oa Current Allergy & Clinical Immunology - Immunology of allergic eye disease : review article

Volume 19, Issue 2
  • ISSN : 1609-3607



Ocular allergy results from the exposure of the conjunctiva to an allergen and includes a spectrum of clinical disorders that involve different levels of immune activity at the conjunctival and / or corneal interface. Each of these clinical entities is caused by an IgE-mediated sensitisation to the antigen and the activation of mast cells and eosinophils. In the more chronic entities, there is also an interaction of the allergen with T-cells and a T-helper 2 pattern of cytokine release. The spectrum of ocular allergy is variable and notably seasonal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC) are the most basic and least severe of the allergic inflammatory disorders. In SAC and PAC, a type I hypersensitivity reaction appears to be responsible for the signs and symptoms. In SAC, there are minimal pathological changes and only the early signs of cellular activation at the molecular level occur. In PAC, the inflammatory markers become more pronounced with the increased duration of allergenic stimulation. In the more chronic forms of allergic conjunctivitis, namely vernal keratoconjunctivitis (VKC) in childhood and atopic keratoconjunctivitis (AKC) in adulthood, there is a mixed type I and type IV hypersensitivity reaction. There is a persistent state of mast cell, eosinophil and lymphocyte activation and this may result in the serious corneal complications that can occur with these diseases. Giant papillary conjunctivitis (GPC) that manifests in contact lens wearers also tends to be chronic with a mixed hypersensitivity reaction but has no significant corneal involvement. As our understanding of the underlying immunological mechanisms in allergic eye disease continues to grow, future avenues for pharmacological targeting of different categories of allergic eye disease will be become available. Appropriate treatment may be based on the specific immunopathology, and directed at the activated cell types primarily responsible for the disease process.

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