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Objective. To assess tolerability and the time of onset of clinical effect of dual­-action antihistamine agents — Epinepta® (epinastine 0.05 %) and olopatadine 0.1 % in patients with seasonal allergic conjunctivitis (SAC).Subjects and methods. This was a prospective multicenter observational study. One hundred fifty patients with SAC (n = 150) were included into the study and divided into two groups (n = 75) in each. Patients in group 1 received epinastine 0.05 %, while patients into group 2 received olopatadine 0.1 %. Evaluation of clinical symptoms severity was performed using itching scale, hyperemia Efrone scale, eyelid swelling scale, lacrimation P. Munk scale, Shirmer test and Norn probe. Patients and healthcare providers satisfaction rate was assessed by Likert scale, patients self-­control diary that helped to assess dry eye severity symptoms. Treatment period lasted 14 days.Results. Seasonal allergic conjunctivitis treatment with epinastine 0.05 % or olopatadine 0.1 % was equally effective. However epinastine 0.05 % was causing dry eye symptoms in lesser degree than olopatadine 0.1 %. These results refer to all parameters assessed by patients’ self­-control diary — itching, discomfort, burning, eye blockage feeling.Conclusion. The study evaluated epinastine 0.05 % advantages compared to olopatadine 0.1 % in tear film preservation and causing less pronounced symptoms of dry eye in patients with acute seasonal allergic conjunctivitis. Monotherapy of seasonal allergic conjunctivitis with epinastine 0.05 % demonstrated high efficacy and lead to SAC clinical manifestations regress. Epinastine 0.05 % is recommended as a first line treatment of SAC.

Purpose: to evaluate the effect of a new antiallergic drug epinastine in the treatment of seasonal conjunctivitis as manifested in clinical cases.Materials and methods. 37 people (22 men and 15 women) were observed during spring exacerbation of the allergic conjunctivitis, from mid-March to the end of June. Indicators of the dynamics of subjective complaints, duration of treatment, clinical effectiveness, were thoroughly recorded; we also assessed how easy it was to stop using the treatment when the condition of the ocular surface returned to normal.Results. We identified four groups of patients depending on the course of the disease, clinical manifestations, and response to epinastine therapy. For each group, we analyze a most informative clinical case.Conclusions. In all of the cases, epinastine instillations brought about a quick and stable reduction of itching and eye discomfort, as well as normalization of the clinical condition of the conjunctiva.

This systematic review aimed to determine the comorbid dry eye (DE) and allergic conjunctivitis (AC) prevalence. We searched PubMed and EMBASE for articles published until 22 March 2022, combining the terms "(dry eye OR keratoconjunctivitis sicca) AND allergic conjunctivitis." Study-specific estimates (DE and AC incidence rates among patients with AC and DE, respectively) were combined using the one-group meta-analysis in a random-effects model. The initial search yielded 700 studies. Five articles reporting AC incidence among individuals with DE and six articles reporting DE incidence among individuals with AC were included in the qualitative synthesis. In these nine articles, the total sample size was 7254 patients. The DE incidence among individuals with AC was 0.9–97.5%; the AC incidence among individuals with DE was 6.2–38.0%. One-group meta-analysis using a random-effects model showed that 47.2% (95% confidence interval: 0.165–0.779; 320/1932 cases) of patients with AC had comorbid DE and 17.8% (95% confidence interval: 0.120–0.236; 793/4855 cases) of patients with DE had comorbid AC, as defined by each article. Complimentary screening and treatment for patients with DE and AC may improve long-term outcomes and prevent chronic ocular damage in highly susceptible populations. [ABSTRACT FROM AUTHOR]

Background: Although immunoglobulin E (IgE) increases significantly in tears and serum during seasonal allergic conjunctivitis (SAC), it is unclear whether tear total IgE can reflect the severity and prognosis of SAC more accurately than serum total IgE. We aimed to investigate the usefulness of measuring the total IgE in tears to evaluate the severity and determine the treatment of SAC. Methods: This prospective, nonrandomized study involved 55 patients with SAC and 10 age‐ and sex‐matched healthy controls. Serum and tears were collected before and after treatment to analyze the total IgE. SAC patients received the same topical anti‐allergy treatment and were followed‐up every 2 weeks for 1 month. The relationship of tear and serum total IgE concentrations with pollen concentrations and symptom severity before and after treatment was assessed. Results: The total IgE concentration in tears was higher in SAC patients than in healthy participants with significant correlations between tear and serum total IgE concentrations. The total IgE concentration in tears, but not in serum, correlated with the pollen concentration and severity of ocular symptoms and reactions in SAC. Treatment‐associated improvements in symptoms and reactions in SAC correlated with decreased concentrations of the tear total IgE. Patients with disease recurrence following treatment demonstrated significantly higher tear total IgE concentrations than patients with no recurrence. Conclusion: The total tear IgE level can indicate the severity and predict the prognosis of SAC more accurately than the serum total IgE. [ABSTRACT FROM AUTHOR]

Abstract Background Although immunoglobulin E (IgE) increases significantly in tears and serum during seasonal allergic conjunctivitis (SAC), it is unclear whether tear total IgE can reflect the severity and prognosis of SAC more accurately than serum total IgE. We aimed to investigate the usefulness of measuring the total IgE in tears to evaluate the severity and determine the treatment of SAC. Methods This prospective, nonrandomized study involved 55 patients with SAC and 10 age‐ and sex‐matched healthy controls. Serum and tears were collected before and after treatment to analyze the total IgE. SAC patients received the same topical anti‐allergy treatment and were followed‐up every 2 weeks for 1 month. The relationship of tear and serum total IgE concentrations with pollen concentrations and symptom severity before and after treatment was assessed. Results The total IgE concentration in tears was higher in SAC patients than in healthy participants with significant correlations between tear and serum total IgE concentrations. The total IgE concentration in tears, but not in serum, correlated with the pollen concentration and severity of ocular symptoms and reactions in SAC. Treatment‐associated improvements in symptoms and reactions in SAC correlated with decreased concentrations of the tear total IgE. Patients with disease recurrence following treatment demonstrated significantly higher tear total IgE concentrations than patients with no recurrence. Conclusion The total tear IgE level can indicate the severity and predict the prognosis of SAC more accurately than the serum total IgE.

