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Allergen-specific immunoglobulin E antibodies in tears and serum of vernal conjunctivitis patients.

Tears and sera of 53 patients of vernal conjunctivitis were examined for antibodies of the IgE type to a panel of 18 allergens. In 18 of the patients (34.0%) allergen-specific IgE was demonstrated in both tears and serum, in 3 (5.7%) in tears only, and in 4 (7.5%) in serum only. The antigen-specific reactions with tear fluid were found in patients with the highest total IgE levels, not only in tears but also in serum. This is evidence for a specific, local allergic reaction in these patients. Most positive reactions were to perennial allergens, particularly house dust mites, cat epithelium and Bermuda grass. This fact is in harmony with the lack of season-linked symptoms in most patients in this geographical area.

Allergens↗

Application of histamine-induced conjunctivitis to the assessment of a topical antihistamine, levocabastine.

In an animal model, topical application of levocabastine to the eye inhibits the inflammatory conjunctival response to topically applied histamine. This is so even at one-fourth the concentration at which levocabastine is normally dispensed. Total blocking of histamine response continues for 24 h and is then irregularly observable for an additional 72 h. Levocabastine may be absorbed through the conjunctiva to give systemically transmitted protection to the contralateral eye. Levocabastine is a potent competitor against histamine for conjunctival H1 receptors and should prove a useful, possibly long-acting drug for the reversal of inflammatory conjunctivitis and inhibition of its recurrence.

Administration, Topical↗

Oxatomide effects in follicular conjunctivitis of presumed allergic cause. A double-blind evaluation.

This double-blind study suggests that oxatomide may be considered a first-line alternative in the treatment of allergic follicular conjunctivitis. For 4 weeks 18 patients were treated with oxatomide at a dosage of 30 mg b.i.d. A randomized control group of 17 patients received a placebo. Already after 2 weeks, and more marked after 4 weeks, oxatomide produced a significantly higher reduction of itching and follicles than the placebo, involving a lower use of supplementary antihistamine medication. Globally, an excellent or good result was obtained in 78% of the oxatomide-treated patients but only in 29% of the placebo-treated patients. In the drug group 1 patient had gastrointestinal complaints and 1 felt slightly sleepy.

Adolescent↗

Trimethoprim-polymyxin eye drops versus neomycin-polymyxin-gramicidin eye drops in the treatment of presumptive bacterial conjunctivitis - a double-blind study.

48 patients witha diagnosis of presumptive bacterial conjunctivitis were assessed. They had been treated with either trimethoprim-polymyxin or neomycin-polymyxin-gramicidin eye drops in a randomised double-blind trial. There were 24 patients in each treatment group. There were no significant differences between the two preparations proved with regard to the eradication of organisms or clinical improvement, and both preparations proved to be very effective. Patient compliance was good and no adverse reactions were encountered with either preparation.

Adolescent↗

Conjunctivitis caused by human parvovirus B19 infection.

A 26-year-old woman with erythema infectiosum is reported. She had small faint erythemas on her extremities and congestion of palpebral and bulbar conjunctiva of both eyes. Human parvovirus B19 (B19) DNA was detected in the specimen of the conjunctiva by the polymerase chain reaction. This result suggests that conjunctivitis in erythema infectiosum may cause the B19 infection.

Adult↗

Roles of OX40 in the development of murine experimental allergic conjunctivitis: exacerbation and attenuation by stimulation and blocking of OX40.

