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| ORIGINAL ARTICLE |
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| Year : 1992 | Volume
: 40
| Issue : 1 | Page : 9-10 |
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Immunotherapy in allergic conjunctivitis
OM Prakash1, KR Murthy2
1 Physician and Allergist, St Martha s Hospital, Bangalore, India
2 Consultant Ophthalmologist, Prabha Eye Clinic, Bangalore, India
Correspondence Address:
O M Prakash
5A. Kumar Krupa Road, High Grounds. Bangalore 560001
India
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 1464456 
Eighty patients with allergic conjunctivitis were treated with immunotherapy employing specific allergens. Sixty-two percent of these showed beneficial response. In cases of vernal conjunctivitis needing topical steroid preparations frequently for control of symptoms, immunotherapy is worth attempting to cause remission of symptoms.
How to cite this article:
Prakash O M, Murthy K R. Immunotherapy in allergic conjunctivitis. Indian J Ophthalmol 1992;40:9-10 |
| Introduction | |  |
Allergic conjunctivitis is a common clinical entity which causes considerable ocular morbidity. Therapy with topical diluent drops and corticosteroid preparations provides transient relief. The use of sodium cromoglycate eyedrops can give additional benefit in some patients [1]. Long term use of corticosteroid drops and ointments is associated with the risk of raised intraocular tension as well as cataract formation. The role of immunotherapy (hyposensitisation) with specific antigens has not been widely studied. Though there is reference to this mode of therapy in the literature [2], there are no published reports in Indian literature. The aim of this study was to attempt immunotherapy in cases of allergic conjunctivitis; our experiences in this regard are reported.
| Material and methods | | |
Eighty subjects suffering from allergic conjunctivitis were studied. These subjects were initially examined by the ophthalmologists and after diagnosis, were referred for allergy evaluation. All three clinical types of cases, namely palpebral, limbal and mixed were included in the study. The presence of the allergic state was diagnosed by performing skin prick tests with a battery of common inhalant allergens relevant to South India. These were according to established methods [3]. These allergens included dust, dust mite, common pollens and fungal allergens, and environmental allergens such as insects. The positive reactions were recorded and the allergy desensitising vaccine prescribed. The vaccine was supplied by a commercial company as per the prescription for each patient. The subjects generally received three concentrations of antigens ending with the most concentrated solution. These solutions were: 1:5000 (w/v), 1:500 and 1:50. Later on, maintenance immunotherapy was continued with the 1:50 concentration for a prolonged period. The duration of immunotherapy ranged from 12 to 24 months. As the therapy was in progress, monthly follow-up visits to the ophthalmologist were adhered to. A record of symptoms and signs was made and any change in the need for medications noted. In order to assess the response in an objective manner, the following criteria were employed:
a. Excellent response: Complete remission in symptoms and signs with no need for topical medications.
b. Fair response: Substantial reduction in symptoms and signs with considerable reduction in medication needs.
c. Poor response: No significant change in symptoms or signs with no change in medication needs.
| Results | | |
The age and sex data of the patients are shown in [Table - 1]. The mean duration of the vernal conjunctivitis as well as the presence of collateral atopy such as rhinitis or asthma are shown in [Table - 2]. Based on the criteria of improvement as noted above, it was noted that thirty percent of the patients showed excellent response to immunotherapy. A further thirty two percent showed fair response, while the rest of the subjects showed no improvement.
| Discussion | | |
The results of this study revealed that sixty two percent of subjects who received immunotherapy responded to it. A variety of allergens can cause exacerbation of allergic symptoms including dust, dustmite, common pollens and fungi as well as insect allergens. It was encouraging to note the response, particularly in the more resistant cases. Such cases are likely to need frequent topical steroid preparations, with associated risks. In this series, two young subjects needed cataract extraction which was iatrogenic in nature. It would therefore appear necessary to attempt an alternate mode of therapy in cases where frequent steroid use is becoming a matter of concern.
Vernal catarrh is one manifestation of type I allergy, wherein antigen-antibody interaction on the surface of the mast cells leads to mediator release and its deleterious consequences. The mechanism of action of immunotherapy would be similar to that which is obtained in treatment of rhinitis and asthma. Immunotherapy with a multi-antigen vaccine specific to the patients' allergy profile causes progressively increasing amounts of blocking antibodies (IgC and IgM); this, coupled with the diminution of the production of specific IgE antibody, is believed to be the main mode of action of immunotherapy [4]. As in other atopic states, hyposensitization caused salutary effects in a proportion of cases The reason for failure in a section of cases is not clear. Nevertheless, the lasting beneficial effects of immunotherapy is very encouraging, particularly, the cessation of topical steroids in many cases was a welcome development. Hence, we feel that in severe cases of vernal conjunctivitis, resistant to conventional methods of treatment, immunotherapy is worth trying as a mode of treatment.
| Acknowledgement | | |
The authors wish to thank Drs Prasasnna Kumar and Neelakantan for case referral. The help and interest of Dr. Bakula Kasyap is gratefully appreciated. The antigens for testing and immunotherapy were obtained from Curewel India Ltd. and Faridabad, Haryana
| References | | |
| 1. | Foster, C.S. Randomised clinical trial of topically administered cromolyn sodium in vernal keratoconjunctivitis. Am J. Opthalmol. 1980. 90. 175.  |
| 2. | Truft, L and Mueller. H. L. in Allergy in Children, W. B. Saunders Company, Philadelphia, 1970. |
| 3. | Pepys, J. in Clinical Aspects of Immunology. Eds. Gell PG H. and Coombs R.R.A.. Blackwell Scientific Publications. London. 1975. |
| 4. | Lawlor, G.J. and Fischer, TJ. in Manual of Allergy and Immunology. Little Brown and Company, Boston. 1981. |
[Table - 1], [Table - 2]
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