INTRODUCTION: Seasonal allergic conjunctivitis (SAC) is a mild but common immunoglobulin E (IgE) mediated ocular allergy. Low serum vitamin D levels have been related to some allergic disorders but such data in the clinical context of SAC are missing. Our study investigated serum IgE and vitamin D levels in SAC patients. MATERIALS AND METHODS: A cross-sectional case-controlled study was conducted at University of Hafr Al-Batin, Saudi Arabia involving patients with established diagnosis of SAC and agematched healthy control subjects. Standard patient evaluation of eye dryness (SPEED) questionnaire was scored for the frequency and severity of symptoms. Blood samples were taken to quantify serum IgE and vitamin D levels. Mean +- SD were calculated and independent sample t-test was applied for comparison between groups. RESULT: A total of 52 subjects were recruited into the study in which 26 subjects were patients aged between 20-60 years with an established diagnosis of SAC and another 26 subjects were age-matched healthy controls without any allergy. Mean serum IgE, vitamin D level and SPEED scores were significantly higher in SAC patients than in healthy control (2181.09 IU/ml +- 1062.33 vs 54.83 IU/ml +- 26.67; 38.96 ng/ml +- 11.37 vs. 29.47 ng/ml+- 11.73; 19.42 +- 4.81 vs. 2.19 +- 1.49) with p-value 0.001, 0.005, and 0.001 respectively. Mean vitamin D levels in both groups were within normal range. CONCLUSION: Higher serum vitamin D levels may be linked with SAC, but further research is needed to eliminate irregularities in the existing evidence on the influence of vitamin D in SAC. [ABSTRACT FROM AUTHOR]

AIM: To analyze the possible risk factors in the development of seasonal allergic conjunctivitis (SAC) through an evaluation of skin allergy tests and data obtained from questionnaires. METHODS: The study included a total of 75 SAC patients and 71 control subjects without SAC diagnosis who were admitted to the Abant Izzet Baysal University Medical Faculty Ophthalmology Clinic between March 2016 and December 2016. Skin prick tests were performed for all participants. Serum levels of total IgE and 25-OH vitamin D were also measured. In the tear, total IgE levels were measured. Moreover, possible risk factors for the onset of SAC (smoking, paracetamol exposure, vitamin D supplementation and environmental factors etc.) were examined for all patients by both prenatal and postnatal aspects. RESULTS: The patients with SAC were found to have a history of maternal paracetamol exposure during the prenatal period. Likewise, in the same patient group, the duration of postnatal vitamin D supplementation was shorter (P

Purpose: To analyze the relationship between the seasonal allergic conjunctivitis (SAC), eotaxin-2, matrix metalloproteinase-9 (MMP-9), and the topographical findings in the keratoconus patients. Methods: Thirty-four eyes of patients without SAC (Group 1), 34 eyes of patients with SAC (Group 2), and 20 eyes of control subjects (control group) were enrolled. Tear samples of the subjects were collected by Schirmer method. Corneal topography parameters, tear MMP-9, and tear eotaxin-2 levels were analyzed. Results: The mean tear MMP-9 levels in Groups 1 and 2 were significantly higher than in the control group (p = 0.004). MMP-9 level exhibited a positive correlation with the keratoconus stage and a negative correlation with the thinnest corneal thickness (r = 0.294, p = 0.018, and r = − 0.302, p = 0.006, respectively). The tear eotaxin-2 level was higher in Group 2 than in Group 1 and control group which is not statistically significant (p = 0.17). Conclusion: The tear eotaxin-2 did not exhibit any difference in the presence of keratoconus. The tear MMP-9 level was higher in the keratoconic eyes, and it showed a correlation with the stage of the disease and the corneal thickness. [ABSTRACT FROM AUTHOR]

Takanori Mizoguchi,1 Mineo Ozaki,2 Nobuchika Ogino3 1Mizoguchi Eye Clinic, Ophthalmology, Sasebo, Japan; 2Ozaki Eye Hospital, Ophthalmology, Miyazaki, Japan; 3Nishigaki Eye Clinic, Ophthalmology, Nagoya, Japan Purpose: To evaluate the efficacy and safety of 0.05% epinastine and 0.1% olopatadine eye drop preparations as seasonal and preseasonal treatments in patients with seasonal allergic conjunctivitis (SAC). Subjects and methods: This was a prospective, randomized, case-control study involving two institutions. The subjects were patients diagnosed with SAC at two institutions between February and March in 2014. To examine the clinical effects of seasonal treatment, 0.05% epinastine and 0.1% olopatadine were administered, and their effects were investigated every 2 weeks (Stage 1). To evaluate the clinical effects of preseasonal therapy, in January 2015, the same eye drop preparations as adopted in Stage 1 were administered to patients who had participated in Stage 1 and provided consent to participate in this study, and their effects were investigated every month (Stage 2). Results: In Stage 1, the 0.05% epinastine group consisted of 43 patients, and the 0.1% olopatadine group consisted of 42 patients. There were significant improvements in the total symptom and objective finding scores at each time point after administration in comparison with those before its baseline, but there were no significant differences between the two groups. In Stage 2, the 0.05% epinastine group consisted of 15 patients, and the 0.1% olopatadine group consisted of 14 patients. The rate of change in the total symptom score in comparison with that at the baseline of preseasonal treatment was significantly higher in the 0.1% olopatadine group 1 month after the start of treatment, suggesting symptom deterioration (P=0.025). There was no significant difference in the rate of change in the total objective finding score between the two groups. Conclusion: Seasonal treatment with 0.05% epinastine or 0.1% olopatadine was equally effective for patients with allergic conjunctivitis. However, for preseasonal therapy, 0.05% epinastine was more effective than 0.1% olopatadine. Keywords: 0.05% epinastine, 0.1% olopatadine, seasonal allergic conjunctivitis, preseasonal treatment, seasonal treatment, inverse agonist

