Tear Histamine Levels in Vernal Conjunctivitis and Other Ocular Inflammations

Histamine levels were measured in tears from normal volunteers (geometric mean, 5 ng/ml), patients with vernal conjunctivitis (16 ng/ml), and patients with a wide variety of external ocular inflammatory disease (3 ng/ml). Histamine levels were significantly higher in patients with vernal conjunctivitis than in normal subjects (P < 0.01) or patients with other types of ocular inflammation (P < 0.001). We postulate that histamine is an important mediator in the expression of the inflammatory response in vernal conjunctivitis, and that its elevation may be caused by abnormalities in the number of mast cells, the stability of the mast cells or in the system that regulates histamine.     

Increase in macrophage migration inhibitory factor levels in lacrimal fluid of patients with severe atopic dermatitis

Background and aims of the study Atopic dermatitis is a chronic inflammatory skin disorder that often involves some ophthalmic features. Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine that is associated with the generation of cell-mediated immune responses. Although serum MIF levels may be elevated in severe atopic dermatitis, the quantity of MIF in regional ocular fluid remains unknown. We measured MIF levels in tears (lacrimal fluid) of patients with atopic dermatitis. Patients and methods Tear samples were collected from 16 patients with atopic dermatitis, 10 patients with allergic conjunctivitis, and 15 healthy control subjects. The clinical severity of atopic dermatitis was evaluated according to the Scoring Atopic Dermatitis (SCORAD) index. The index was calculated by summing the following scores: extent criteria, intensity criteria, and subjective symptoms. Macrophage migration inhibitory factor levels were determined by a human MIF enzyme-linked immunosorbent assay. All comparisons were two-tailed, and P values <0.01 were considered as statistically significant.Results The mean MIF concentration in lacrimal fluid collected from healthy control subjects was 0.69±0.2 ng/ml. The mean tear MIF levels were 17.87±6.3 ng/ml in moderate-to-severe atopic dermatitis (SCORAD≥15, P=0.002), 0.93±0.08 ng/ml in mild atopic dermatitis (SCORAD<15), and 2.76±0.86 ng/ml in allergic conjunctivitis (P=0.008).Conclusions A proinflammatory cytokine MIF level was elevated in tears as well as serum in cases of severe atopic dermatitis. These results suggest that MIF may play an important role in the induction or enhancement of ophthalmic features related to severe atopic dermatitis.     

Tear and serum soluble leukocyte activation markers in conjunctival allergic diseases

PURPOSE: To measure markers of leukocyte activation in patients with an exclusively ocular inflammatory or bacterial disease. METHODS: Neutrophil myeloperoxidase, eosinophil cationic protein, eosinophil neurotoxin, and soluble interleukin-2 receptor were measured in serum and tears of 17 patients with allergic vernal keratoconjunctivitis, seven with atopic keratoconjunctivitis, 11 with seasonal allergic conjunctivitis, seven with giant papillary conjunctivitis, 13 with rosacea blepharokeratoconjunctivitis, seven with bacterial conjunctivitis, and 13 normal subjects as controls. RESULTS: In serum of patients with vernal and atopic keratoconjunctivitis, levels of eosinophil cationic protein, eosinophil neurotoxin, and interleukin-2 receptor were significantly increased compared with control subjects but were not correlated with the severity of ocular symptoms. In tears of patients with vernal and atopic keratoconjunctivitis and seasonal allergic conjunctivitis, as well as in the nonallergic diseases, rosacea blepharokeratoconjunctivitis and bacterial conjunctivitis, levels of eosinophil cationic protein, neurotoxin, and interleukin-2 receptor were significantly increased compared with control subjects. The highest values of these markers were found in vernal keratoconjunctivitis samples. Neutrophil myeloperoxidase was significantly increased in vernal and atopic keratoconjunctivitis, rosacea blepharokeratoconjunctivitis, and bacterial conjunctivitis. In vernal keratoconjunctivitis, tear markers were correlated to the clinical score of the disease, but not with cytology. CONCLUSIONS: Tear histamine was measured in 10 allergic patients after allergen challenge. Although none of the above markers can be considered specific to a single disease, their measurement may still be useful for the quantification of local cell activation in ocular inflammatory diseases.     

