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LETTER TO THE EDITOR
Year : 2017  |  Volume : 65  |  Issue : 9  |  Page : 899-900

Comment: Allergen-specific exposure associated with high immunoglobulin E and eye rubbing predisposes to progression of keratoconus


Dr. Rajendra Prasad Center of Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication14-Sep-2017

Correspondence Address:
Yogita Gupta
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_517_17

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How to cite this article:
Gupta Y. Comment: Allergen-specific exposure associated with high immunoglobulin E and eye rubbing predisposes to progression of keratoconus. Indian J Ophthalmol 2017;65:899-900

How to cite this URL:
Gupta Y. Comment: Allergen-specific exposure associated with high immunoglobulin E and eye rubbing predisposes to progression of keratoconus. Indian J Ophthalmol [serial online] 2017 [cited 2020 Feb 19];65:899-900. Available from: http://www.ijo.in/text.asp?2017/65/9/899/214650

I read with great interest the article, “Allergen-specific exposure associated with high immunoglobulin E (IgE) and eye rubbing predisposes to progression of keratoconus” by Shetty et al.[1] The authors have commendably investigated the role of ocular allergy in causing keratectasia progression. This contributes well to the present literature on the association of ocular allergy and keratoconus. However, I wish to draw the attention of readers and authors to a few points.

Atopic ocular diseases (AODs) form a spectrum of immune-inflammatory responses [2] characterized by persistent mast cell, eosinophil, and lymphocyte activation that result in pathologic changes, and include seasonal allergic conjunctivitis, perennial allergic conjunctivitis, atopic keratoconjunctivitis (AKC), and vernal keratoconjunctivitis (VKC).[3]

Other causes of clinical improvement and cessation of rubbing in the discussed cases such as patient's conscious avoidance of eye rubbing after clinician's advice and frequent visits to clinic (modified health behavior), temporal association of seasonal improvement (well known in VKC) with avoidance of allergens exposure and response to short course of antihistaminic drugs per se should be borne in mind.

VKC remains an important differential diagnosis and cases could have been alternatively managed as refractory VKC with systemic immunomodulators.[4] A clinical diagnosis could obviate the need for IgE testing, cost limitation of which has been agreed upon by the authors. In addition, skin patch test has been reported to have only low to moderate predictive value [5] in cases of atopy, with not much described on its diagnostic role in AOD.

Furthermore, if AKC is strongly suspected, prompt immunology referral, more complete family history, and further investigations for systemic evidence of atopy (e.g., respiratory allergies, atopic dermatitis) would be helpful since gastrointestinal symptoms (in case 1 having sunflower oil allergy) and dermatological symptoms (in case 2 having allergy to woolen clothes) are well expected due to heightened immunological response (raised serum IgE). Their absence may lead us to exclude AKC. In fact, an IgE level test could have been repeated to document atopy to the allergens, as advice on changing patient's lifestyle to avoid certain exposures should be given by the clinician only after obtaining a convincing body of evidence.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Shetty R, Sureka S, Kusumgar P, Sethu S, Sainani K. Allergen-specific exposure associated with high immunoglobulin E and eye rubbing predisposes to progression of keratoconus. Indian J Ophthalmol 2017;65:399-402.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Strauss EC, Foster CS. Atopic ocular disease. Ophthalmol Clin North Am 2002;15:1-5.  Back to cited text no. 2
[PUBMED]    
3.
La Rosa M, Lionetti E, Reibaldi M, Russo A, Longo A, Leonardi S, et al. Allergic conjunctivitis: A comprehensive review of the literature. Ital J Pediatr 2013;39:18.  Back to cited text no. 3
[PUBMED]    
4.
Leonardi A, Motterle L, Bortolotti M. Allergy and the eye. Clin Exp Immunol 2008;153 Suppl 1:17-21.  Back to cited text no. 4
[PUBMED]    
5.
Diepgen TL, Coenraads PJ. Sensitivity, specificity and positive predictive value of patch testing: The more you test, the more you get? ESCD working party on epidemiology. Contact Dermatitis 2000;42:315-7.  Back to cited text no. 5
[PUBMED]    




 

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