Diagnostic tools in ocular allergy.

Ocular allergy (OA) includes a group of common and less frequent hypersensitivity disorders frequently misdiagnosed and not properly managed. The diagnosis of OA is usually based on clinical history and signs and symptoms, with the support of in vivo and in vitro tests when identification of the specific allergen is required. To date, no specific test is available for the diagnosis of the whole spectrum of the different forms of OA. The lack of recommendations on diagnosis of OA is considered a medical need not only for allergists but also for ophthalmologists. This position paper aims to provide a comprehensive overview of the currently available tools for diagnosing OA to promote a common nomenclature and procedures to be used by different specialists. Questionnaires, sign and symptom grading scales, tests, and potential biomarkers for OA are reviewed. We also identified several unmet needs in the diagnostic tools to generate interest, increase understanding, and inspire further investigations. Tools, recommendations, and algorithms for the diagnosis of OA are proposed for use by both allergists and ophthalmologists. Several unmet needs in the diagnostic tools should be further improved by specific clinical research in OA.

Ocular allergy: recognizing and diagnosing hypersensitivity disorders of the ocular surface.

Ocular allergy includes several clinically different conditions that can be considered as hypersensitivity disorders of the ocular surface. The classification of these conditions is complex, and their epidemiology has not been adequately studied because of the lack of unequivocal nomenclature. Ocular allergy symptoms are often, but not always, associated with other allergic manifestations, mostly rhinitis. However, specific ocular allergic diseases need to be recognized and managed by a team that includes both an ophthalmologist and an allergist. The diagnosis of ocular allergy is usually based on clinical history and signs and symptoms, with the support of in vivo and in vitro tests when the identification of the specific allergic sensitization is required for patient management. The aims of this Task Force Report are (i) to unify the nomenclature and classification of ocular allergy, by combining the ophthalmology and allergy Allergic Rhinitis and its Impact on Asthma criteria; (ii) to describe current methods of diagnosis; (iii) to summarize the therapeutic options for the management of ocular allergic inflammation.

Adult coeliac disease.

Coeliac disease is an auto-immune inflammatory reaction characterized by a partial or total villi's atrophy of the proximal small intestine occuring after ingestion of gluten in genetically predisposed patients. The classic form is much more frequent in children. Thereby there has been a misevaluation and improper treatment of coeliac disease in adults who suffer more from asymptomatica and atypical forms. Currently the only effective treatment is a strict gluten free diet for life. However recent researches brought a new light on the matter. Now oats as a causative factor is controvertial. The introduction of some moderate intestinal lesions (pre-atrophic with intra-epithelial hyperlymphocytosis qualified as "weak enteropathies") in the definition of coeliac disease might be possible. Moreover the way to diagnose has evolved as serological tests and markers are more used due to their efficiency.

[Allergic conjunctivitis: diagnosis and treatment]. / Conjonctivite allergique: diagnostic et traitement.

Allergic conjunctivitis are the most frequent presentation of ocular allergy. They concern two specialists, ophthalmologists and allergists, who must establish a close collaboration, to succeed in an etiological diagnosis and consequent efficacious treatment. On one hand the history of allergy must be deep and on the other a simple pollen etiology giving simple functional signs: skin tests (pricks or epicutaneous) after a flawless questioning, at need completed by the measurement of specific and total IgE titres in the tears and even sometimes by a conjunctival provocation test, minimal other ophthalmological examination, researching anomalies in the tear level and signs of cellular suffering (Break-up time: time of rupture of the tear film). The differential diagnosis falls into the field of the ophthalmologist: traumatic or infectious conjunctivitis (herpes), vernal kerato-conjunctivitis for acute conjunctivitis; dry eye, viral conjunctivitis, anomalies of convergence for the most frequent signs of chronic conjunctivitis. The treatments are symptomatic to relieve the patient, eye lotions without preservatives for long term treatment and etiological that include allergen avoidance, without forgetting specific desensitisation (mites, pollens) that may need a rigorous indication.