Purpose: To study the tolerability and efficacy of two formulations of topical ketotifen ophthalmic solutions for the treatment of seasonal allergic conjunctivitis (SAC).Methods: 81 active SAC patients were treated with either ketotifen 0.025% or 0.05% eye drops for 3 weeks. Allergic signs and symptoms were evaluated at baseline (V0), after 7 (V1) and 21 days (V2). Drugs tolerability and ratings of global efficacy were recorded.Results: Both concentrations of ketotifen were highly effective. The total signs and symptoms scores (TSSS) were significantly better reduced by ketotifen 0.025% compared to 0.05% at both V1 and V2 (p < 0.001). Ketotifen 0.025% was better tolerated than 0.05% at the first instillation and at days 2, 4, and 6 (p < 0.0001), and had a better responder rate (p < 0.001) according to the patient's and investigator's assessments.Conclusions: Ketotifen 0.025% was more effective and better tolerated than 0.05% in SAC. [ABSTRACT FROM AUTHOR]

Purpose: Seasonal allergic conjunctivitis (SAC) is an inflammatory disease of the conjunctiva. Red cell distribution width (RDW) is a widely accepted inflammatory marker. We aimed to investigate whether RDW level is associated with the development of SAC in pediatric population.Methods: The present study consisted of 90 subjects (45 children with SAC and 45 age- and sex-matched healthy children). The demographic findings, complete blood count parameters including RDW and laboratory parameters, were evaluated.Results: The mean RDW levels were significantly higher in children with SAC compared to the control group (14.02 ± 0.82 vs. 13.26 ± 0.64%, respectively, p < 0.001). In receiver operating characteristic analysis, the area under the curve for RDW for predicting SAC was 0.786, and a RDW value of 13.45 or higher predicted SAC with a sensitivity of 75.6% and specificity of 65%.Conclusion: Our study suggests that elevated RDW levels are significantly associated with SAC in pediatric population, which may imply a possible role of increased inflammatory status and oxidative stress in the pathogenesis of SAC. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy and safety of 0.05% epinastine and 0.1% olopatadine eye drop preparations as seasonal and preseasonal treatments in patients with seasonal allergic conjunctivitis (SAC). Subjects and methods: This was a prospective, randomized, case-control study involving two institutions. The subjects were patients diagnosed with SAC at two institutions between February and March in 2014. To examine the clinical effects of seasonal treatment, 0.05% epinastine and 0.1% olopatadine were administered, and their effects were investigated every 2 weeks (Stage 1). To evaluate the clinical effects of preseasonal therapy, in January 2015, the same eye drop preparations as adopted in Stage 1 were administered to patients who had participated in Stage 1 and provided consent to participate in this study, and their effects were investigated every month (Stage 2). Results: In Stage 1, the 0.05% epinastine group consisted of 43 patients, and the 0.1% olopatadine group consisted of 42 patients. There were significant improvements in the total symptom and objective finding scores at each time point after administration in comparison with those before its baseline, but there were no significant differences between the two groups. In Stage 2, the 0.05% epinastine group consisted of 15 patients, and the 0.1% olopatadine group consisted of 14 patients. The rate of change in the total symptom score in comparison with that at the baseline of preseasonal treatment was significantly higher in the 0.1% olopatadine group 1 month after the start of treatment, suggesting symptom deterioration (P=0.025). There was no significant difference in the rate of change in the total objective finding score between the two groups. Conclusion: Seasonal treatment with 0.05% epinastine or 0.1% olopatadine was equally effective for patients with allergic conjunctivitis. However, for preseasonal therapy, 0.05% epinastine was more effective than 0.1% olopatadine. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between the dosage of allergic conjunctivitis (AC) and anti allergic eye drops, and to analyze the influence of seasonal factors on it. Methods: The concentration of airborne pollen was monitored by gravitational sedimentation method in Beijing city in the whole year of 2015. The number of allergy department for AC visits and the dosage of three major anti allergic eye drops in Beijing Shijitan Hospital in 2015 were counted.and the relationship between the number of AC visits and the dosage of anti allergic eye drops were analyzed by using Spearman correlation analysis. Results: In the whole year of 2015. a total of 76164 pollen was monitored. Pollen distribution showed two peaks in Spring and Autumn. The number of pollen in April was the most (34.84%). followed by March (29.72%). May (10.87%). September (10.52%). August (9.94%). and the least pollen months were January and November (0.11%). The average number of pollen was 19150 in the peak period of Spring pollen from March to May, the average number of pollen was 7792 in the peak period of Autumn pollen from August to September, and the average number of pollen in Autumn was lower than that in Spring, hi 2015. the average monthly visit rate of AC in the hospital was (80.42±54.28). AC was the highest in August, accounting for 18.03% of the year, followed by September (16.99%). April (13.99%), March (12.54%). May (7.98%). The average dosage of anti allergic eye drops was (148.67± 148.63) bottle, the highest dosage of anti allergy eye drops was in August, accounting for 28.25%, followed by March (17.21%), September (14.18%). April (13.11%). May (8.30%), and the number of AC visits and the dosage of anti allergic eye drops showed Spring and Autumn peak. Spearman correlation analysis showed that there was a positive correlation between the amount of pollen and the number of AC visits and the dosage of anti allergic eye drops(r=0.806,0.830. P=0.000.0.000). and there was a positive correlation between the number of AC visits and the dosage of anti allergic eye drops (t-0.923. P=0.000). Conclusion: The distribution of pollen, the number of AC visits and the dosage of anti allergic eye drops all appear Spring and Autumn peak. The pollen sensitization in Autumn is higher than that in Spring, and the peaks of medication and AC visits are in Autumn. [ABSTRACT FROM AUTHOR]

