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Allergen immunotherapy for allergic rhinoconjunctivitis: A systematic review and meta-analysis

Dhami S, Nurmatov U, Arasi S, Khan T, Asaria M, Zaman H, et al.

Allergy, 2017 Nov;72(11):1597-1631.
PMID: 28493631 DOI: 10.1111/all.13201

BACKGROUND: The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing Guidelines on Allergen Immunotherapy (AIT) for Allergic Rhinoconjunctivitis. To inform the development of clinical recommendations, we undertook a systematic review to assess the effectiveness, cost-effectiveness, and safety of AIT in the management of allergic rhinoconjunctivitis.
METHODS: We searched nine international biomedical databases for published, in-progress, and unpublished evidence. Studies were independently screened by two reviewers against predefined eligibility criteria and critically appraised using established instruments. Our primary outcomes of interest were symptom, medication, and combined symptom and medication scores. Secondary outcomes of interest included cost-effectiveness and safety. Data were descriptively summarized and then quantitatively synthesized using random-effects meta-analyses.
RESULTS: We identified 5960 studies of which 160 studies satisfied our eligibility criteria. There was a substantial body of evidence demonstrating significant reductions in standardized mean differences (SMD) of symptom (SMD -0.53, 95% CI -0.63, -0.42), medication (SMD -0.37, 95% CI -0.49, -0.26), and combined symptom and medication (SMD -0.49, 95% CI -0.69, -0.30) scores while on treatment that were robust to prespecified sensitivity analyses. There was in comparison a more modest body of evidence on effectiveness post-discontinuation of AIT, suggesting a benefit in relation to symptom scores.
CONCLUSIONS: AIT is effective in improving symptom, medication, and combined symptom and medication scores in patients with allergic rhinoconjunctivitis while on treatment, and there is some evidence suggesting that these benefits are maintained in relation to symptom scores after discontinuation of therapy.

Matched MeSH terms: Conjunctivitis, Allergic/therapy*
Fulltext Kingella kingae Keratitis in a Child with Underlying Vernal Keratoconjunctivitis

Nurul-Laila S, Chai KS, Liza-Sharmini AT, Shatriah I

Case Rep Ophthalmol Med, 2017;2017:1087821.
PMID: 28546880 DOI: 10.1155/2017/1087821

Kingella kingae had rarely been reported as a causative organism for corneal ulcer and had not been described before in vernal keratoconjunctivitis (VKC). Generally regarded as commensals of respiratory tract particularly in young children, it had however been isolated from the corneal ulcer scraping of both adult and children. We report a case of bacterial ulcer with isolation of Kingella kingae from the corneal scraping in a young child with underlying VKC.

Matched MeSH terms: Conjunctivitis, Allergic
Vernal Keratoconjunctivitis-When Medication Fails

Abd Hamid MR, Tai ELM, Wan Hazabbah WH, Ramli N

J Allergy Clin Immunol Pract, 2019 Apr;7(4):1308-1309.
PMID: 30581132 DOI: 10.1016/j.jaip.2018.11.016
Matched MeSH terms: Conjunctivitis, Allergic/diagnosis*
Fulltext The association between tobacco and the risk of asthma, rhinoconjunctivitis and eczema in children and adolescents: analyses from Phase Three of the ISAAC programme

Mitchell EA, Beasley R, Keil U, Montefort S, Odhiambo J, ISAAC Phase Three Study Group

Thorax, 2012 Nov;67(11):941-9.
PMID: 22693180 DOI: 10.1136/thoraxjnl-2011-200901

BACKGROUND: Exposure to parental smoking is associated with wheeze in early childhood, but in 2006 the US Surgeon General stated that the evidence is insufficient to infer a causal relationship between exposure and asthma in childhood and adolescents.
AIMS: To examine the association between maternal and paternal smoking and symptoms of asthma, eczema and rhinoconjunctivitis.
METHODS: Parents or guardians of children aged 6-7 years completed written questionnaires about symptoms of asthma, rhinoconjunctivitis and eczema, and several risk factors, including maternal smoking in the child's first year of life, current maternal smoking (and amount) and paternal smoking. Adolescents aged 13-14 years self completed the questionnaires on these symptoms and whether their parents currently smoked.
RESULTS: In the 6-7-year age group there were 220 407 children from 75 centres in 32 countries. In the 13-14-year age group there were 350 654 adolescents from 118 centres in 53 countries. Maternal and paternal smoking was associated with an increased risk of symptoms of asthma, eczema and rhinoconjunctivitis in both age groups, although the magnitude of the OR is higher for symptoms of asthma than the other outcomes. Maternal smoking is associated with higher ORs than paternal smoking. For asthma symptoms there is a clear dose relationship (1-9 cigarettes/day, OR 1.27; 10-19 cigarettes/day, OR 1.35; and 20+ cigarettes/day, OR 1.56). When maternal smoking in the child's first year of life and current maternal smoking are considered, the main effect is due to maternal smoking in the child's first year of life. There was no interaction between maternal and paternal smoking.
CONCLUSIONS: This study has confirmed the importance of maternal smoking, and the separate and additional effect of paternal smoking. The presence of a dose-response effect relationship with asthma symptoms suggests that the relationship is causal, however for eczema and rhinoconjunctivitis causality is less certain.

