos ≤ 14 años con el objetivo de tratar de averiguar, en una primera fase, el perfil de sensibilización y, en una segunda fase, la evolución de dicho perfil tras 3 años de seguimiento. En esta publicación se presenta la primera fase. Métodos: Se incluyeron en primera visita 187 pacientes por 5 Unidades de Alergia, con edad entre 2 y 14 años y síntomas sugestivos de enfermedad alérgica (rinoconjuntivitis y/o asma). El diagnóstico alergológico fue posteriormente confirmado por prueba cutánea y/o IgE específica. Posteriormente se analizó la IgE a los alérgenos principales. Resultados: Los pacientes mostraron sensibilización tanto a alérgenos estacionales (gramíneas, olivo, ciprés, Cynodon) como perennes (Alternaria) y panalérgenos (especialmente profilina y proteínas transportadoras de lípidos). Un 60% estaban polisensibilizados. La sensibilización a ciertos alérgenos (Cup s1, Phl p1 o Sal k1) parece aumentar con la edad. Los pacientes sensibilizados a profilina mostraron un mayor número de sensibilizaciones que los negativos al panalérgeno, siendo un posible factor de confusión diagnóstica Conclusiones: Pacientes pediátricos que viven en áreas de alta exposición a numerosos alérgenos son polisensibilizados, estando un alto porcentaje de ellos sensibilizados a panalérgenos, por lo que la implementación de nuevas herramientas diagnósticas como el diagnóstico por componentes se hace imprescindible para su correcto diagnóstico (AU)

Background and objective: In areas with a high number of allergens and high allergen concentrations, it is essential to identify the main causes of allergy, especially in pediatric patients. This study was conducted in allergic patients aged 14 or less to identify sensitization profiles during an initial phase, and to then evaluate changes in these profiles after 3 years of follow-up. This article describes the first phase of our investigation. Methods: A total of 187 patients aged between 2 and 14 years were included by 5 allergy units; all the children had symptoms suggestive of allergic disease (rhinoconjunctivitis and/or asthma). Allergy diagnosis was confirmed by evaluation of clinical history, allergen exposure, and in vivo or in vitro tests. Specific immunoglobulin E (sIgE) to major allergens was tested. Results: Patients were sensitized to both seasonal (especially grass, olive, cypress and Cynodon dactylon) and perennial allergens (Alternaria alternata) and to panallergens (especially profilin and lipid transfer protein). Almost 60% of the patients included were polysensitized. Sensitization to certain major allergens such as Cup s1, Phl p1, or Sal k1 seems to increase with age. Patients sensitized to profilin had a higher number of sensitizations than non-profilin-sensitized patients. This panallergen is a diagnostic confounding factor. Conclusions: A high percentage of allergic pediatric patients living in an area with high exposure levels to a large number of allergens are polysensitized and have a high percentage of sensitization to panallergens. The implementation of new diagnostic tools such as component-resolved diagnosis is crucial (AU)

Mediadores alérgicos en lágrimas de niños con conjuntivitis alérgica estacional y perenne / Allergic mediators in tear from children with seasonal and perennial allergic conjunctivitis

ObjetivoEvaluar la concentración de diferentes moléculas mediadoras de alergia en lágrima de niños con conjuntivitis alérgica estacional (CAE) y conjuntivitis alérgica perenne (CAP) frente a controles.MétodosSe incluyeron 20 niños con conjuntivitis alérgica (17 CAE y 3 CAP), y 16 niños sanos utilizados como controles. Las muestras de lágrima se obtuvieron mediante una hemosteta de acetato de polivinilo (OASIS, 0525) colocándola en el canto externo. Se eluyó la lágrima de la hemosteta utilizando un tampón y centrifugación a 20.000rpm durante 30 minutos a 4°C. Una vez cuantificadas las muestras se determinaron las concentraciones de histamina (HIS), triptasa (TPS), factor quimiotáctico del eosinófilo (ECF), proteína básica (MBP), proteína catiónica del eosinófilo (ECP), neurotoxina (EDN), IgE y E-selectina mediante la técnica ELISA (enzyme-linked immunosorbent assay). Los resultados se compararon con el test no paramétrico U de Mann-Whitney (p<0,05) y se realizaron análisis multivariantes mediante regresión logística.ResultadosPresentaron diferencias estadísticamente significativas la TPS (p=0.014), MBP (p=0,032), ECP (p=0,0041), IgE (p=0,014) y EDN (p=0,00077), cuando se comparó la lágrima de niños con CAE y CAP frente a la de niños control.ConclusionesEl análisis simultáneo de mediadores alérgicos en la lágrima de niños con CAE y CAP indica que existe una alteración en la lágrima referida principalmente a un aumento significativo de la concentración de EDN, ECP, MBP, y disminución de IgE y TPS. Los análisis estadísticos revelan una exactitud diagnóstica del 94,4% usando el panel de las 8 moléculas analizadas(AU)