Objective: To evaluate oxidative stress parameters and serum magnesium (Mg) levels in patients with seasonal allergic conjunctivitis (SAC) during the pollen season. Methods: This observational cross-sectional study involved 35 patients with SAC without any other ocular and systemic diseases, and 38 consecutive, age- and sex-matched healthy subjects. Serum malondialdehyde (MDA), adjusted ischemia modified albumin (IMA), and Mg levels were quantified, and the results were compared between the groups. Results: No significant differences were found between the groups with respect to age (p = 0.416) and sex (p = 0.362). Serum MDA and adjusted IMA levels of the subjects with SAC (69.54 ± 7.71 μM and 0.74 ± 0.39 ABSU) were significantly higher than the control group (64.61 ± 5.89 μM and 0.57 ± 0.19 ABSU) (p = 0.002 andp = 0.025, respectively). There was no significant difference for serum Mg levels between the groups (p = 0.177). Conclusion: We demonstrated higher levels of oxidative stress parameters in patients with SAC compared to the control group, which imply a possible role of oxidative stress in the pathogenesis of SAC. [ABSTRACT FROM AUTHOR]

AIM: To compare three clinically similar patient groups and a control group in terms of tear function tests, ocular surface staining and conjunctival impression cytology.METHODS: This was a single-centre, prospective, double-blind, randomised and controlled trial. The study includes 20 dry eye patients with Schirmer 1 scores less than 10mm and a tear film break-up time(TBUT)less than 10s, 20 anterior blepharitis patients with drying and crusting of the eyelashes, 20 seasonal allergic conjunctivitis patients with papillary hypertrophy of the upper eyelid tarsal conjunctiva and 20 control group patients. The Schirmer scores, TBUT scores, ocular surface staining(as graded by the Oxford scheme scale), goblet cell density(as observed using impression cytology and metaplasia scores for all patients evaluated by the Nelson grading scheme)were compared.RESULTS: Significant differences were identified between these patient groups and the control group in terms of tear functions tests, ocular surface-staining scores, goblet cell density and metaplasia scores(PCONCLUSION: Inflammatory response against these three diseases was demonstrated to cause damage in parallel to the severity of the local inflammation they generate on the ocular surface. We confirmed that this damage has very serious effects, especially on conjunctival goblet cell density and metaplasia. We believe that the degree of this loss in goblet cells is correlated with clinical findings.

El ojo es uno de los órganos más sensibles y está permanentemente expuesto a diversos agentes ambientales. Dado que la conjuntiva es un tejido inmunológicamente activo, no es sorprendente que sea un sitio común de respuestas alérgicas. Las alergias oculares son un grupo de enfermedades que afectan la superficie conjuntival y están asociadas usualmente a reacciones de hipersensibilidad tipo 1. Pueden ser divididas en varias categorías: conjuntivitis alérgica estacional, conjuntivitis alérgica perenne, queratoconjuntivitis vernal y queratoconjuntivitis atópica. La inflamación de la superficie ocular produce prurito, lagrimeo, edema conjuntival y fotofobia. Como en otras enfermedades alérgicas, se puede desarrollar una condición crónica, acompañada de remodelación de los tejidos oculares. Las estrategias para el tratamiento de la alergia ocular han aumentado exponencialmente y los clínicos disponen de un inventario cada vez mayor de agentes dirigidos a la protección del ojo contra la inflamación. En este trabajo presentamos una revisión sobre las principales formas de alergia ocular, haciendo énfasis en el cuadro clínico, el diagnóstico y las nuevas opciones terapéuticas disponibles en la actualidad. The eye, one of the most sensitive organs, is permanently exposed to different environmental agents. Since the conjunctiva is an immunologically active tissue, it is not surprising for it to be a common site for allergic responses. Ocular allergies constitute a group of diseases affecting the conjunctival surface; they are usually associated with type 1 hypersensitivity reactions. This disorder can be divided into several categories: seasonal allergic conjunctivitis, perennial allergic conjunctivitis, vernal keratoconjunctivitis and atopic keratoconjunctivitis. Ocular surface inflammation results in itching, tearing, conjunctival edema, and photophobia. As is the case with other allergic diseases, a chronic situation can also develop, accompanied by remodeling of the ocular surface tissues. Ocular allergy management strategies are increasing exponentially, and a growing list of agents aimed at protecting the eye from inflammation is available to clinicians. We present a review on the main forms of ocular allergy, with emphasis on the clinical picture, the diagnosis, and the new therapeutic options presently available.