PURPOSE: To investigate the roles of interaction between OX40 and OX40 ligand (OX40L) in the development of experimental allergic conjunctivitis (EC) in mice. METHODS: BALB/c mice actively immunized with short ragweed pollen (RW) were intraperitoneally injected on days 0, 2, 4, 6, and 8 with agonistic anti-OX40 Ab, blocking anti-OX40L Ab, or normal rat (nr)IgG. On day 10, the mice were challenged with RW in eye drops, and 24 hours later their conjunctivas, spleens, and blood were harvested for analyses. For examination of the effects of the Abs during the late induction (or effector) phase, actively immunized mice were treated with the Abs just before or at the same time as the challenge. In addition, splenocytes from RW-primed mice were transferred into syngeneic naïve mice, and the recipients were treated with Abs twice (on days 2 and 4). On day 4, the mice were challenged with RW and evaluated. RESULTS: When the treatments were performed during the induction phase, anti-OX40 Ab treatment significantly increased clinical EC and eosinophil infiltration into the conjunctiva, whereas anti-OX40L Ab treatment significantly reduced eosinophil infiltration. Compared with splenocytes from nrIgG-treated mice, splenocytes from anti-OX40 Ab-treated mice proliferated vigorously against RW and produced significantly higher amounts of IL-2, -4, and -5 by RW stimulation but a significantly lesser amount of IFN-gamma after Con A stimulation. In contrast, splenocytes from anti-OX40L Ab-treated mice produced significantly less IL-5 with RW stimulation and IL-2 and IL-5 with Con A stimulation, whereas significantly more IFN-gamma was induced by Con A stimulation. Treatment with anti-OX40 and anti-OX40L Abs during the late induction or effector phase of EC did not affect eosinophil infiltration. CONCLUSIONS: Blocking of the interaction between OX40 and OX40L in vivo inhibits the development of EC. In contrast, forced stimulation of OX40 in vivo significantly exacerbates EC by activating T cells, especially Th2 cells. These effects were noted only in the induction phase of EC, suggesting that the interaction between OX40 and OX40L is important in the generation of Th2 immune responses in the development of EC.

Adoptive Transfer↗

Novel transglutaminase inhibitors reverse the inflammation of allergic conjunctivitis.

Steroidal anti-inflammatory drugs induce proteins that inhibit phospholipase A(2) (PLA(2)), including uteroglobin and lipocortin-1 (annexin I). Uteroglobin and lipocortin-1 retain several conserved sequences. Based on these sequences, several nonapeptides (antiflammins) were synthesized. These nonapeptides were shown to have anti-inflammatory effects in vitro and in vivo, possibly by inhibiting PLA(2). Subsequent research showed that PLA(2) is activated by transglutaminase 2 (TGase 2). We hypothesize here that TGase 2 inhibitors may increase the anti-inflammatory efficacy of inhibiting PLA(2) activity. To test this theory, we constructed recombinant peptides containing sequences from pro-elafin (for inhibition of TGase 2), and from lipocortin-1, lipocortin-5, and uteroglobin (for inhibition of PLA(2)). The recombinant peptides, which had dual inhibitory effects on purified TGase 2 and PLA(2), reversed the inflammation of allergic conjunctivitis to ragweed in a guinea pig model. The present work suggests that novel recombinant peptides may be safe and effective agents for the treatment of various inflammatory diseases.

Animals↗

Acute bacterial conjunctivitis. Bacteriology and clinical implications.

We report the results of eye culture specimens, obtained from patients under 20 years of age, submitted to the Bacteriology Department of our institution from January 1 through April 30, 1983. A total of 72 specimens were positive for one or more strains of bacteria. The most commonly isolated bacteria was Hemophilus influenzae (34 strains, 42%), followed by Staphylococcus epidermidis (11 strains, 13.75%) and Streptococcus pneumoniae (9 strains, 11.25%). Mean age of patients with H. influenzae (excluding a 20-year-old patient) was 15 months with standard deviation of 13 months. Chloramphenicol and tetracycline showed excellent in vitro activity against bacteria of all age groups. Tetracycline may prove to be the drug of choice for the treatment of acute conjunctivitis if comparative clinical data support its in vitro superiority.

Adolescent↗

Meningococcal conjunctivitis in neonates.

Three neonates were admitted with purulent conjunctivitis, and an initial diagnosis of gonococcal ophthalmia was made because gram-negative diplococci were seen on gram stains of conjunctival exudates. Meningococci were grown from eye exudates of all three infants and from the blood of one. Since Neisseria species other than gonococci can sometimes cause neonatal ophthalmia, an etiologic diagnosis should not be made until microbiologic identification is complete. Before the results of definitive bacteriologic studies are known, care should be taken in discussing the cause of the infection with family members and in planning their medical management. Since systemic infections may occur in some infants with ophthalmia due to Neisseria species, blood and spinal fluid in addition to eye exudate cultures may be indicated, and patients should be managed with parenteral antibiotics.

Anti-Bacterial Agents↗

Oxymetazoline in the treatment of allergic and non-infectious conjunctivitis.

In a double-blind study of 141 patients, 0.025% oxymetazoline ophthalmic solution was compared with its vehicle in the treatment of allergic and non-infectious conjunctivitis. There was a marked difference in response at the first evaluation. By the tenth day (second evaluation) the total improvement in hyperaemia was 95% for oxymetazoline compared to 54% for the placebo. Oxymetazoline's decongestant effect in the eye matches its effect as a nasal vasoconstrictor.

