Allergic conjunctivitis laboratory findings: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Allergic conjunctivitis}} | {{Allergic conjunctivitis}} | ||
{{CMG}} {{AE}} {{Sujaya}} | |||
==Overview== | ==Overview== | ||
[[Allergic]] [[conjunctivitis]] is usually a [[clinical]] [[diagnosis]]. [[Laboratory]] tests are primarily supportive. They may help in differentiating [[intrinsic]] and [[extrinsic]] forms of the condition and thus, guide the [[treatment]]. | [[Allergic]] [[conjunctivitis]] is usually a [[clinical]] [[diagnosis]]. [[Laboratory]] tests are primarily supportive. They may help in differentiating [[intrinsic]] and [[extrinsic]] forms of the condition and thus, guide the [[treatment]]. | ||
==Laboratory findings== | ==Laboratory findings== | ||
===[[Skin]] [[prick]] test=== | ===[[Skin]] [[prick]] test=== | ||
[[Intradermal]] [[injections]] of [[individual allergens]] are administered to detect [[sensitivity]]<ref name="pmid23497516">{{cite journal| author=La Rosa M, Lionetti E, Reibaldi M, Russo A, Longo A, Leonardi S | display-authors=etal| title=Allergic conjunctivitis: a comprehensive review of the literature. | journal=Ital J Pediatr | year= 2013 | volume= 39 | issue= | pages= 18 | pmid=23497516 | doi=10.1186/1824-7288-39-18 | pmc=3640929 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23497516 }} </ref>. | *[[Intradermal]] [[injections]] of [[individual allergens]] are administered to detect [[sensitivity]]<ref name="pmid23497516">{{cite journal| author=La Rosa M, Lionetti E, Reibaldi M, Russo A, Longo A, Leonardi S | display-authors=etal| title=Allergic conjunctivitis: a comprehensive review of the literature. | journal=Ital J Pediatr | year= 2013 | volume= 39 | issue= | pages= 18 | pmid=23497516 | doi=10.1186/1824-7288-39-18 | pmc=3640929 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23497516 }} </ref>. | ||
* It is a highly sensitive test<ref name="pmid18431959">{{cite journal| author=Bernstein IL, Li JT, Bernstein DI, Hamilton R, Spector SL, Tan R | display-authors=etal| title=Allergy diagnostic testing: an updated practice parameter. | journal=Ann Allergy Asthma Immunol | year= 2008 | volume= 100 | issue= 3 Suppl 3 | pages= S1-148 | pmid=18431959 | doi=10.1016/s1081-1206(10)60305-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18431959 }} </ref>. | |||
*The result is considered positive when the resulting [[wheal]] is at least 3 mm larger than the negative control. [[Systemic]] reactions are rare<ref name="pmid11167952">{{cite journal| author=Wilson AM, Orr LC, Sims EJ, Lipworth BJ| title=Effects of monotherapy with intra-nasal corticosteroid or combined oral histamine and leukotriene receptor antagonists in seasonal allergic rhinitis. | journal=Clin Exp Allergy | year= 2001 | volume= 31 | issue= 1 | pages= 61-8 | pmid=11167952 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11167952 }} </ref>. | |||
===[[IgE]] estimation=== | ===[[IgE]] estimation=== | ||
[[In-vitro]] tests to detect [[IgE]] [[antibodies]] to specific [[allergens]] are widely used<ref name="pmid29996875">{{cite journal| author=Arasi S, Corsello G, Villani A, Pajno GB| title=The future outlook on allergen immunotherapy in children: 2018 and beyond. | journal=Ital J Pediatr | year= 2018 | volume= 44 | issue= 1 | pages= 80 | pmid=29996875 | doi=10.1186/s13052-018-0519-4 | pmc=6042356 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29996875 }} </ref>. | [[In-vitro]] tests to detect [[IgE]] [[antibodies]] to specific [[allergens]] are widely used<ref name="pmid29996875">{{cite journal| author=Arasi S, Corsello G, Villani A, Pajno GB| title=The future outlook on allergen immunotherapy in children: 2018 and beyond. | journal=Ital J Pediatr | year= 2018 | volume= 44 | issue= 1 | pages= 80 | pmid=29996875 | doi=10.1186/s13052-018-0519-4 | pmc=6042356 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29996875 }} </ref> if skin testing is indicated but not advised such as<ref name="pmid31993069">{{cite journal| author=Dupuis P, Prokopich CL, Hynes A, Kim H| title=A contemporary look at allergic conjunctivitis. | journal=Allergy Asthma Clin Immunol | year= 2020 | volume= 16 | issue= | pages= 5 | pmid=31993069 | doi=10.1186/s13223-020-0403-9 | pmc=6975089 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31993069 }} </ref>: | ||
*The patient cannot discontinue [[antihistaminic]] [[medications]] | |||
*Ambiguous results (e.g., presence of [[dermatographism]]) | |||
*To complement the results of previous [[skin]] testing. | |||
===[[Conjunctival]] [[allergen]] challenge=== | |||
* It involves instillation of an [[allergen]] on the [[conjunctiva]] of the affected [[eye]] and a control solution in the other<ref name="pmid27430124">{{cite journal| author=Fauquert JL, Jedrzejczak-Czechowicz M, Rondon C, Calder V, Silva D, Kvenshagen BK | display-authors=etal| title=Conjunctival allergen provocation test : guidelines for daily practice. | journal=Allergy | year= 2017 | volume= 72 | issue= 1 | pages= 43-54 | pmid=27430124 | doi=10.1111/all.12986 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27430124 }} </ref>. | |||