Immunoassay of tear lysozyme in conjunctival diseases.

The tear lysozyme content in 111 normal subjects and in 159 patients with various conjunctival diseases was determined by a single radial immunodiffusion technique. Tear lysozyme level in normal people was 1.33/mg/ml. (SI conversion: mg/ml = g/l.) The mean tear lysozyme levels in patients with chronic irritative conjunctivitis (0.97 mg/ml) and nutritional deficiency with epithelial xerosis (0.76 mg/ml) were significantly lower than in the normal controls. The mean tear lysozyme levels in tears from patients with vernal conjuctivitis (1.20 mg/ml), phlyctenular conjunctivitis (1.10 mg/ml), and acute bacterial conjunctivitis (1.48 mg/ml) were not significantly different from those in the normal controls. Superimposition of acute bacterial conjunctivitis on trachoma did not alter the low tear lysozyme level that existed before in these patients.     

Levocabastine. Evaluation in the histamine and compound 48/80 models of ocular allergy in humans

The efficacy of a new antihistamine, levocabastine, in alleviating the ocular allergic reactions induced by both histamine and 48/80 was evaluated in humans. Levocabastine (0.5%) was instilled in one eye of 30 volunteers, and vehicle in the contralateral eye. After 15 minutes, half of the subjects received histamine (25 mg/ml) and half, 48/80 (7.5 mg/ml). The signs and symptoms of allergy were graded clinically after 30 minutes. Compared with a buffer control, levocabastine significantly alleviated itching (P = 0.01), redness (P = 0.0156), and chemosis (P = 0.005) induced by histamine, and itching (P = 0.032) and redness (P = 0.029) induced by 48/80. The results from these pharmacologic models support the clinical use of levocabastine for the treatment of allergic conjunctivitis.     

Histamine content in tears in patients with allergic rhinoconjunctivitis

Summary The classic clinical symptoms of allergic conjunctivitis (type I allergy) – itching and lacrimation – are the effect of histamine. Determination of histamine levels in tears may be useful in evaluating the dynamics of local histamine release in connection with the clinical findings. Patients and methods: Between 1. 7. 1994 and 31. 6. 1995 we analyzed the histamine levels in tears and investigated the clinical symptoms (score of 0–3) of 32 hyposensitized pollen-sensitive patients (14 males and 18 females, aged 18–45 years, group I) and of 32 controls (group II) without any allergic disease, performed in each case once in season and once out of season. Tear production and composition were measured by Schirmer's test and tear break-up time at the same time. The histamine levels of the tear samples (obtained by microcapillary method) were analyzed by electrochemical determination. Results: In group I there was a highly significant increase of the mean histamine level from 0.89 ± 2.22 ng/ml (out of season) to 7.71 ± 7.51 ng/ml (in season) for the right eye and from 0.73 ± 2.36 ng/ml (out of season) to 9.51 ± 9.07 ng/ml (in season) for the left eye (P = 0.0000). The histamine level in tears of the controls (group II) was below the detection limit in all samples. The seasonal histamine level were higher with the severity of atopy (Erlangen atopy score). There was no significant influence of age and gender. The reduction of allergic symptoms during hyposensitization was not comparable to the degree of seasonal histamine level. Compared with the clinical findings, the histamine level in tears did not correlate with the symptoms of lacrimation, itching and conjunctival hyperemia. Conclusion: The histamine level in tears alone is not useful as a marker for the clinical severity of this atopyassociated disorder and for the efficacy of the anti-allergic therapy. After standardization of the determination method and the identification of other soluble mediators simultaneously, the histamine level in tears can be used as one part of a profile of mediators to evaluate the clinical symptoms.      

Platelet activating factor degradation in tear fluid from guinea pigs with allergic conjunctivitis.

