Allergic conjunctivitis: Clinical manifestations and diagnosis
- Pedram Hamrah, MD
Pedram Hamrah, MD
- New England Eye Center/Tufts Medical Center
- Tufts University School of Medicine
- Reza Dana, MD, MPH, MSc
Reza Dana, MD, MPH, MSc
- Claes Dohlman Professor of Ophthalmology
- Harvard Medical School
The most prevalent forms of allergic conjunctivitis are acute allergic conjunctivitis, which develops upon episodic exposure to an allergen, as well as seasonal and perennial allergic conjunctivitis. These are relatively benign ocular diseases that cause significant suffering and use of healthcare resources, although they typically do not threaten vision.
The clinical manifestations, epidemiology, pathogenesis, diagnosis, and differential diagnosis of seasonal and perennial allergic conjunctivitis are reviewed here. The management of these disorders is reviewed separately. (See "Allergic conjunctivitis: Management".)
An overview of conjunctivitis and discussions of other specific types of atopic conjunctivitis are presented elsewhere. (See "Conjunctivitis" and "Vernal keratoconjunctivitis" and "Atopic keratoconjunctivitis" and "Giant papillary conjunctivitis".)
Ocular allergy is estimated to affect at least 20 percent of the population on an annual basis, and the incidence is increasing [1-4]. It is predominantly a disease of young adults, with an average age of onset of 20 years. Symptoms tend to decrease with age, but older adults can continue to have severe symptoms.
It is possible to develop allergic conjunctivitis for the first time as an older adult, although this is not typical. The patient should be questioned about environmental changes (eg, a newly acquired pet or a new living arrangement) and symptoms earlier in life. In older adults, dry eye disease, blepharitis, and toxic conjunctivitis can mimic allergic conjunctivitis. (See 'Differential diagnosis' below.)
- Singh K, Axelrod S, Bielory L. The epidemiology of ocular and nasal allergy in the United States, 1988-1994. J Allergy Clin Immunol 2010; 126:778.
- Wang HY, Pizzichini MM, Becker AB, et al. Disparate geographic prevalences of asthma, allergic rhinoconjunctivitis and atopic eczema among adolescents in five Canadian cities. Pediatr Allergy Immunol 2010; 21:867.
- Kusunoki T, Morimoto T, Nishikomori R, et al. Changing prevalence and severity of childhood allergic diseases in kyoto, Japan, from 1996 to 2006. Allergol Int 2009; 58:543.
- Rosario N, Bielory L. Epidemiology of allergic conjunctivitis. Curr Opin Allergy Clin Immunol 2011; 11:471.
- Bousquet J, Khaltaev N, Cruz AA, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008; 63 Suppl 86:8.
- Tsubota K, Takamura E, Hasegawa T, Kobayashi T. Detection by brush cytology of mast cells and eosinophils in allergic and vernal conjunctivitis. Cornea 1991; 10:525.
- Ehlers WH, Donshik PC. Allergic ocular disorders: a spectrum of diseases. CLAO J 1992; 18:117.
- Bonini S, Bonini S, Berruto A, et al. Conjunctival provocation test as a model for the study of allergy and inflammation in humans. Int Arch Allergy Appl Immunol 1989; 88:144.
- Cohan VL, Massey WA, Gittlin SD, et al. The heterogeneity of human histamine containing cells. In: Mast cell and basophil differentiation and function in health and disease, Galli SJ, Austen KF (Eds), Raven Press, New York 1989.
- Bonini S, Centofanti M, Schiavone M, et al. The pattern of the ocular late phase reaction induced by allergen challenge in hay fever conjunctivitis. Ocul Immunol Inflamm 1994; 2:191.
- Abelson MB, Madiwale N, Weston JH. Conjunctival eosinophils in allergic ocular disease. Arch Ophthalmol 1983; 101:555.
- Bonini S, Centofanti M, Schiavone M. Passive transfer of the ocular late-phase reaction. Ocul Immunol Inflamm 1993; 4:323.
- Abelson MB, Udell IJ, Weston JH. Conjunctival eosinophils in compound 48/80 rabbit model. Arch Ophthalmol 1983; 101:631.
- Brauninger GE, Centifanto YM. Immunoglobulin E in human tears. Am J Ophthalmol 1971; 72:558.
- Insler MS, Lim JM, Queng JT, et al. Tear and serum IgE concentrations by Tandem-R IgE immunoradiometric assay in allergic patients. Ophthalmology 1987; 94:945.
- Rodier F, Gautrin D, Ghezzo H, Malo JL. Incidence of occupational rhinoconjunctivitis and risk factors in animal-health apprentices. J Allergy Clin Immunol 2003; 112:1105.
- Ono SJ, Abelson MB. Allergic conjunctivitis: update on pathophysiology and prospects for future treatment. J Allergy Clin Immunol 2005; 115:118.
- TYPES OF ALLERGIC CONJUNCTIVITIS
- Acute allergic conjunctivitis
- Seasonal allergic conjunctivitis
- Perennial allergic conjunctivitis
- CLINICAL MANIFESTATIONS
- Clinical history
- Physical examination
- DIFFERENTIAL DIAGNOSIS
- SOCIETY GUIDELINE LINKS