Allergic conjunctivitis can be classified as an acute or chronic condition. Acute allergic conjunctivitis encompasses seasonal allergic conjunctivitis and perennial allergic conjunctivitis. The more severe chronic conditions include vernal keratoconjunctivitis, acute keratoconjunctivitis and giant papillary conjunctivitis. The mainstay in the treatment of allergic conjunctivitis remains the use of topical dual-acting agents which have mast cell stabilising properties and act as antihistamines. Although corticosteroids are among the most effective agents in the treatment of allergic conjunctivitis, they can cause serious adverse effects and their use should be reserved for short-term “pulse” treatment to gain quick control of the symptoms. Topical nonsteroidal anti-inflammatory drugs can also cause corneal melting. However, their use may be considered in severe cases to reduce the use of topical steroids. Several new agents acting at newly identified targets in the inflammatory process are under investigation for the treatment of allergic conjunctivitis.

Ocular allergy is a significant and growing issue worldwide but for many patients, it is often not differentiated from systemic conditions, such as hay fever. Management of seasonal and perennial allergic conjunctivitis is often poor. Management is principally through avoidance measures (blocking or hygiene), nonpharmaceutical (such as artificial tears and cold compresses) and pharmaceutical (such as topical antihistamines and prophylactic mast cell stabilizers). Vernal and atopic keratoconjunctivitis are more severe and generally need treatment with NSAIDs, steroids and immunomodulators. Giant papillary conjunctivitis can be related to allergy but also is often contact lens related and in such cases can be managed by a period of abstinence and replacement of the lens or a change in lens material and/or design. Immunotherapy can be efficacious in severe, persistent cases of contact lens or allergic conjunctivitis. [ABSTRACT FROM AUTHOR]

We evaluated high-affinity receptor for IgE (FcεRI)- binding serum IgE in patients with atopic keratoconjunctivitis (AKC; n=31) and with seasonal allergic conjunctivitis (SAC; n=13) by enzyme-linked immunosorbent assay (ELISA) using a recombinant soluble form of the human FcεRIα ectodomain (soluble α). The quantities of FcεRI-binding IgE are compared with those of total IgE measured by a conventional sandwich ELISA. Both of the quantities of FcεRI-binding and total IgE in AKC were significantly larger than those in SAC (P

Purpose To evaluate plasma 25-hydroxyvitamin D and serum total immunoglobulin E ( IgE) levels in patients with seasonal allergic conjunctivitis ( SAC). Methods This observational case-control study involved 49 patients with SAC without any other ocular and systemic diseases, and 44 consecutive, age- and sex-matched healthy subjects. Plasma 25-hydroxyvitamin D and serum total IgE levels of all subjects were quantified with electrochemiluminescence technique. Results were compared between the groups, and p values of <0.05 were considered as statistically significant. Results No significant differences were found between the groups with respect to age (p = 0.41) and sex (p = 0.98). Plasma vitamin D levels of the subjects with SAC (median 8.03 ng/ml, range 3.00-17.97 ng/ml) were significantly lower than the control group (median 10.52 ng/ml, range 3.30-25.92 ng/ml) (p = 0.007). Serum total IgE levels of patients with SAC (median 48.65 IU/ml, range 1.77-812.00 IU/ml) were significantly higher when compared to the control group (median 32.49 IU/ml, range 0.14-104.60 IU/ml) (p = 0.003). Conclusions We found lower plasma vitamin D levels and higher serum total IgE levels in patients with SAC. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the therapeutic effects of low-effective steroid fluorometholone 0.1% and non-steroidal anti-inflammatory ketorolac 0.4% when concomitantly used with olopatadine 0.01% in relieving clinical signs and symptoms of acute seasonal allergic conjunctivitis (SAC). Methods: In this randomized, placebo-controlled, multi-center study, 104 eyes of 52 patients with the diagnosis of SAC were conducted. The patients were assigned into two groups to receive either olopatadine and fluorometholone one eye and placebo in the contralateral eye or olopatadine and ketorolac one eye and placebo in the contralateral. The clinical signs (chemosis, mucus secretion, eyelid edema) and symptoms (itching, redness, tearing, burning) of the patients were evaluated by summing up the scores using a 3-point scale. Results were analyzed by Mann-Whitney U test, p values less than 0.05 were defined as significant. Results: All parameters were improved less amount on the first day of the treatment in both groups, however, significant reduction in clinical signs and symptoms were seen on the 10th day compared with those receiving placebo. Fluorometholone was found superior to ketorolac in reducing redness, mucus secretion, chemosis and eyelid edema ( p = 0.032 for redness, p = 0.028 for mucus secretion, p = 0.030 for chemosis, p = 0.042 for eyelid edema) and both drugs were similar in alleviating the symptoms itching, burning and tearing ( p = 0.074 for itching, p = 0.064 for burning, p = 0.072 for tearing). Conclusions: Fluorometholone was better than ketorolac in relieving redness, chemosis, mucus secretion and eyelid edema when concomitantly used with olopatadine, however, these two drugs were found equal in attenuating the symptoms itching, burning and tearing. [ABSTRACT FROM AUTHOR]

The most common ocular manifestation of allergy, allergic conjunctivitis (AC), is the result of a hypersensitivity response occurring after exposure of the ocular surface to airborne antigens. Treatment options for AC comprise antihistamines, mast cell stabilizers, dual-acting mast cell stabilizer-antihistamines, corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), and combinations thereof. Despite clinical evidence to support the use of antihistamines, such as levocabastine, antihistamines are unable to mitigate all symptoms of AC because histamine is not the only mediator released during the allergic inflammatory response and has no direct effect on inflammatory cells involved in clinical symptoms. Dual-acting mast cell stabilizer-antihistamines, such as bepotastine, alcafatidine, epinastine, ketotifen, and olopatadine, have a broader effect than antihistamines alone. Corticosteroids inhibit the entire inflammatory cascade and therefore offer the most complete option for AC, although their use has been limited due to concerns about increased intraocular pressure (IOP) and the potential for cataract formation with extended use. Loteprednol etabonate (LE) has a decreased effect on IOP and cannot form Schiff base intermediates with lens protein, which is considered a first step in cataractogenesis. The efficacy and safety of LE in the treatment of seasonal AC (SAC) has been demonstrated in clinical trials. [ABSTRACT FROM AUTHOR]