* More common in [[research]] settings to test [[novel]] [[treatments]] or to compare existing [[therapies]]<ref name="pmid31993069">{{cite journal| author=Dupuis P, Prokopich CL, Hynes A, Kim H| title=A contemporary look at allergic conjunctivitis. | journal=Allergy Asthma Clin Immunol | year= 2020 | volume= 16 | issue= | pages= 5 | pmid=31993069 | doi=10.1186/s13223-020-0403-9 | pmc=6975089 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31993069 }} </ref>. | |||
* Clinically helpful to identify local [[allergies]] in suspect patients but with negative or discordant [[skin]] prick testing and [[serum]] specific [[IgE]]<ref name="pmid25997302">{{cite journal| author=Sánchez-Hernández MC, Montero J, Rondon C, Benitez del Castillo JM, Velázquez E, Herreras JM | display-authors=etal| title=Consensus document on allergic conjunctivitis (DECA). | journal=J Investig Allergol Clin Immunol | year= 2015 | volume= 25 | issue= 2 | pages= 94-106 | pmid=25997302 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25997302 }} </ref> . *Useful to assess the relationship between [[symptoms]] and [[exposure]] in [[polysensitized]] [[patients]] and the response to initiated therapy<ref name="pmid25997302">{{cite journal| author=Sánchez-Hernández MC, Montero J, Rondon C, Benitez del Castillo JM, Velázquez E, Herreras JM | display-authors=etal| title=Consensus document on allergic conjunctivitis (DECA). | journal=J Investig Allergol Clin Immunol | year= 2015 | volume= 25 | issue= 2 | pages= 94-106 | pmid=25997302 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25997302 }} </ref>. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Latest revision as of 18:44, 7 September 2022
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sujaya Chattopadhyay, M.D.[2]
Overview
Allergic conjunctivitis is usually a clinical diagnosis. Laboratory tests are primarily supportive. They may help in differentiating intrinsic and extrinsic forms of the condition and thus, guide the treatment.
Laboratory findings
Skin prick test
- Intradermal injections of individual allergens are administered to detect sensitivity[1].
- It is a highly sensitive test[2].
- The result is considered positive when the resulting wheal is at least 3 mm larger than the negative control. Systemic reactions are rare[3].
IgE estimation
In-vitro tests to detect IgE antibodies to specific allergens are widely used[4] if skin testing is indicated but not advised such as[5]:
- The patient cannot discontinue antihistaminic medications
- Ambiguous results (e.g., presence of dermatographism)
- To complement the results of previous skin testing.
Conjunctival allergen challenge
- It involves instillation of an allergen on the conjunctiva of the affected eye and a control solution in the other[6].
- More common in research settings to test novel treatments or to compare existing therapies[5].
- Clinically helpful to identify local allergies in suspect patients but with negative or discordant skin prick testing and serum specific IgE[7] . *Useful to assess the relationship between symptoms and exposure in polysensitized patients and the response to initiated therapy[7].
References
- ↑ La Rosa M, Lionetti E, Reibaldi M, Russo A, Longo A, Leonardi S; et al. (2013). "Allergic conjunctivitis: a comprehensive review of the literature". Ital J Pediatr. 39: 18. doi:10.1186/1824-7288-39-18. PMC 3640929. PMID 23497516.
- ↑ Bernstein IL, Li JT, Bernstein DI, Hamilton R, Spector SL, Tan R; et al. (2008). "Allergy diagnostic testing: an updated practice parameter". Ann Allergy Asthma Immunol. 100 (3 Suppl 3): S1–148. doi:10.1016/s1081-1206(10)60305-5. PMID 18431959.
- ↑ Wilson AM, Orr LC, Sims EJ, Lipworth BJ (2001). "Effects of monotherapy with intra-nasal corticosteroid or combined oral histamine and leukotriene receptor antagonists in seasonal allergic rhinitis". Clin Exp Allergy. 31 (1): 61–8. PMID 11167952.
- ↑ Arasi S, Corsello G, Villani A, Pajno GB (2018). "The future outlook on allergen immunotherapy in children: 2018 and beyond". Ital J Pediatr. 44 (1): 80. doi:10.1186/s13052-018-0519-4. PMC 6042356. PMID 29996875.
- ↑ 5.0 5.1 Dupuis P, Prokopich CL, Hynes A, Kim H (2020). "A contemporary look at allergic conjunctivitis". Allergy Asthma Clin Immunol. 16: 5. doi:10.1186/s13223-020-0403-9. PMC 6975089 Check
|pmc=value (help). PMID 31993069. - ↑ Fauquert JL, Jedrzejczak-Czechowicz M, Rondon C, Calder V, Silva D, Kvenshagen BK; et al. (2017). "Conjunctival allergen provocation test : guidelines for daily practice". Allergy. 72 (1): 43–54. doi:10.1111/all.12986. PMID 27430124.
- ↑ 7.0 7.1 Sánchez-Hernández MC, Montero J, Rondon C, Benitez del Castillo JM, Velázquez E, Herreras JM; et al. (2015). "Consensus document on allergic conjunctivitis (DECA)". J Investig Allergol Clin Immunol. 25 (2): 94–106. PMID 25997302.