The purpose of this study was to investigate the role of platelet-activating factor (PAF) and PAF acetylhydrolase (AH) in conjunctiva. The influence of PAF on conjunctival vascular permeability and the presence of PAF or its metabolites in tears from guinea pigs with allergic conjunctivitis were investigated. We instilled PAF to the eyes of guinea pigs and evaluated vascular permeability. Tear samples were collected from passively sensitized guinea pigs, and the concentration of PAF and its metabolites determined by liquid chromatography-tandem mass spectrometry. Exogenous PAF degradation in tear samples was evaluated with or without diisopropyl fluorophosphate (DFP). Topically applied PAF increased vascular permeability in conjunctiva. In the tear samples from guinea pigs with allergic conjunctivitis, PAF could not be detected. However, 40 +/- 6 ng/ml of lyso-platelet activating factor (lyso-PAF) and 230 +/- 50 ng/ml of 1-alkyl-2-acyl-sn-glycero-3-phosphocholine were detected at 10 min after challenge. Exogenous PAF was rapidly degraded in the tear samples from guinea pigs with allergic conjunctivitis, but not from normal guinea pigs. This PAF degradation was inhibited by DFP. These results suggest that PAF in the tear fluid is quickly hydrolyzed to lyso-PAF by PAF AH, which may be released or activated in allergic conjunctivitis.     

Tissue, tear, and serum IgE concentrations in vernal conjunctivitis.

Abnormal upper tarsal tissue from four patients with vernal conjunctivitis stained immunofluorescently contained abundant IgA-, IgD-, and IgE-forming plasma cells in two of four patients. These were absent in normal upper tarsal conjunctiva. The IgE levels of paired tear-serum samples of 11 patients with vernal conjunctivitis and ten control subjects were 130 ng/ml in patients that did nor differ significantly from the normal tear IgE value of 61 ng/ml. The serum IgE means of 1,031 ng/ml for patients and 201 ng/ml for normal subjects differed significantly (P less than .05). Tear and serum IgE values correlated significantly for both groups (P less than .01 for patients, P less than .05 for normal subjects). These findings are consistent with a hyperplasia of IgA, IgD, and IgE antibody-forming cells in tarsal conjunctiva of some patients with vernal conjunctivitis, and tear IgE levels being a function of serum IgE levels.     

Lysozyme content of tears in normal subjects and in patients with external eye infections

We studied the lysozyme content of tears in 267 subjects (521 eyes), including 241 healthy subjects, 7 patients (14 eyes) with bilateral blepharitis, 8 patients (12 eyes) with conjunctivitis, and 11 patients (16 eyes) with keratitis. The concentration of lysozyme in the tears rises with age between childhood and maturity. The highest values were seen in the age group of 21-40 years, and a decrease of lysozyme concentration occurred with an increase in age from 30-40 years. The mean lysozyme content of tears was 1,768 micrograms/ml in healthy subjects; no significant differences occurred between the sexes. Patients with blepharitis, conjunctivitis, and keratitis had normal mean lysozyme content of tears. The tears of patients with herpes simplex keratitis had low lysozyme values.     

Tear cytokine levels in allergic rhinitis without ocular symptoms

ObjectiveTo compare cytokine levels in the pre-corneal tear film between patients with allergic rhinitis, allergic rhinoconjunctivitis and the normal population.DesignA comparative cross sectional study.ParticipantsPatients were divided into Group 1 (allergic rhinitis without conjunctivitis), Group 2 (allergic rhinoconjunctivitis), and Group 3 (normal population).MethodsA comparative cross-sectional study was conducted. Patients were divided into; Group 1 (allergic rhinitis without conjunctivitis), Group 2 (allergic rhinoconjunctivitis), and Group 3 (normal controls). Tears were collected using Schirmer strips and cytokine analysis performed using enzyme linked immunosorbent assay.ResultsThere were a total of 68 subjects. Median values of cytokines in the allergic rhinitis group were as follows; TNFa (45.34 pg/ml), IL-4 (61.91 pg/ml), IL-5 (8.92 pg/ml), IL-6 (538.37 pg/ml) and IL-8 (1438.72 pg/ml). Cytokine levels in the group with allergic rhinoconjunctivitis were approximately two-fold higher than in the group with allergic rhinitis only. The median cytokine level in the control group was lowest. A significant inter-group difference was observed for TNF-alpha, IL-4, IL-6 and IL-8 levels, with allergic rhinoconjunctivitis patients demonstrating significantly elevated cytokines compared to those with allergic rhinitis only (p<0.001). These four cytokines were also significantly higher in those with allergic rhinitis than in controls (p<0.005). Although the group with allergic rhinoconjunctivitis had the highest levels of IL-5, no statistically significant inter-group difference was noted (p=0.479).ConclusionThis study demonstrated the presence of raised tear film inflammatory cytokines even in allergic rhinitis patients without ocular symptoms. These patients may be at increased risk of developing allergic conjunctivitis. These findings not only substantiate the immunological theory of the naso-ocular reflex, but have clinical and therapeutic implications for the holistic management of allergic rhinitis and conjunctivitis.     

