Prevalence of allergic conjunctivitis and its therapeutic considerations

When the ocular surface is exposed to allergen, it results in the inflammation of conjunctiva (inside of eyelid covering the eyeball) and cornea leading to allergic conjunctivitis also known as pink eyes. The prevalence of the allergic conjunctivitis is found more in summer and spring (Høvding, 2008). The substance that triggers the conjunctivitis include:

  • pollen,
  • dust,
  • eye drop,
  • mites,
  • irritants (such as cigarette smoke, perfumes)

The symptoms of the conjunctivitis are:

  • red and teary eyes,
  • itching and watery discharge,
  • pain,
  • soreness,
  • swollen eyelids (Azari & Barney, 2013).

There are different types of allergic conjunctivitis:

  • atopic conjunctivitis,
  • simple allergic conjunctivitis,
  • seasonal or perennial conjunctivitis,
  • vernal conjunctivitis
  • and giant papillary conjunctivitis (Quinn et al., 2002).

Prevalence of allergic conjunctivitis

Allergic conjunctivitis is an increasingly prevalent allergic reaction having clinical gravity similar to asthma and allergic rhinitis. Currently around, 40% of global population is suffering from allergic conjunctivitis (Azari & Barney, 2013).

Exposure to particulate matter less than 2.5 µm can lead to allergic reactions. Studies have reflected impact of high PM2.5 levels on increasing prevalence of allergic conjunctivitis among countries like Japan (Mimura et al, 2014). Among the case countries, 40% of the population in Japan is suffering from conjunctivitis and the prevalence is increasing rapidly (Rosario & Bielory, 2011). This is due to change in lifestyle and environmental factors. Further, in case of Africa, the prevalence was found to be 32% and was found most prevalent among children aged between 1-16 years (38.4%) (Malu, 2014). On the other hand in USA and Australia it was found to be 20%. Similarly in case of UK it was found to be 17.5% (Perkin, Bader, Rudnicka, Strachan, & Owen, 2015).

Allergic Conjunctivitis as one of most serious eye problem in India

Pattern of eye diseases in India (Source : Puri, Ashat, Singh, Kaur & Kumar, 2013)

In comparison the prevalence in India is on higher side with 25.5% population affected by this allergy (Puri, Ashat, Singh Sarpal, Kaur, & Kumar, 2013). High level of allergy in India is because of high pollution levels in the country. Critical review of the situation reflects that the prevalence is common among children studying in government schools due to poor hygiene. Further, in India, consequence of allergic conjunctivitis is blindness (prevalent among 1.84%) and corneal blindness (prevalent among 8.6%) (Dandona & Dandona, 2001).

Diagnosis of allergic conjunctivitis

According to research scholars, allergist has a central role in diagnosis of allergic conjunctivitis who determine the disease with evaluation of patient’s clinical history and observation. Further, one can conduct skin test and blood test to test the presence of IgE produced by allergic reaction. Clinically, one of the main tests for the evaluation of the conjunctivitis is by scraping of the conjunctiva tissue. This test examines the white blood cells (WBC), which are activated and increase in number in case of a reaction (Badii, 2016). Also, the allergist test to detect the presence of eosinophil in tears for diagnosis of seasonal or perennial conjunctivitis and vernal or atopic conjunctivitis.

Further, to determine the consequence of allergic conjunctivitis, Visual Acuity Measurement (VAM) is conducted to measure the vision and gravity of infection (Cronau, Kankanala, & Mauger, 2010). In India, Council for Scientific and Industrial Research (CSIR) developed DNA Macro chip for the diagnostic methods and treatment strategies (Sharma, 2010).

Therapeutic considerations

Topical anti histamines in the form of eye drops is used to block the histamine release and to shrink congested blood vessels. According to the research, one should use anti-histamines along with mast cell stabilizer or decongestants. This helps to to bring quick response and treat the symptoms of allergic conjunctivitis i.e. redness, tearing and burning.

Further, Non-Steroidal Anti-inflammatory drugs (NASIDs) and corticosteroids are also used. However over use can make the conditions severe, thus allergists should be consulted for dosage (Quinn et al., 2002). They are preferred treatment drug since they do not have any side effects. Surface acting steroids (fluorometholone, rimexolone) are used to relieve the symptoms such as itching inflammation (Azari & Barney, 2013). Artificial tears (normal saline or lubricant), is another new technique which is used to wash the allergens and reduce irritation (Quinn et al., 2002).