Adolescent↗

A comparison of topical mequitazine and disodium cromoglycate in allergic conjunctivitis induced by a specific conjunctival provocation test.

PURPOSE: Twenty-two people with a history of grass pollen allergic conjunctivitis were enrolled outside the pollen season in this study to compare the efficacy of 0.05% mequitazine eyedrops with topical 2% disodium cromoglycate. METHODS: This randomized, double-blind study compared right and left eyes. Subjects received 2% disodium cromoglycate eyedrops in one eye and mequitazine vehicle in the fellow eye 4 times daily for 4 days. For the last instillation, mequitazine vehicle was replaced by one drop of 0.05% mequitazine and 15 min later a conjunctival provocation test (CPT) with grass pollen was performed. RESULTS: The sum of the scores for hyperemia and itching, and total composite score were lower after 0.05% mequitazine than after 2% disodium cromoglycate (p < 0.0001 in each case). The allergen threshold dose which elicited a positive allergic response was higher in the mequitazine group (p < 0.001). Both treatments showed good tolerance upon instillation. No adverse events related to study treatment occurred. CONCLUSIONS: These results demonstrate the superior efficacy of a single drop of 0.05% mequitazine 15 min before CPT compared with 2% disodium cromoglycate 4 times daily for 4 days.

Administration, Topical↗

Tear and serum eosinophil cationic protein levels in seasonal allergic conjunctivitis.

PURPOSE: Eosinophil cationic protein (ECP) levels in tear fluid and sera of patients with seasonal allergic conjunctivitis (SAC) were measured to assess local and systemic eosinophilic activity in SAC. The correlation between ECP levels and disease activity was evaluated. METHODS: Tears and sera were collected from 21 patients with SAC and 13 healthy control subjects. ECP levels in tears and sera were measured before and 4 weeks after treatment with 0.1% lodoxamide eyedrops. Clinical signs and symptoms of SAC were scored and the correlation of ECP levels with the clinical scores was evaluated. RESULTS: Tear and serum levels of ECP were significantly increased (p = 0.01, p = 0.02, respectively) in patients with SAC compared with the control subjects, but ECP levels were not correlated with the severity of the disease. Following treatment with topical 0.1% lodoxamide eyedrops, the mean level of ECP in tears decreased significantly (p = 0.02), whereas no significant change was observed in serum ECP levels. Furthermore, a significant decrease in clinical signs and symptoms scores was found after treatment (both p < 0.0001). CONCLUSIONS: Increased serum and tear ECP levels in patients with SAC confirms that both local and systemic eosinophil activation occurs in SAC. However, clinical signs and symptoms of SAC were not found to be correlated with the degree of eosinophilic activity. Thus ECP does not seem to have an important role in clinical manifestations of SAC.

Adult↗

Efficacy of norfloxacin in bacterial conjunctivitis.

We investigated the efficacy and safety of norfloxacin 0.3% ophthalmic solution in 120 patients with bacterial conjunctivitis or blepharitis. Patients were selected for the study if they showed conjunctival hyperemia and at least three of the following criteria: a) symptoms of a surface ocular infection; b) a purulent discharge; c) crusting of the eyelids, and d) thickened, red lid margins. After taking a specimen for culture from the conjunctiva or skin-lash margin, the test drug was administered to the infected eye every two hours for one day, then 4 times daily for one week. Of the 120 patients who entered the study, 84.1% were cured. No serious adverse reactions occurred.

Adolescent↗

The safety and efficacy of topical norfloxacin compared with placebo in the treatment of acute, bacterial conjunctivitis. The Norfloxacin-Placebo Ocular Study Group.

Two hundred and eighty-four patients with acute conjunctivitis were enrolled in a double-masked study comparing norfloxacin ophthalmic solution with placebo. The proportion of patients who were clinically improved after 5 days treatment was 88.1% in the norfloxacin group and 71.6% in the placebo group (p less than 0.01). The proportion of patients who had all organisms eradicated, including the coagulase-negative staphylococci, after two to three days treatment was 52.7% for norfloxacin and 23.9% for placebo (p less than 0.01) and 64.7% and 26.3% (p less than 0.01) respectively when the coagulase-negative staphylococci were not included. Adverse experiences occurred in 4.2% of the patients receiving norfloxacin compared to 7.1% of the placebo patients. None of the adverse experiences was serious.

