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    What's trending in ocular allergy treatment

    Prevalence of allergy is increasing, and so should your knowledge

    The advent of spring yields the annual pilgrimage of patients into our offices complaining of the itchy, watery eyes of allergy. As any eyecare practitioner can attest, ocular allergy is one of the most common presentations to an eyecare practice. The ocular conjunctiva is particularly susceptible to airborne allergens and is a very common site of allergic inflammation.1

    Ocular allergy presents in conjunction with other systemic atopic manifestations, including rhinoconjunctivitis (hay fever), rhinosinusitis, asthma, urticaria (hives), and/or atopic dermatitis (eczema).1 Ocular allergy includes a spectrum of disorders with overlapping symptoms and progressing in severity; these disorders include seasonal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC), atopic keratoconjunctivitis (AKC), and vernal keratoconjunctivitis (VKC). SAC and PAC are the most common forms of ocular allergy.

    Prevalence of allergy

    Approximately 15-20 percent of the world population is affected by some form of allergic disease. Ocular symptoms present in about 40-60 percent of allergic patients2 and contribute significantly to poor quality of life.3 Most recent estimates suggest that 15–25 percent of the U.S. population, or between 50 and 85 million Americans, suffer from ocular allergy and/or allergic conjunctivitis.4,5 Other studies have estimated the prevalence of allergic conjunctivitis to range between 15 and 40 percent of the U.S. population.6 Here in the United States, the National Health and Nutrition Examination Survey III (NHANES III) found that 40 percent of the adult population had ocular symptoms, defined as “episodes of tearing and ocular itching,  with no significant differences according to age, though there was a predominance in the south vs. other regions of the country.7 The prevalence of allergic conjunctivitis is similar in Europe, Japan, and Australia, and is increasing worldwide.6

    Nonpharmacologic care for ocular allergies

    According to an analysis from 1993 to 2008, prescribing medications for allergic conditions has similarly accelerated by about 20 percent.8 This likely reflects an increasing prevalence of allergic disease in developed countries. Although the exact reason for this increase is not known, many factors are thought to play a role, including air pollution, industrialization and urbanization, climate change, and the “hygiene hypothesis,” which in essence attributes immune hypersensitivity among city dwellers to low microbial exposure during childhood.1,9

    While not life threatening, the symptoms of ocular allergy as suffered by affected individuals have a significant impact on their productivity and quality of life.10 Ocular allergy symptoms can produce patient discomfort and interfere with visual tasks, including computer work and recreational activities. The quality of life of patients dealing with allergic conjunctivitis can be affected by intense itching, which produces sensation of dryness, vision fatigue and reading difficulties. Some 20 percent of allergy suffers report missing some time from work due to allergy symptoms.11 More severe forms of the ocular allergy, such as AKC12 or VKC,13 are rare yet can be sight threatening. Similar to other allergic conditions, allergic conjunctivitis may demonstrate both an early, acute phase triggered by mast cell degranulation and a late, chronic phase involving allergic inflammation.14

    SAC and PAC have seen a worldwide trend of increased prevalence over the past few decades.6 For example, increases in SAC and PAC in children have been well documented by the International Study of Asthma and Allergies in Childhood (ISAAC).15 Earlier studies suggest a difference between children from developed countries and those from more rural countries: while the overall health of children from underdeveloped countries may be worse, their risk of developing allergic disease was substantially lower than that seen in Europe, North America, or Japan.16 Nations undergoing substantial economic growth report spikes in the prevalence of allergic conjunctivitis and symptoms associated with rhinitis or allergic conjunctivitis.16

    Diagnosing and managing ocular allergy

    Another factor in the rise in allergic disease prevalence receiving considerable attention in recent literature is the role of air pollution as an exacerbating factor in allergic signs and symptoms.17 About 89 percent of the world’s population lives in areas where the levels of airborne particulate matter exceed the World Health Organization’s (WHO) guidelines for air quality.18 There is also evidence that suggests some allergic resistance is passed passively from mother to child. Children born by Caesarean section19 and those who were fed milk other than breast milk during the first 4 months of life20 have an increased risk of developing allergies.

    Next: Diagnosing ocular allergy

    Ernie Bowling, OD, MS, FAAO
    Dr. Ernie Bowling is Chief Optometric Editor of Optometry Times. He received his Doctor of Optometry and Master of Science in ...

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