PurposeTo evaluate the concentration of allergic mediators in tears of children with seasonal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC) compared with controls.MethodsTwenty children with allergic conjunctivitis (17 SAC, and 3 PAC) and sixteen healthy children were included in this study. Tear samples were collected using a Merocel sponge (Oasis, 0525), and immediately eluted by incubation in elution buffer and subsequent centrifugation at 20,000rpm for 30min at 4°C. Concentrations of histamine (HIS), tryptase (TPS), eosinophil chemotactic factor (ECF), major basic protein (MBP), eosinophil cationic protein (ECP), eosinophil-derived neurotoxin (EDN), IgE and E-selectin were measured using enzyme linked immunosorbent assays (ELISA). Data were compared with the Mann-Whitney U test (P<.05), and multivariate analyses were also performed.ResultsTear levels of TPS (P=.014), MBP (P=.032), ECP (P=.0041), IgE (P=.014) and EDN (P=.00077) showed significant differences in children with SAC and PAC compared to controls.ConclusionThe simultaneous analyses of allergic mediators in the tears of children with SAC and PAC showed a significant elevated concentration in EDN, ECP and MBP in allergic group and decreased levels in IgE and TPS. Statistical analyses showed a diagnostic accuracy of 94.4% using the eight molecules panel(AU)

Valoración del estudio alérgico en niños con atopia / Allergic study assessment in atopic children

Introducción: la atopia se define como la tendencia a producir anticuerpos IgE específicosfrente a alérgenos y se expresa clínicamente como dermatitis-eccema, asma y rinoconjuntivitis. En los últimos años se ha documentado el aumento de la prevalencia de atopia en los países desarrollados. La detección de los alérgenos implicados es necesaria para unas medidas terapéuticasóptimas.El objetivo del estudio es describir el perfil de sensibilizaciones en los niños con atopia delmunicipio de Zaragoza. Material y métodos: durante el verano de 2009 se revisaron las historias clínicas de los niñosde 0-14 años, de las consultas de 6 pediatras de Atención Primaria. Se obtuvo una muestrade 194 niños con clínica y estudio alérgico positivo en los últimos 5 años. Resultados: distribución por sexo: 62,9% varones y 37,1% mujeres. Hallazgos clínicos: asma:78%, rinitis: 68%, conjuntivitis: 50% y dermatitis: 29%; con frecuencia se asociaron diferentes diagnósticos. Los alérgenos positivos fueron: gramíneas: 48%, hongos: 35%, árboles: 34%, animales: 26%, alimentos: 24%, ácaros: 19% y malezas: 18%. Conclusiones: las causas más importantes de sensibilización en nuestro estudio son primerolas gramíneas y luego la Alternaria; olivo, animales, ácaros y malezas les siguen por este orden.En nuestra zona geoclimática, si hay síntomas en invierno o al final del verano se debe estudiarel ciprés, plátano de sombra, Chenopodium y Salsola. La alta sensibilización a alimentosencontrada se corresponde con otros estudios. La identificación de las sensibilizaciones permiterelacionarlas con la clínica, tomar las medidas terapéuticas oportunas y mejorar la calidad de vidade los niños (AU)

Introduction: atopy is defined as the tendency to produce allergen-specific IgE antibodiesand is expressed clinically as dermatitis, eczema, bronchial asthma and rhino-conjunctivitis. Inthe last years, an increased prevalence of atopy in developed countries has been documented.The detection of allergens involved is necessary for optimal therapeutic measures. The aim ofthis study is to describe the profiles of sensitizations in children with atopy in the municipalityof Zaragoza.Material and methods: in the summer of 2009 the clinical histories of 0-14 year-old children,of 6 pediatricians’ consultations were reviewed. A sample of 194 children with clinicalfindings and allergic positive study in the last 5 years was collected.Results: distribution between sexes: 62.9% male and 37.1% female. Clinical findings:78% asthma, 68% rhinitis, 50% conjunctivitis and 29% dermatitis; often several diagnoseswere associated. The allergens found were: 48% gramineae, 35% fungi, 34% trees, 26% animals,24% food, 19% dust-mites and 18% weeds.Conclusions: the most important causes of sensitization in our study are gramineae in thefirst place followed by Alternaria. Olive tree, animals, dust-mites and weeds follow them in thisorder. We must study cypress, platanus orientalis and Chenopodium, and Salsola, which areprevalent in our geoclimatic zone, if there are symptoms in winter or in late summer. The high sensitization to food matches other studies. The identification of the sensitizations will allow usto relate them to the clinic, take the appropriate therapeutic measures and to improve the quality of life of these children (AU)