Acute Disease↗

Group comparative trial of 2% nedocromil sodium with placebo in the treatment of seasonal allergic conjunctivitis.

A double blind group comparative trial comparing 2% nedocromil sodium with placebo in treating seasonal allergic conjunctivitis over a four week period is reported. Sixty-four patients were analysed. During the period of peak pollen challenge, statistically significant differences in favour of nedocromil sodium for itching and soreness were demonstrated. During a longer period of a less high pollen count, a significant difference in favour of nedocromil sodium was shown only for the symptom of soreness.

Conjunctivitis, Allergic↗

Levocabastine eye drops: a new approach for the treatment of acute allergic conjunctivitis.

Acute allergic conjunctivitis (AAC) is a common ocular allergic disorder and incident rates as high as 20% have been reported. Although a wide range of therapeutic agents are available for the treatment of AAC, the ideal treatment seems to have remained elusive. Levocabastine, a highly potent specific H1-receptor, appears to offer a promising alternative as a topical single-agent therapy. Levocabastine eye drops have been found to be well tolerated with an adverse-effect profile comparable to placebo and sodium cromoglycate. In addition, ocular levocabastine has been shown to have a rapid onset and long duration of action. The efficacy of levocabastine has been extensively investigated in conjunctival provocation tests and environmental studies. The available data suggest that ocular levocabastine is an effective therapeutic agent. Statistically significant differences in favour of levocabastine have been observed in comparisons with sodium cromoglycate, antazoline/naphazoline and oral terfenadine.

Acute Disease↗

Unusual manifestations of giant cell arteritis: pulmonary nodules, cough, conjunctivitis and otitis with deafness.

The major manifestations of giant cell arteritis have been well described. Pulmonary manifestations, however, are rare. We report the case of a 75 year old woman with temporal arteritis, presenting with atypical manifestations, i.e. nodular pulmonary lesions, dry cough, rhinitis, conjunctivitis, and otitis with hearing loss. We conclude that overlapping features of giant cell arteritis and Wegener's granulomatosis occur in some patients.

Aged↗

Effects of a new formulation of olopatadine ophthalmic solution on nasal symptoms relative to placebo in two studies involving subjects with allergic conjunctivitis or rhinoconjunctivitis.

BACKGROUND: A new formulation of olopatadine hydrochloride ophthalmic solution (olopatadine 0.2%) was evaluated in two separate, randomized, placebo-controlled, double-masked, hybrid environmental studies intended to determine efficacy and safety in subjects with histories of seasonal allergic conjunctivitis or rhinoconjunctivitis. DESIGN AND METHODS: In these 10- and 12-week trials (conducted April-August 2003 and July-December 2001, respectively), subjects assessed their ocular signs and symptoms. Additionally, subjects in the 10-week trial evaluated the frequency of their nasal symptoms while subjects in the 12-week trial evaluated both the frequency and severity of their nasal symptoms. The two trials had a combined enrollment of 500 subjects (217 males, 283 females) including 44 children aged 10-17 years; the combined population was 81.4% Caucasian, 9.2% Black, 2% Hispanic, and 7.4% other. Daily throughout these studies, either ragweed (fall study) or grass (spring study) pollen counts were obtained from each investigative center. Slope analyses were conducted on the nasal symptom assessments by pollen count. RESULTS: The nasal results from the two clinical trials are presented herein. In the fall study, relative to placebo, olopatadine 0.2% significantly reduced the frequency of pollen effects on sneezing (p = 0.0355) and itchy nose (p = 0.0032), and reduced the severity of pollen effects on sneezing (p = 0.0451), itchy nose (p = 0.0178), and runny nose (p = 0.0327). In the spring study, olopatadine 0.2% significantly reduced the frequency of pollen effects on sneezing (p = 0.0017) and runny nose (p = 0.0031) relative to placebo. In the fall trial, 2 subjects discontinued due to treatment-related adverse events (tachycardia and dry eye), while in the spring study, no subject discontinued due to a treatment-related adverse event. No subject in either study suffered a treatment-related serious adverse event. CONCLUSIONS: For the subjects enrolled in these studies, olopatadine 0.2% appeared to be safe, well-tolerated, and effective in significantly reducing the frequency and/or severity of some effects of pollen on nasal symptoms.

Adolescent↗