Allergic conjunctivitis (AC) affects an estimated 20% of the population in the Western world, with a large fraction suffering due to seasonal or perennial allergen exposures. Bepotastine besilate ophthalmic solution (BBOS) 1.5%, a dual-acting histamine (H1) receptor antagonist and mast cell stabilizer, is indicated for itching associated with AC. This study was designed to evaluate the efficacy and safety of BBOS 1.5% for reducing ocular itching associated with AC in subjects enrolled in a natural exposure trial. Eligible subjects in a multicenter, double-masked, randomized, parallel-group, placebo-controlled, natural exposure clinical trial were randomly assigned to either BBOS 1.5% or placebo eyedrops on a 1:1 basis and instilled 1 drop of the test agent into both eyes twice daily for 2 weeks. The mean change from baseline in instantaneous and reflective ocular itching scores at the end of 2 weeks of treatment were evaluated based on subject-assessed severity of instantaneous and reflective itching. Subject-reported adverse events (AEs) were also recorded for safety. Treatment with BBOS 1.5% significantly reduced instantaneous and reflective ocular itching scores from baseline compared with placebo over the 2-week study period (p = 0.007 and p = 0.005, respectively). BBOS 1.5% was well tolerated, and AEs were generally transient and mild. This clinical study indicates BBOS 1.5% effectively and safely treated ocular itching in a natural exposure allergy study and is a useful treatment option for the management of ocular itching associated with AC. (ClinicalTrials.gov identifier number: NCT01174823.) [ABSTRACT FROM AUTHOR]

. Seasonal allergic conjunctivitis (SAC) is an inflammatory response of the conjunctiva triggered by exposure to seasonal allergens. Treatment options for SAC include artificial tears, antihistamines, decongestants, mast cell stabilizers, nonsteroidal anti-inflammatory drugs, dual antihistamine/mast cell stabilizers, immunotherapy and corticosteroids. Topical, intranasal and systemic formulations of corticosteroids have traditionally provided the most effective relief of the inflammation and signs and symptoms associated with severe, acute exacerbations of SAC. However, steroid-induced ocular and systemic side-effects have limited the prescribing of these agents. This limitation of traditional corticosteroids led to the development of modified corticosteroids that retain the anti-inflammatory mechanism of action of traditional corticosteroids with a much-improved safety profile because of their rapid breakdown to inactive metabolites after exerting their activity. The development of one such novel corticosteroid, loteprednol etabonate (LE), led to the insertion of an ester (instead of a ketone) group at the carbon-20 (C-20) position of the basic corticosteroid structure. Clinical trials assessing this C-20 ester corticosteroid have demonstrated similar efficacy to C-20 ketone corticosteroids in the prevention or treatment of the signs and symptoms of SAC but with a greatly improved safety profile, as the C-20 ester corticosteroid is less likely to elevate intraocular pressure. In addition, the ketone at the C-20 position has been implicated in the formation of cataract, while nonketolic corticosteroids do not form Schiff base intermediates with lens proteins, which is a common first step in cataractogenesis. The clinical relevance of the C-20 ester corticosteroid class, as modelled by LE, is that they provide both effective and safe treatment of the inflammation associated with SAC and relief of its signs and symptoms. Loteprednol etabonate offers a well-tolerated treatment option for patients with debilitating acute exacerbations as well as chronic forms of the disease. [ABSTRACT FROM AUTHOR]