[Childhood allergic rhinitis]. / Rhinites allergiques de l'enfant.

Allergic rhinitis is the most common chronic disease in children. This frequency is in strong progress. According to ISAAC' study, it concerns a child (6/7 years) on four and a teenager on two. The seasonal rhinitises are generally well treated. Perennial allergic rhinitises are chronic and often neglected. They are more often complicated or associated to asthma which represents the major evolutionary risk. In a general way, allergic rhinitis are sub-diagnosed and untreated while we have more and more effective therapeutic means. Although allergic rhinitis is not considered as a severe disease, its echo on children's quality of life, physical and psychological well-being, and capacity to learn. It has also important socio-economic consequences. A better coverage is imperative itself as far as the diagnosis based on the symptoms and the allergy cutaneous tests which are easy. The options for treating allergic rhinitis in the child are not so different as those for adult. Complete avoidance of inhalant allergens is not always possible and medication are quite always possible. Intranasal corticosteroids are sometimes prescribed. In persistent disease, allergen immunotherapy may be considered according to the last OMS consensus statement.

[How to manage allergic rhinitis in current practice]. / Comment gérer la rhinite allergique en pratique courante.

The allergic rhinitis is a very frequent condition. Its consequences are probably underestimated because of the large number of self-medicated patients. The clinical history is often telling. Etiological diagnosis is based on cutaneous Prick-Tests, which have a high sensibility and specificity-rate and which can be easily applied to young children. The treatment relies on the use of oral anti-histamines and local steroid sprays, for a period of time covering the exposure to allergens. In all the cases, the avoidance of the allergen constitutes the decisive element to determine the efficiency of the treatment. The starting up of a treatment prevents the outbreak of complications or enables to decrease their strength. Specific immunotherapy may be considered according to the last OMS consensus statement.

Do patients with skin allergies have higher levels of anxiety than patients with allergic respiratory diseases? Results of a large-scale cross-sectional study in a French population.

BACKGROUND: Psychological comorbidity is a known aspect of allergic disease. However, there is recent evidence that a large proportion of allergic patients remains undiagnosed and untreated for psychological disease. In addition, the complexities of the anxiety-allergy relationship, i.e. differences for current and past disease, or differences among allergic disease types, are not well understood. OBJECTIVES: To measure the level of anxiety in a large allergic population in France using a standardized measure, the State/Trait Anxiety Inventory (STAI). METHODS: Allergy patients in France (n = 3939) who visited their allergy specialists participated in the study. The patients completed a questionnaire which was then linked to the questionnaire completed by their physician. Only patients with both subject and physician questionnaire were kept in the analyses. Mean STAI scores for the State (S) and Trait (T) scales were obtained for each allergic disease. ANCOVA models testing group differences on the mean scores, using the categories "current disease", "past disease" and "allergic disease ever", were assessed along with relevant confounders. RESULTS: Allergic rhinitis (AR), asthma and atopic dermatitis (AD) were the most prevalent conditions of the 12 allergic diseases assessed in the study. Women had higher mean STAI S/T scores than men and age was also found to be associated with higher S scores; therefore, both age and gender were included as covariates where relevant. A single ANCOVA model for each STAI scale showed a statistical difference among the various allergic diseases. Using the category "current disease" each allergic disease was assessed separately regarding the presence or absence of that disease. Higher, statistically significant mean STAI scores were found for AD and allergic urticaria on the S scale and for AD on the T scale. Similarly, for the category "allergic disease ever", AD and allergic urticaria reached statistical significance on the S scale, while on the T scale only AD was statistically significant. When patients were assessed for anxiety based on their past disease, asthma, AR and sinusitis were significant on the S scale while asthma and nasal polyps were statistically significant on the T scale. When asthma and AD were tested simultaneously, only the latter was significant. CONCLUSIONS: High mean scores for State and Trait anxiety were mostly associated with AD.