Are cutaneous hypersensitivity tests to inhalant allergens a severity marker for vernal keratoconjunctivitis?

PURPOSE: The purpose of this study was to analyze the cutaneous sensitivity to a variety of allergens in patients with vernal keratoconjunctivitis (VKC) and to demonstrate the relation between skin response and clinical aspects of the disease. METHODS: Twenty patients with vernal keratoconjunctivitis were randomly chosen from the External Disease and Cornea Sector. They were clinically evaluated, and a score ranging from 0 to 20 was applied based on signs and symptoms on ophthalmic examination. All subjects underwent a skin prick test against standardized allergens, such as house dust mites D. pteronyssinus, D. farinae, and Blomia tropicalis, as well as allergens from cat, dog, fungi and feather. RESULTS: Seventy-five per cent of patients were positive for at least one of the allergens tested. House dust mites were responsible for the majority of the cases (75 percent). There was a poor correlation between the clinical score and sensitivity to allergens (r= - 0.119 for fungi; r= - 0.174 for dog; r= - 0.243 for house dust mites; r= - 0.090 for feather). A significant correlation was found only for cat allergen extract (r = - 0.510; p=0.024). CONCLUSIONS: Our study demonstrated poor correlation between cutaneous hypersensitivity tests and clinical findings in patients with vernal keratoconjuntivitis. We concluded that skin response to inhalant allergens is not a useful test to identify clinical severity and chronicity of inflammatory process in this disease.

OBJETIVO: Avaliar o papel da sensibilização cutânea a diferentes aeroalérgenos em pacientes com ceratoconjuntivite vernal e a correlação entre esta e os aspectos clínicos da doença. MÉTODOS: Vinte pacientes do setor de doenças externas e córnea foram aleatoriamente convidados para participar deste estudo. Os pacientes foram avaliados e a eles foi atribuído um escore clínico variando de 0 a 20 de acordo com sinais e sintomas presentes no exame oftalmológico. Todos os pacientes foram submetidos a testes cutâneos de hipersensibilidade imediata contra aeroalérgenos padronizados como os ácaros domiciliares D. pteronyssinus, D. farinae e Blomia tropicalis, assim como também a alérgenos de epitélio de gato, epitélio de cão, mistura de fungos e mistura de penas. RESULTADOS: Setenta e cinco por cento dos pacientes tiveram teste de hipersensibilidade imediata positivo contra pelo menos um dos antígenos testados. Os ácaros domiciliares foram responsáveis pela maioria destes casos (75 por cento). Houve uma pobre correlação entre o escore clínico e a hipersensibilidade cutânea aos alérgenos (r= -0,119 para fungos; r= -0,174 para epitélio de cão; r= -0,243 para ácaros domiciliares; r= -0,090 para mistura de penas). Houve correlação significativa apenas contra epitélio de gatos (r= -0,510; p=0,024). CONCLUSÃO: O estudo demonstrou uma pobre correlação entre os testes cutâneos de hipersensibilidade imediata e os achados clínicos nos pacientes com ceratoconjuntivite vernal. Os testes cutâneos de hipersensibilidade imediata contra aeroalérgenos não foi parâmetro eficaz na identificação dos casos de maior gravidade e cronicidade de ceratoconjuntivite vernal.