In conclusion, prevalence of the allergy was found mostly in Japan and Africa wherein in case of Japan this is due to high PM2.5 values and in case of Africa it was mostly due to environmental and lifestyle changes.  Currently, research efforts in case of allergic conjunctivitis are focused on severe forms of ocular allergies in order to standardise the diagnosis and development new treatment options.

References

  • Azari, A. A., & Barney, N. P. (2013). Conjunctivitis A Systematic Review of Diagnosis and Treatment. Clinical Review and Education, 310(16), 1–4. https://doi.org/10.1001/jama.2013.280318.
  • Badii, C. (2016). Allergic Conjunctivitis: Types, Causes, and Symptoms. Chicago. Retrieved from http://www.healthline.com/health/allergic-conjunctivitis#Overview1.
  • Cronau, H., Kankanala, R. R., & Mauger, T. (2010). Diagnosis and Management of Red Eye in Primary Care – American Family Physician. American Family Physician, 81(2), 137–144. Retrieved from http://www.aafp.org/afp/2010/0115/p137.html.
  • Dandona, R., & Dandona, L. (2001). Review of findings of the Andhra Pradesh Eye Disease Study: policy implications for eye-care services. Indian Journal of Ophthalmology, 49(4), 215–34. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12930114.
  • Emptage, N. P., Collins, N., & Mizuiri, D. (2013). Conjunctivitis. America.
  • Høvding, G. (2008). Acute bacterial conjunctivitis. Acta Ophthalmologica, 86(1), 5–17. https://doi.org/10.1111/j.1600-0420.2007.01006.x.
  • Malu, K. N. (2014). Allergic conjunctivitis in Jos-Nigeria. Nigerian Medical Journal : Journal of the Nigeria Medical Association, 55(2), 166–70. https://doi.org/10.4103/0300-1652.129664.
  • Mimura T., Ichinose T., Yamagami S., Fujishima H., Kamei Y, Goto M., Takada S., and Matsubara M., (2014). Airborne Particulate Matter (PM 2.5) and the prevalence of allergic conjunctivitis in Japan, Science of the Total Environment, 487, 493-49.
  • Perkin, M. R., Bader, T., Rudnicka, A. R., Strachan, D. P., & Owen, C. G. (2015). Inter-Relationship between Rhinitis and Conjunctivitis in Allergic Rhinoconjunctivitis and Associated Risk Factors in Rural UK Children. PloS One, 10(11), e0143651. https://doi.org/10.1371/journal.pone.0143651.
  • Puri, S., Ashat, M., Singh Sarpal, S., Kaur, T., & Kumar, A. (2013). Pattern and Distribution of Ocular Morbidity in Patients Visiting the Field Practice Area of Tertiary Care Hospital of North India. Journal of Biomedical and Pharmaceutical Research, 2(2), 42–46. Retrieved from jbpr.in/index.php/jbpr/article/viewFile/117/119.
  • Quinn, C. J., Author Dennis Mathews, P. E., Richard Noyes, O. F., Gary Oliver, O. E., James Thimons, O. J., Randall Thomas, O. K., … Mills, D. (2002). Allergic conjunctivitis. In J. C. Townsend (Ed.), Optometric Clinical Practice Guideline care of the patient with conjunctivitis (Second, pp. 1–5). America: American optometric association. Retrieved from www.aoa.org/documents/optometrists/CPG-11.pdf.
  • Rosario, N., & Bielory, L. (2011). Epidemiology of allergic conjunctivitis. Current Opinion in Allergy and Clinical Immunology, 11(5), 471–476. https://doi.org/10.1097/ACI.0b013e32834a9676.
  • Schneider, J. E., Scheibling, C. M., & Segall, D. (n.d.). Epidemiology and Economic Burden of Conjunctivitis: A Managed Care Perspective. Journal of Managed Care Medicine, 17(1), 1–6. Retrieved from www.namcp.org/journals/jmcm/articles/17-1/conjuctivitis.pdf.
  • Sharma, S. (2010). Ocular infections: research in India. Indian Journal of Medical Microbiology, 28(2), 91–4. https://doi.org/10.4103/0255-0857.62481.

Anamika

Research analyst at Project Guru
Anamika is Master’s in Pharmacy. She has worked as an Assistant Professor in Pt. B.D. Sharma University and is a published research scholar. She has worked on severalProjects like Anti-Ulcer Drugs, Sustained Release Formulations, Floating Tablet Formulations. Herinterest lies in books, writing and she loves to travel and explore new places.

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