The value of the cytological exam in the diagnosis of allergic conjunctivitis

Cytologic investigations was performed in four groups of patients: central group (10 cares), without pathologic lesions; 12 patients were admitted with allergic conjunctivitis (with positive allergy tests, atopic state or clinical manifest allergic diseases), 20 cases with bacterial conjunctivitis; 8 cases with mix allergic and bacterial conjunctivitis (that hardly respond to therapy). Smears from the conjunctivae secretion were air-dried and stained with blue-polycrometanin Dr?gan method. Cytologic lesions characteristic for each group of patients are described. Our results suggest that cytology from the conjunctivae secretion is helpful in the diagnosis of the allergic etiology; also, it accurately the allergic components mix conjunctivitis.     

New trends in the treatment of allergic conjunctivitis

Histamine is the key mediator producing itching, redness and chemosis in allergic conjunctivitis. Histamine levels in tears are increased ten-fold in patients with this allergic condition. Levocabastine is a newly synthesized histamine H₁ antagonist which has been formulated as both eye drops and nasal spray. In well established assays of antihistamine activity, levocabastine was found to be the most potent antihistaminic compound available, being 15 000 times more potent than chlorpheniramine. Ocular provocation studies in man have shown that levocabastine protects against the symptoms of allergen-induced conjunctivitis. Ophthalmological examinations, including slit lamp and ophthalmoscopy showed no adverse effects. Data from therapeutic studies are available for more than 1700 patients with allergic conjunctivitis treated for 2–16 weeks. One drop of levocabastine (0.5 mg/ml) per eye given two to four times daily provided significantly better symptom control than placebo, with good to excellent results in 71% of patients on levocabastine compared to 55% on placebo (p < 0.001). Levocabastine has a fast onset of action. In one study 94% of patients experienced symptom relief within 15 minutes after the first instillation. The effects observed with levocabastine were at least as good as those with ocular cromoglycate or oral terfenadine. The incidence of adverse experiences was not different from placebo. Levocabastine promises to be a valuable treatment for patients with allergic conjunctivitis.     

Comparative evaluation of olopatadine ophthalmic solution (0.1%) versus ketorolac ophthalmic solution (0.5%) using the provocative antigen challenge model.

OBJECTIVE: This study was conducted to compare the efficacy and safety of olopatadine ophthalmic solution (0.1%) with ketorolac ophthalmic solution (0.5%) in a clinical model of acute allergic conjunctivitis. Olopatadine is a dual acting H1 histamine receptor antagonist and a mast cell stabilizer, shown to be effective in treating allergic conjunctivitis. Ketorolac is a non-steroidal anti-inflammatory drug approved in the United States for the relief of ocular itching associated with seasonal allergic conjunctivitis. METHODS: The provocative antigen challenge model was used in this randomized, double-blind, single-center, crossover study. The allergen and concentration that consistently elicited a positive allergic reaction was used for challenge. After at least 14 days, subjects were randomized to receive either olopatadine in one eye and placebo in the contralateral eye, or ketorolac in one eye and placebo in the contralateral eye. Twenty-seven minutes after drug instillation subjects were challenged with allergen. At 3, 10, and 20 minutes following allergen challenge, subjects graded ocular itching and were assessed for hyperemia in conjunctival, ciliary, and episcleral vessel beds. Approximately 14 days later, subjects received the alternate treatment in one eye and placebo in the contralateral eye. They were again challenged with allergen and their responses were rated in the same manner. RESULTS: Olopatadine significantly (p < 0.0001) reduced both ocular itching and hyperemia in all three vessel beds compared to placebo at all time points tested following allergen challenge. Ketorolac did not significantly reduce itching and showed a trend of increased hyperemia compared to placebo. Olopatadine was significantly (p < 0.001) more effective than ketorolac in reducing hyperemia and ocular itching at all time points and was also significantly (p < 0.05) more comfortable than ketorolac as reported by subjects immediately following drug instillation. CONCLUSION: The study demonstrated that olopatadine is effective and safe in preventing and treating ocular itching and hyperemia associated with acute allergic conjunctivitis and is more effective and more comfortable than ketorolac.     

