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Anne Marie Salapatek, Dan Wilson, Deepen Patel, Pina D'Angelo, Jianhua Liu, Jonathan A. Bernstein, Daphne Tsitoura, Robert Murdoch, Joanne S. Lee; Specific Ocular Symptoms are Evoked in NARC patients, Following Exposure to Simulated Weather Change and Environmental Irritant Triggers in an Environmental Exposure Chamber. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6423.
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The Non-Allergic Rhinoconjunctivitis (NARC) EEC (Environmental Exposure Chamber) clinical model has been demonstrated to induce significant nasal and ocular symptoms. The specificity of ocular symptoms evoked by simulated weather change (Cold Dry Air/CDA, 14oC, 5±3ft/s) or environmental irritant (ozone, 200ppb) challenges was assessed in the NARC EEC.
Patients with ≥1 year history of NAR and negative skin prick test to a panel of allergens were exposed to CDA and ozone at Visit 2 (60 minutes) and Visit 3 (90 minutes), respectively in the NARC EEC. Patients with ≥4/12 change from baseline in Total Nasal Symptom Score (nasal congestion, rhinorrhea, and post-nasal drip rated on a 0-4 scale) during Visits 2 or 3 were challenged during Visit 4 using the trigger which induced the greatest response (n=26 patients per trigger). At each visit, the severity of the nasal as well as three ocular symptoms, redness, itching and watery eyes, were recorded on diary cards using a 5-point scale (0-4) with total possible maximum score of 12.
Both CDA and ozone induced specific and significant ocular symptoms. However, challenge with CDA evoked a greater tearing response compared to a greater itching response observed with ozone. The maximum tearing score observed following CDA exposure was 1.58±0.180 units at Visit 2 and 1.08±0.0.18 units at Visit 4. The maximum scores for itching and redness were 1.25 and 0.85 units, respectively. Ozone exposure resulted in maximum itching scores of 1.85±0.223 units at Visit 3 and 1.63±0.226 units at Visit 4. Tearing and redness maximum scores were 1.17 and 1.33 units, respectively. For both triggers, significant ocular symptoms were consistently evoked with repeated challenges.
The NARC triggers induced specific ocular symptoms with CDA evoking primarily tearing and ozone evoking primarily itching. The NARC EEC clinical model is an effective and safe way to phenotype patients for investigating novel NARC therapies.
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