Background: Seasonal allergic conjunctivitis can manifest itself through tear film instability and symptoms of eye discomfort during the pollen season. This study investigated whether seasonal allergic inflammation defines tear film instability outside the season. Methods: Twenty-three control subjects and 13 ragweed-allergic patients were involved (21 female, 15 male; mean age 26.6 ± 5.4 years). Outside the pollen season, subjective ocular symptoms, non-invasive tear film break-up time, lower tear meniscus height and the tear lipid layer's interference pattern grade were recorded. C3a complement activation level was also measured in collected tear samples. Results: Non-invasive tear film break-up time, lower tear meniscus height, C3a complement activation level and the incidence of the different grades of tear lipid pattern did not differ significantly in the two examined groups (p ≥ 0.223). The mean eye symptom score outside the season was greater in the allergic group, but the difference was not significant (p = 0.062). The C3a complement activation level showed a significant and inverse correlation with the lipid layer grade (r = -0.343, p = 0.017). Among the participants with thinner tear lipid layers, the complement activation in the tear samples was higher than among those patients with normal tear lipid layers. Conclusion: Seasonal allergic inflammation did not cause permanent tear film instability and eye symptoms were not observed outside the pollen season. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Purpose: We aimed to compare the clinical efficacy and ocular surface variables of olopatadine, ketotifen fumarate, epinastine, emedastine and fluorometholone acetate ophthalmic solutions in preventing the signs and symptoms of seasonal allergic conjunctivitis (SAC). Methods: This was a prospective, randomized, double-blinded and placebo-controlled study. A total of 100 patients with SAC were randomly assigned to one of five groups, in which they were administered olopatadine, ketotifen fumarate, epinastine, emedastine or fluorometholone acetate, instilled twice daily for 2 weeks. One eye of each patient was treated with the study drug and the other was treated with a placebo. Signs and symptoms of allergic conjunctivitis (itching, redness, tearing, chemosis and eyelid swelling) were scored on a 4-point scale. Each symptom was assessed at baseline and then again after 1 and 2 weeks of treatment. Ocular surface variables were assessed by conjunctival impression cytology. Results: At weeks 1 and 2, all antiallergic agents were significantly more effective than placebo in alleviating itching, redness, tearing, chemosis and eyelid swelling. Fluorometholone acetate was significantly less effective than the other agents in reducing itching and redness at all control visits. Ocular surface findings by impression cytology improved significantly after all treatments compared with placebo. Conclusions: In patients with SAC, olopatadine, ketotifen, epinastine and emedastine are more efficacious than fluorometholone acetate in preventing itching and redness. All the antiallergic agents gave similar results in terms of reducing tearing, chemosis and eyelid swelling. Our data showed that impression cytology parameters improved after treatment with antiallergic agents in patients with SAC. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of this study was to compare short-term (5-minute) ocular comfort and drying effects of 3 topical antihistamine/mast cell stabilizers—epinastine, azelastine, and ketotifen—in patients with allergic conjunctivitis (AC). Methods: Adults with a history of AC, as confirmed on skin testing conducted within the previous 2 years, were enrolled in this single-center, randomized, doublemasked crossover study. At visit 1, patients were randomized to receive a single drop of epinastine in 1 eye and either azelastine or ketotifen in the other eye. Ocular comfort was assessed by patients on an 11-point scale (0 = very comfortable to 10 = very uncomfortable) immediately (0 minute) and at 0.5, 1, 2, and 5 minutes after instillation. Patients were also asked to describe how their eyes felt at 3 minutes using a standardized list of positive (soothing, smooth, refreshing, cool, and comfortable), neutral (thick, sticky, and filmy), and negative (stinging, irritating, and burning) descriptor words. At visits 2 to 4, patients were examined for ocular drying and tear-film stability using fluorescein staining and ocular protection index (OPI) evaluation, respectively. Results: A total of 40 patients (27 women, 13 men; mean age, 40 years [range, 18-73 years]) were included in the study. The mean comfort score was significantly lower (indicating more comfort) with epinastine compared with azelastine at 0.5, 1, 2, and 5 minutes (between-treatment differences, 2.90, 1.85, 1.35, and 0.63, respectively; P < 0.001, P < 0.001, P = 0.001, and P = 0.019) and compared with ketotifen immediately after instillation (between-treatment difference, 1.2; P = 0.014). The mean ocular comfort score was significantly lower with ketotifen compared with azelastine at 0.5, 1, and 2 minutes (between-treatment differences, 2.35, 1.35, and 1.10, respectively; P = 0.001, P = 0.023, and P = 0.028). A majority (85%) of patients chose positive comfort descriptors to describe epinastine versus 34% with azelastine. No significant differences in fluorescein staining or OPI were observed. Conclusions: In this small study in patients with AC, following administration of a single drop, epinastine was rated as more comfortable than azelastine and ketotifen. None of the tested medications were associated with significant acute ocular drying effects. [Copyright &y& Elsevier]

Background Conjunctival mast cells (MCs) are important effector cells in seasonal allergic conjunctivitis, via histamine and cytokine secretion. Several new anti-allergic eye drops stabilize MCs and block histamine receptors, but their anti-inflammatory effects are unclear. Objective Anti-allergic drugs were compared for their anti-inflammatory effects in an in vitro model of human MC activation and in an experimental murine model of allergic conjunctivitis. Methods Human cord blood stem cell-derived (CBMC) and conjunctival biopsy-derived MCs were stimulated via FcℇRI, degranulation and histamine release were assayed at 1 h and cytokine secretion at 24 h using multiplex arrays. Mice sensitized to short ragweed pollen were given anti-allergics topically before allergen challenge, and conjunctival immuno-staining was performed at 24 h. Results After a 1 h stimulation, 80% of the CBMC had degranulated and secreted histamine (27.9±4.7 ng/106 cells; P<0.05). Pre-treatment by all drugs significantly reduced histamine and TNF-α, whereas IL-5, IL-8, IL-10 and TNF-β profiles were differentially decreased. For conjunctival biopsy-derived cultures ( n=11), FcℇR1 stimulation increased histamine, TNF-α, TNF-β, IL-5 and IL-8 levels and the production of IL-5, IL-6 ( P<0.05), histamine and IL-8 ( P<0.01) was inhibited by epinastine. In vivo, epinastine and olopatadine pre-treatment significantly reduced the clinical scores and eosinophil numbers ( n=6; P<0.05) while epinastine also reduced neutrophils ( P<0.02). Conclusion Differential effects on MC cytokine inhibition were observed, with epinastine inhibiting MC secretion of IL-5, IL-8, IL-10 and conjunctival neutrophil infiltration. The anti-allergic drugs have anti-histamine and mast-cell stabilizing properties but might differ in clinical improvement depending on the individual and the cytokines involved. [ABSTRACT FROM AUTHOR]

Aims: Allergic eye disease affects up to 20% of the population with varying severity. The conjunctival epithelium plays a key role in allergic eye disease. The purpose of this study was to determine whether the conjunctival epithelium is abnormal in allergic eye disease. Methods: Conjunctival biopsy samples were taken from patients with seasonal allergic conjunctivitis (SAC) ‘in’ and ‘out of season’ and nonatopic control subjects. Specimens were fixed in glycol methacrylate, 2 μm serial sections cut and Image-J used to assess the sites and areas of immuno-staining. Results: E-cadherin, CD44, keratins K5/6, K8, K13, K14, K18 and pan-keratin immuno-staining were all significantly lower in patients ‘out of season’ compared with normal controls. No structural differences in the epithelium were observed between the two groups. The epithelium of patients ‘in season’ was thicker and immuno-staining of the above markers similar to controls. Conclusions: The expression of a wide spectrum of epithelial cell adhesion proteins and cytoskeletal elements is downregulated in the conjunctiva of SAC patients ‘out of season’ compared with normal controls. We suggest that this could have an important impact on the ability of the epithelium to protect itself against allergen penetration, potentially influencing the development and course of allergic eye disease and offering a novel area for therapeutic control. [ABSTRACT FROM AUTHOR]