HE和Giemsa染色在儿童细菌性和过敏性结膜炎诊断中的比较

目的：探讨苏木精-伊红染色法(HE)和吉姆萨(Giemsa)染色法在儿童细菌性和过敏性结膜炎中的诊断效果。

方法：选取2016-10/2019-10期间于我院眼科经结膜刮片检查诊断为结膜炎儿童患者422例作为研究对象，分别采用HE与Giemsa染色法进行结膜刮片染色，并根据染色结果诊断细菌性/过敏性结膜炎。观察两种染色结果对细菌性/过敏性结膜炎的阳性检出率及染色情况。

结果：HE染色诊断细菌性结膜炎阳性率(33.0%)和符合率(63.6%)显著低于Giemsa染色(90.7%和88.8%，均P<0.001)，而过敏性结膜炎阳性率无明显差异(90.8% vs 87.2%，P>0.05)。

结论：Giemsa染色法检查可准确诊断儿童细菌性结膜炎且方法简便，HE与Giemsa染色法均对过敏性结膜炎具有较好的诊断效果，可为提高临床诊断效率及早期治疗方案提供依据。     

Eosinophil cationic protein in tears in allergic conjunctivitis.

AIMS/BACKGROUND--Eosinophil cationic protein (ECP) is a quantifiable product secreted by activated eosinophils. The aim of this study was to assess the degree of eosinophil activity in different clinical stages of various forms of allergic conjunctivitis. METHODS--Tears were collected in glass capillary tubes from 14 subjects with seasonal allergic conjunctivitis (SAC), 23 subjects with vernal keratoconjunctivitis (VKC), 16 subjects with atopic keratoconjunctivitis (AKC), 10 subjects with giant papillary conjunctivitis (GPC), and 16 healthy control subjects. The samples were analysed in duplicate with a radio-immunoassay for ECP. RESULTS--Statistically significant differences were evident between healthy controls and allergic subjects (p < 0.001). Subjects with AKC and VKC had significantly higher tear ECP values than subjects with GPC and SAC. In addition, there was a significant correlation between ECP values and disease severity in all disorders. CONCLUSION--The data suggest a particular pathogenic role of the eosinophil in VKC and AKC, and a less pronounced but still important eosinophil involvement in the disease processes of GPC and SAC.     