Matched MeSH terms: Conjunctivitis, Allergic/chemically induced*; Conjunctivitis, Allergic/epidemiology
Fulltext Case series of children with steroid-Induced glaucoma

Lam, C.S., Umi Kalthum, M.N., Norshamsiah, M.D., Bastion, M.L.C.

Malaysian Family Physician, 2018;13(3):32-37.
MyJurnal

Steroid-induced glaucoma is the most serious complication of the injudicious use of steroids,
particularly among children affected by allergic conjunctivitis. This condition is steroid-dependent,
and children are commonly being prescribed topical anti-inflammatories, including topical steroids,
by general practitioners. Furthermore, topical steroids are also available over the counter, and this
availability contributes to overuse without proper monitoring by an ophthalmologist. We present
a series of five cases illustrating the devastating effect of unmonitored, long-term use of steroids
among children for vernal keratoconjunctivitis. The medications were prescribed initially by general
ophthalmologists and were continually bought over the counter by parents. At the presentation to
our center, these patients were already compromised visually, exhibiting glaucomatous optic disc
changes and high intraocular pressure. The series highlights the optic nerve damage resulting in
irreversible visual compromises among children on long-term, topical steroids and the importance
of regular monitoring with a low threshold for ophthalmologist referral.

Matched MeSH terms: Conjunctivitis, Allergic
A retrospective study of the incidence of giant papillary conjunctivitis seen in the Optometry clinic UKM. [Kajian retrospektif insidens konjunktivitis papillari gergasi di Klinik Optometri UKM]

Ong BL

Sains Malaysiana, 1996;25(3):13-18.

A retrospective study of the incidence of Giant Papillary Conjunctivitis (GPC) seen in the Optometry clinic in Universiti Kebangsaan Malaysia from 1989 to 1994 was carried out. In the period of the 6 years, 37 contact wearers were diagnosed to have GPC. Of the 37 patients, 21 were Malays (57%), 12 were Chinese (32%) and the remaining 4 patients were Indians (11%). 18 or 48% of those with GPC were soft lens wearers, 46% of the wearers (17 patients) were rigid gas permeable lens wearers and 1 of the patients seen was a hard (PMMA) wearer (3%) and the other one was a disposable lens wearer (3%). Thirty patients were female (81%) and 7 (19%) were male. The age range of those with GPC were between 9 to 60 years old.
Study site: Optometry clinic, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia

Matched MeSH terms: Conjunctivitis, Allergic
Novel Polyvinyl Pyrrolidone-Loaded Olopatadine HCl-Laden Doughnut Contact Lens to Treat Allergic Conjunctivitis

Xue Y, Zhang W, Lei Y, Dang M

J Pharm Sci, 2020 05;109(5):1714-1724.
PMID: 32007507 DOI: 10.1016/j.xphs.2020.01.022

Olopatadine HCl is an antiallergic drug used for the management of allergic conjunctivitis. Currently, it is delivered via eye drop solution, which is highly inefficient due to low bioavailability. Silicone contact lenses can be used to sustain the release of ophthalmic drugs. However, the presence of drug alters the optical transmittance and physical properties of the contact lens. The objective was to design a novel polyvinyl pyrrolidone (PVP)-coated olopatadine-ethyl cellulose microparticles-laden doughnut contact lens to sustained ocular delivery with limited alteration to the optical and swelling properties of the contact lens. The doughnut was implanted within the periphery of the lens using modified casting technique. Olopatadine HCl was loaded by soaking (SM-OL), direct loading (DL-OL), and doughnut casting method (DNT-OL). PVP (comfort agent) was loaded on the surface of contact lens for all the batches via novel curing technique. The in vitro olopatadine HCl release data of SM-OL (up to 48-72 h) and DL-OL batches (up to 72 h) showed high burst release, whereas DNT-OL batch showed sustained release up to 120 h without significant (p > 0.05) alteration in the optical and swelling properties of contact lens. All the batches showed sustained release of PVP up to 120 h. The in vivo studies in the rabbit tear fluid showed improvement in the olopatadine HCl and PVP retention time in comparison to eye drop solution. The PVP-loaded DNT-OL-500 lens showed tear stabilization (comfort wear) in Schirmer strip test (rabbits) with no protein adherence in comparison to DNT-OL-500 lens without PVP. The study demonstrated the successful delivery of olopatadine HCl and PVP-K30 from the doughnut contact lens for the extended period with limited alteration to the optical and swelling properties of contact lens.

Matched MeSH terms: Conjunctivitis, Allergic