Abstract Background:: Topical antiallergic agents, such as antihistamines and mast-cell stabilizers, are the main therapeutic options for seasonal allergic conjunctivitis (SAC). Ketotifen fumarate and olopatadine HCl have dual action that offers a combination of these 2 mechanisms. Although clinical studies comparing the efficacy of these 2 drugs have shown that both were effective in the treatment of SAC, the results were contradictory and did not include the effects of these drugs on inflammatory markers. Objectives:: The aims of this study were to compare the clinical efficacy of topical ketotifen and olopatadine eye drops and to determine the effects of these 2 drugs on the expression of cell adhesion molecules (CAMs) and inflammatory markers in conjunctival surface cells in patients with SAC. Methods:: This 30-day, randomized, double-masked, artificial tear substitute (ATS)-controlled clinical trial was conducted at the Department of Ophthalmology, Karadeniz Technical University, School of Medicine, Trabzon, Turkey. Patients with SAC were included in the study and randomly assigned to 1 of 3 groups: topical ketotifen fumarate 0.025% ophthalmic solution, topical olopatadine HCl 0.1% ophthalmic solution, or ATS (control group). All drugs were administered 2 drops per eye BID for 30 days. At the beginning of the study (day 0; baseline), on day 15, and on day 30, clinical scores (itching, tearing, redness, eyelid, swelling, and chemosis) and conjunctival impression cytology specimens were obtained. The percentages of cells expressing intercellular adhesion molecule 1, vascular CAM-1, human leukocyte antigen-DR, and β1-integrin (CD29) from conjunctival impression cytology specimens were determined using flow cytometry. Patients were questioned about adverse events (AEs) at each visit. Ocular discomfort on installation of the drugs was recorded as an AE. Results:: Thirty-nine patients (20 men, 19 women; age range, 18–61 years) with SAC were included. Twelve patients received ketotifen; 13, olopatadine; and 14, ATS. In both active-treatment groups, the improvements of clinical scores (tearing and itching) were more pronounced compared with those in the ATS group, although the day-30 difference in tearing score between the olopatadine and ATS groups was not statistically significant. No significant within-group or between-group differences in mean scores for redness, chemosis, or eyelid swelling were found. The expression rates of CAMs and inflammatory markers in conjunctival surface cells were significantly more reduced with ketotifen and olopatadine compared with ATS. However, clinical and flow cytometric parameters were improved with ATS at 15 and 30 days compared with baseline. No AEs were observed during the study period. Conclusions:: In this short-term study in a selected, small study population with SAC, ketotifen and olopatadine diminished the expression of CAMs and inflammatory markers on the conjunctival surface cells effectively. Both active treatments were more efficacious compared with ATS and were well tolerated. [Copyright &y& Elsevier]

Introduction : Seasonal allergic conjunctivitis (SAC) is a highly prevalent condition that exacts a range of costs from its sufferers. The aim of this study was to examine quality of life (QoL) and economic consequences of SAC amongst private health care patients in Spain. Methods : 201 sufferers of SAC and 200 controls were recruited from four private eye clinics and one public hospital in five Spanish cities: Alicante, Madrid, Albacete, Las Palmas de Gran Canarias and Valladolid. Participants were between 10 and 80 years of age and Spanish speaking. All potential participants were asked selected questions and sorted into one of the two groups or excluded. Sufferers were administered a set of four questionnaires by researchers consisting of the EQ-5D Health Questionnaire, the National Eye Institute (US) Visual Functioning Questionnaire 25 (VFQ-25), the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and a Health Economic and Demographic Questionnaire (HEDQ). Control participants self-administered the full EQ-5D and VFQ-25 and abbreviated versions of the RQLQ and HEDQ. Results : The groups were comparable in terms of age and sex, but sufferers had a significantly higher hourly income than controls (p = 0.02). Sufferers exhibited a significantly higher incidence of asthma, nasal symptoms, perennial allergic conjunctivitis, food allergies and other allergies (p [ABSTRACT FROM AUTHOR]

Purpose: To study the effects of ketotifen fumarate, olopatadine, and levocabastine on ocular active anaphylaxis in guinea pigs and on ocular immediate hypersensitivity in albino rats. Methods: Clinical grading scores and Evans blue dye leakage to eyelids and to eyeballs were assessed in five treatment groups (n = 10): ketotifen fumarate 0.025%, olopatadine 0.1%, levocabastine 0.05%, negative control, and positive control. Results: At 20 minutes after challenge, edema scores for ketotifen-treated guinea pigs were statistically significantly lower than those for levocabastine or olopatadine. Active treatment significantly reduced vascular leakage in both models. Ketotifen significantly reduced vascular leakage in eyelids compared with the other drugs. In guinea pigs, vascular leakage in eyeballs was significantly reduced with ketotifen fumarate compared with olopatadine and levocabastine. Conclusions: In the guinea pig model, ketotifen was more effective than olopatadine and levocabastine at reducing conjunctival edema and vascular permeability in eyelids and eyeballs. In the rat model, ketotifen was more effective at reducing vascular permeability in eyelids than olopatadine and levocabastine. [ABSTRACT FROM AUTHOR]