Sensibilización a polen de castaño y polinosis en el norte de Extremadura / Sensitization to Castanea sativa pollen and pollinosis in northern Extremadura (Spain)

Introducción: La alergia al polen de castaño (Castanea sativa) ha sido considerada rara y clínicamente insignificante. En nuestra área geográfica (Plasencia, Cáceres, España) es un polen predominante. Objetivo: Este trabajo pretende determinar las fluctuaciones atmosféricas y la existencia de individuos sensibilizados al polen de castaño y su comparación con otras especies. Métodos: Pacientes que acudieron en el año 2003 por primera vez a nuestra consulta por síntomas respiratorios. Se les realizó prueba del prick con extractos comerciales de una batería de aeroalérgenos que incluía polen de castaño. Se determinó la IgE específica a polen de Castanea sativa por CAP system (Pharmacia & Upjohn, Uppsala, Suecia). El estudio aerobiológico se realizó con un captador Cour, durante los años 2000-2003. Resultados: Los taxones más abundantes fueron (media de la concentración semanal máxima de los 4 años, en granos de polen/m 3 de aire): Quercus 968, gramíneas 660, olivo 325, plátano de sombra 229, pino 126, cupresáceas 117, llantén 109, aliso 41, chopo 40, castaño 32... Se estudiaron 346 pacientes. En los 210 diagnosticados de polinosis, los porcentajes de sensibilización fueron: Dactylis glomerata 80,4 %, Olea europea 71,9 %, Fraxinus excelsior 68 %, Plantago lanceolata 62,8 %, Chenopodium album 60,9 %, Robinia pseudoacacia 49 %, Artemisia vulgaris 43,8 %, Platanus acerifolia 36,6 %, Parietaria judaica 36,1 %, Populus nigra 32,3 %, Betula alba 27,6 %, Quercus ilex 21,4 %, Alnus glutinosa 20,9 %, Cupressus arizonica 7,6 % y Castanea sativa 7,1 %. Hubo quince pacientes sensibilizados al polen de castaño, catorce con rinoconjuntivitis y asma. Diez tuvieron IgE específica sérica a polen de castaño, aunque el valor mayor encontrado fue de 17,4 ku/L. El castaño polinizó en las semanas 23 a 28, con pico en la 25. Conclusiones: Los pólenes alergénicos más importantes en el norte de Extremadura fueron gramíneas, Olea europea y Plantago sp. La prevalencia de sensibilización al polen de Castanea sativa fue del 7,1 %, cifra muy baja. La mayoría de los pacientes eran asmáticos y estuvieron polisensibilizados. El polen de castaño no es un alérgeno importante en nuestra zona como causa de polinosis

Background: Castanea sativa pollen allergy has generally been considered to be uncommon and clinically insignificant. In our geographical area (Plasencia, Cáceres, Spain) Castanea sativa pollen is a major pollen. Objective: To determine the atmospheric fluctuations and prevalence of patients sensitized to Castanea pollen in our region and to compare this sensitization with sensitizations to other pollens. Methods: Patients with respiratory symptoms attending our outpatient clinic for the first time in 2003 were studied. The patients underwent skin prick tests with commercial extracts of a battery of inhalants including Castanea sativa pollen. Serologic specific IgE to Castanea sativa pollen was determined using the CAP system (Pharmacia & Upjohn, Uppsala, Sweden). Airborne pollen counts in our city were obtained using Cour collection apparatus over a 4-year period (2000 to 2003). Results: The most predominant pollens detected were (mean of the maximal weekly concentrations over 4 years in pollen grains/m 3): Quercus 968, Poacea 660, Olea 325, Platanus 229, Pinus 126, Cupresaceae 117, Plantago 109, Alnus 41, Populus 40, Castanea 32. We studied 346 patients (mean age: 24.1 years). In 210 patients with a diagnosis of pollinosis, the percentages of sensitization were: Dactylis glomerata 80.4 %, Olea europea 71.9 %, Fraxinus excelsior 68 %, Plantago lanceolata 62.8 %, Chenopodium album 60.9 %, Robinia pseudoacacia 49 %, Artemisia vulgaris 43.8 %, Platanus acerifolia 36.6 %, Parietaria judaica 36.1 %, Populus nigra 32.3 %, Betula alba 27.6 %, Quercus ilex 21.4 %, Alnus glutinosa 20.9 %, Cupressus arizonica 7.6 % and Castanea sativa 7.1 %. Fifteen patients were sensitized to Castanea sativa and 14 had seasonal rhinoconjunctivitis and asthma. Ten patients had serum specific IgE to Castanea pollen (maximum value: 17.4 Ku/l). Castanea pollen is present in our area in large amounts from the 23rd to the 28th weeks of the year, with a peak pollen count in the 25th week. Conclusions: The most important allergenic pollens in northern Extremadura were Poaceae, Olea europaea and Plantago sp. The prevalence of sensitization to Castanea sativa pollen was very low (7.1 %). Most sensitized patients had asthma and polysensitization. Castanea sativa pollen is not a major cause of pollinosis in our area