In-office allergy testing narrows cause of ocular symptoms

Point-of-care testing can help rule in or rule out the contribution of ocular allergies to the patient’s symptom complex.

Issue: May 10, 2015

In-office point-of-care allergy testing is now available for ophthalmologists to more expediently diagnose ocular allergy and narrow down the cause, according to a presenter at Hawaiian Eye 2015.

“What’s new is that there are some very interesting point-of-care diagnostics for making a diagnosis of ocular allergy that can really help us sort out the contribution of allergy to that very difficult symptom complex of ocular surface diseases — dry eyes, allergies and blepharitis. [It] can be awfully difficult sometimes for us to make a diagnosis of exactly what is going on with the patient,” Jodi Luchs, MD, FACS, said.

Ocular allergies

Ocular allergies affect up to 25% of the general population, which is approximately 80 million people in the U.S. with some degree of ocular allergy, Luchs said.

In a recent survey completed by patients who have seasonal allergies, 70% reported that their ocular allergies were as severe as, if not more severe than, their rhinitis symptoms, he said.

Jodi Luchs

“Allergies can affect our patients’ lives in ways which are greater than we as physicians or often patients tend to realize,” he said. “So it is important for us to make a good diagnosis and to treat our patients appropriately to improve their quality of life.”

Allergic conjunctivitis occurs in seasonal form, such as with pollen, and perennial form with causative antigens in the environment year-round, such as with dust mites.

Confusing symptoms

The most common symptom in allergic conjunctivitis is itch, even though many patients may not complain of itch at their office visit, Luchs said.

“They may have had an itch 2 or 3 days before, now they started rubbing, now their eyes are red and irritated and burning and tearing, and that’s why they’re coming in to see you, having forgotten about that history of itch that they had a few days ago,” he said. “That illustrates the importance of taking a very careful history in order to help make a diagnosis of ocular allergies.”

Additionally, allergy symptoms can be similar to symptoms seen in other ocular surface diseases, such as dry eyes and blepharitis. Symptoms of dry, gritty foreign body sensation, burning eyes and some degree of itch, along with clinical signs of hyperemia, tearing, chemosis and lid swelling, can be seen, Luchs said.

“Sometimes it can be very difficult to sort out exactly what ocular surface disease is causing the patient’s symptom complex or combination of ocular surface diseases,” he said. “We now have some new tools that can help us sort out the contribution of allergies to our patients’ symptom complex, and that includes the availability of in-office allergy testing.”

In-office testing

The test consists of a tray with 60 different antigens specific to the varying regions of ophthalmology practice, Luchs said. The antigens are applied to the skin, making multiple small impressions. After approximately 10 minutes, reactions appear for the antigens that the patient is allergic to.

“It’s a very nice diagnostic test to help us rule in or rule out the contribution of ocular allergies to our patients’ ocular surface disease symptom complex,” Luchs said.

In the future, testing for immunoglobulin E in the tear film may be available, and new formulations of existing drugs, such as combinations of antihistamines, mast cell stabilizing drugs and vasoconstrictors, may be used, Luchs said.

“Consider in-office allergy testing as a new adjunct to help you rule in or rule out the contribution of ocular allergies to your patient’s symptom complex,” he said. “For the more severe patients, you may also wish to consider co-managing with an allergist. That can be very helpful in those cases.” – by Kristie L. Kahl

Jodi Luchs, MD, FACS’s, presentation at Hawaiian Eye 2015 can be accessed at http://www.healio.com/ophthalmology/cornea-external-disease/news/online/%7B739b70eb-db9a-468d-ab72-67fe26841822%7D/video-ocular-allergic-disease-therapeutic-update.

For more information:

Jodi Luchs, MD, FACS, can be reached at South Shore Eye Care, 2185 Wantagh Ave., Wantagh, NY 11793; email: jluchs@aol.com.
Disclosure: Luchs reports he is a consultant for Allergan, Bausch + Lomb, Nicox, Doctors Allergy Rx, Optos, TearLab, and Shire; is a researcher for Allergan, Alcon, Bausch + Lomb, Shire, Eleven and Auven; and had ownership interest in CXLO, Insightful Solutions, RPS, Omega Ophthalmics and Calhoun Vision.