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A. C. Plumer, A. Rosenthal, A. Gulati, P. J. Gomes, D. L. Welch, M. B. Abelson; Evaluation of Daily Ocular and Nasal Allergic Signs and Symptoms during 4 Weeks of Ragweed Season in Untreated Allergic Conjunctivitis and Rhinitis Subjects. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2701.
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The purpose of this study was to evaluate the impact of environmental factors in a population of patients with a history of allergic conjunctivitis during 4 weeks in ragweed season without treatment.
This was a 4-week, single-center, environmental model study. Patients with allergic conjunctivitis and a positive skin test reaction to ragweed completed two questionnaires at each of 3 office visits (days 0, 14, 28). Subjects recorded ocular and nasal allergic signs and symptoms in a diary each day between visits (morning, afternoon, evening). In the office, allergic signs and symptoms were assessed by the investigator, nasal inspiratory flow was measured, and tears were collected for subsequent evaluation of eosinophil counts. Pollen counts were also recorded throughout the study period.
There were 33 subjects enrolled and 32 completed.Ocular: Daily mean ocular itching scores ranged from 0.6 to 1.3 and daily mean redness scores ranged from 0.4 to 1.3 (0-4 scale for both). For both parameters, evening scores were overall lower than in the morning and afternoon. Mean scores were consistently higher during the first 2 weeks (morning mean itching score: 1.2 vs. 0.9; morning mean redness score: 1.1 vs. 0.8).Nasal: Rhinorrhea, nasal congestion, and nasal pruritis were the most prevalent nasal symptoms reported. Approximately 84.8% of subjects experienced nasal symptoms during the trial.Tear Cytology: There was a large amount of variability in tear neutrophil levels at both visit 2 (range: 0-2080, median: 4) and visit 3 (0-300, median: 6). The same was true of tear eosinophil levels at visit 2 (0-50, median: 0) and visit 3 (0-124, median: 0).Quality of Life: Both the Ora Environmental Allergy Questionnaire (Ora-EAQ) and the Allergic Conjunctivitis Quality of Life Questionnaire (ACQLQ) were completed by subjects at each visit. Overall, as the season progressed, patients reported more days when they were affected by allergic signs and symptoms (from 2 to 5 days/week) and productivity scores decreased over time (by ~5%).
Our study demonstrated the dramatic effects of environmental influence on allergic conjunctivitis. The patterns of pollination corresponded to patients’ allergic reactions, symptoms were attenuated with increased rainfall, and time of day had a large impact (symptoms worse in the morning).
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