745例变应性结膜炎的临床特点

背景 变应性结膜炎是临床上常见疾病,但由于不同类型变应性结膜炎常有伴随症状和变应性疾病,因此影响诊疗的正确性和及时性,全面了解变应性结膜炎的临床特点有助于其正确的诊断和治疗.目的 探讨各类变应性结膜炎的临床特点. 方法 采用描述性研究方法,对2011年4月至2015年3月于北京同仁眼科中心确诊和治疗的745例各类变应性结膜炎患者的临床资料进行回顾性分析,包括患者一般情况、病史、家族史、个人过敏史、用药史、角膜接触镜配戴史、病程、每次发作持续时间、症状加重和缓解因素、眼部以外的变应性疾病、眼部伴随疾病和症状以及裂隙灯显微镜下眼前节检查结果和治疗反应,总结患者的临床特点,并分析不同年龄与症状的关系.结果 745例患者中,包括季节性变应性结膜炎(SAC)和常年性变应性结膜炎(PAC) 562例,占75.44％;春季结膜炎(VKC) 163例,占21.88％;巨乳头性结膜炎(GPC) 18例,占2.42％;AKC 2例,占0.27％.变应性结膜炎7月份就诊者例数最多,为180例,占24.16％,12月份就诊者最少,为26例,占3.49％.变应性结膜炎眼部常见症状为眼痒(395例,占53.02％)、眼红(273例,占36.64％)、瞬目增多/揉眼(163例,占21.88％).≤14岁组患者434例,占58.26％,15 ～ 39岁组患者254例,占34.09％,≥40岁组患者57例,占7.65％;3个组间男女比例比较差异有统计学意义(x2=89.431,P=0.000);290例患者伴有眼部以外的变应性疾病,包括变应性鼻炎、湿疹、荨麻疹、变应性紫癜和哮喘.391例患者伴有其他眼部疾病,分别为干眼、屈光不正、睑缘炎和睑板腺功能障碍、角膜上皮病变、倒睫和前葡萄膜炎.Logistic回归分析发现,≤14岁组患者瞬目增多/揉眼症状为主诉者多于＞14岁组,差异有统计学意义(β=-2.039,P=0.000),而眼干涩、异物感、酸胀/痛为主诉者少于≤14岁组,差异均有统计学意义(β=1.585,P=0.001;β=1.174,P=0.003;β=1.218,P=0.037).所有患者均接受过双效药物或抗组胺药物、糖皮质激素或免疫抑制剂的局部治疗,均可缓解症状.结论 变应性结膜炎中以SAC/PAC多见,其次为VKC.变应性结膜炎以夏季高发,临床症状多样,同时可伴有其他眼病或眼部以外变应性疾病.双效药物或抗组胺药物、糖皮质激素或免疫抑制剂的局部应用是变应性结膜炎的常用治疗方法.     

The role of nitric oxide in experimental allergic conjunctivitis

PURPOSE: To evaluate the role of nitric oxide (NO) in the pathogenesis of allergic conjunctivitis and the effect of NO-synthase (NOS) inhibitors. METHODS: The experimental allergic conjunctivitis was provoked in rabbits and healthy human volunteers by mast cell activators (codeine phosphate, 2.5 mg/mL; compound 48/80, 50 mg/mL; and lipopolysaccharide, 10 ng/eye). NOS inhibitors (aminoguanidine [AG], 1.5%, or N(G)-nitro-L-arginine methyl ester [L-NAME], 200 microg/eye) were applied as a pretreatment. In a rabbit model, concentrations of nitrite plus nitrate in the tear were measured colorimetrically using the Griess reaction after 0.5, 1.5, 3, 6, and 9 h. Immunohistochemical study for NOS was performed. The clinical scoring was performed in human volunteers. The vascular permeability was determined by measuring the albumin content in the tear of the challenged human eyes after 1 h. RESULTS: After the instillation of mast cell activator, the NO level and clinical symptoms were markedly increased within 1.5 h. The NOS inhibitors suppressed the NO level. Vascular permeability was also increased in the activator-treated group. The NO-synthase immunoreactivity has been detected in the conjunctival subepithelial area and stroma for brain and endothelial isoform. L-NAME significantly reduces the immunoreactivity for NOS. CONCLUSION: These results suggest that the expression of NOS mainly contributes to the allergic symptoms. Therefore, NO is an important factor in the induction and progress of the allergic reaction to ocular surface. The NOS inhibitors may have a beneficial effect for allergic conjunctivitis.     

