Research abstract about chemical allergy eye reaction from nasal meds

[MaryVa61]

I thought this was pretty interesting since some of my eye pain problems were caused by my nasal sprays for rhinitis, and some of my nasal symptoms were caused by my eye meds, but it took about 15 years to find that out. All due to type IV hypersensitivities and the T.R.U.E. tests identified some of the chemical allergens for me.

http://www.jiaci.org/issues/vol21issue01/11.pdf

This is a pretty good atricle too:

http://www.medscape.com/viewarticle/711467_2

I hope it's useful to someone. DES is bad enough, but then to get these chemical problems on top of it is really tough and eye doctors don't seem to always recognize and treat those, so can really compound the eye pain over time.

Mary

[Scout]

Mary,

Thank you for posting this. I have excerpted from the second article on Medscape (requires account and log-in) with some interesting points:

There are many adverse reactions associated with topical ophthalmic medications. Most of these reactions are toxic and result from chemical irritation. Only about 10% of all adverse reactions to topical ophthalmic drugs are truly allergic. Furthermore, allergies (IgE and cell mediated) are more commonly caused by the active pharmaceutical agents, such as neomycin or sulfa-based agents and rarely by preservatives or other additives.[1,2] As the incorporation of preservatives in topical ophthalmic solutions becomes more common, sensitization toward preservatives is increasing. The salts of benzalkonium have been classified as being moderately allergenic (4–11% skin test positive) whereas mercurial products are strongly allergenic (13–37% of skin tests are positive). True allergic sensitization by other preservatives (chlorhexidine and chlorobutanol) is unusual.

The different types of hypersensitivity reactions can be separated into the following categories: allergic reactions (IgE-mast cell mediated hypersensitivity), cicatrizing allergic conjunctivitis (type II and III hypersensitivities) due to antibody localizing to ocular tissue or immune complexes deposition and allergic contact conjunctivitis, a type IV hypersensitivity reaction (Table 1).[3–5] The term allergy in the ophthalmological literature is commonly used interchangeably with immunological responses of any type and does not necessarily denote an IgE-mast cell mediated process.

The second section that I highlighted above is a very difficult concept to understand, both for patients and for doctors.

Many different ocular reactions (allergic, hypersensitive, inflammatory, toxic, irritated, etc) are confused with each other. However, each one of those reactions has the potential to trigger inflammatory conditions like conjunctivitis, eyelid dermatitis, blepharitis, meibomitis, rhinitis and of course, ocular surface disease and dry eye.

The concern I have for so many dry eye patients is that because of the use of the word “allergies” to describe all types of reactions, many patients do not get a proper diagnosis or treatment.

Eye doctors may suspect allergies and will do a routine exam and conclude that the patient does not have allergies due to the absence of typical allergy symptoms (red, itchy eyes). Or the doctor may refer the patient to an allergist and the allergist performs the scratch test which tests for typical allergens instead of a patch test which uses substances from the patient’s own environment to diagnose contact allergies and sensitivities.

So the dry eye patient thinks they don’t have allergies, when they might be highly sensitive to a chemical or substance that worsens the ocular surface inflammation over time.

If I had not figured out what my eyes were sensitive to, I would be still suffering from pain, redness, headaches and inflammation.

Scout

[MaryVa61]

I couldn't agree more Scout. And I'm an example. None of the specialists I saw before my type IV hypersensitivity diagnosis took responsibility for trying to determine if my severe eye pain was due to hypersensitivities since my allergist had said I don't have Type I allergies.

The eye docs didn't deal with allergies. The allergist didn't deal with non-type IV "allergies" and the Dermatologist didn't deal with DES or "ocular allergies". It was a terrible feeling when I was in severe pain for months and just on my own because no one felt their specialty fit the potential cause of the problem so they wouldn't even attempt to investigate "allergies".

No amount of lubricating drops, plugs or eye medications would have controlled a problem caused by my hypersensitivities to BAK, formaldehyde and fluorescein. When I got answers and removed those things from my life, my eye pain went from a 9 to a 2 most days (with me still treating the DES). Looks like all those types of specialists I saw would want to be a part of doing that for patients.

Mary