Cellular characteristics of non‐allergic eosinophilic conjunctivitis

Purpose: This study examines the histology of conjunctival biopsy samples from patients with persistent allergic eosinophilic conjunctivitis (AEC) or non‐allergic eosinophilic conjunctivitis (NAEC). Methods: Fourteen patients with conjunctivitis and eosinophilia in cytology samples were included in the study. Seven had positive skin‐prick tests (the AEC group) and seven had negative skin‐prick tests (the NAEC group). Eight asymptomatic subjects with negative skin‐prick tests served as a control group. In conjunctival biopsies eosinophils were identified with monoclonal antibodies. Mast cells were identified by specific immunostaining and tryptase‐positive granules were counted around them. The percentage of degranulated mast cells was used as a measure of cell activation. Eosinophil and goblet cell numbers were counted, epithelial thickness was measured, and the symptoms were characterized and graded. Results: The numbers of eosinophils in biopsies were higher in patients with AEC than in healthy controls (p = 0.010). The proportion of activated mast cells tended to be higher in AEC patients (65%) than in NAEC patients (48%) or control subjects (40%). Patients with AEC had more goblet cells than control subjects (p = 0.049) and their epithelial layer was thicker (p = 0.054). Patients with AEC had more severe symptoms than control subjects (p = 0.0005), whereas the symptoms of NAEC patients did not differ statistically from those of controls (p = 0.065). Conclusions: Patients with NAEC were characterized by mild eosinophilic inflammation and only minor structural conjunctival changes. The condition seems to run a relatively mild but persistent clinical course.     

Chitinase levels in the tears of subjects with ocular allergies

PURPOSE: Chitin is abundant in the structural coatings of fungi, insects, and parasitic nematodes. The host defense against chitin-containing pathogens includes production of chitinases. An acidic mammalian chitinase (AMCase) is produced in human epithelial cells of lower airways through a TH2-specific, interleukin-13-dependent pathway and appears to be associated with allergic asthma. The role of AMCase in allergic ocular pathologies has never been studied previously. METHODS: Six patients with vernal keratoconjunctivitis (VKC), 7 patients with season allergic conjunctivitis (SAC), and 8 healthy controls (4 children and 4 adults) were enrolled in this study. AMCase activity was measured in tears, RNA was extracted from epithelial cells of the conjunctiva, and AMCase mRNA expression was evaluated by real-time polymerase chain reaction. RESULTS: AMCase activity was increased in patients affected by VKC (33.7 +/- 10.8 nmol/mL/h) and SAC (7.3 +/- 4.1 nmol/mL/h) compared with healthy controls (1.6 +/- 0.2 nmol/mL/h), and AMCase activity was higher in subjects with VKC (P = 0.0001). Receiver operating characteristic analysis showed that the sensitivity and specificity were 100%, addressing the use of AMCase assay in the biochemical diagnosis of VKC and SAC. AMCase mRNA was detected in epithelial cells of the conjunctiva, and the expression was significantly higher in VKC and SAC. CONCLUSIONS: AMCase may be an important mediator in the pathogenesis of TH2 inflammation eye diseases, suggesting a potential diagnostic and therapeutic target in these pathologies.     

Relation Between Total Tear IgE and Severity of Acute Seasonal Allergic Conjunctivitis

Purpose: Measurement of total tear immunoglobulin E (IgE) is useful for the diagnosis of allergic conjunctivitis, but it is still unknown whether measurement of total tear IgE is useful for assessment of the severity of allergic conjunctivitis. We evaluated the relation between the total IgE level in tears and objective signs of allergic conjunctivitis. Methods: A prospective, nonrandomized, and cross-sectional study was conducted in 84 patients with allergic conjunctivitis (allergic group) and 80 age- and sex-matched healthy control subjects (control group). The total tear IgE score was obtained with the Allerwatch(?) test (0, 1, and 2), and ten severity scores (0, 1, 2, 3) were determined for objective ocular findings of the palpebral and bulbar conjunctiva, as well as limbal and corneal lesions. Results: The scores for total tear IgE and each of the objective ocular findings were higher in the allergic group than in the control group (all p < 0.01). The total tear IgE score was correlated with the severity of each clinical feature of allergic conjunctivitis (p < 0.01), except for corneal epithelial damage in the allergic group. Multivariate analysis revealed that the severity of giant papillae was the most important indicator of the total tear IgE score (odds ratio = 1.33, p < 0.00001). Conclusion: The total tear IgE score was correlated with the scores for objective signs of allergic conjunctivitis. This rapid test for total IgE in tear fluid is easy to perform and could be used to assess the severity of allergic conjunctivitis on an outpatient basis.