Allergic rhinoconjunctivitis (a tool to help clinicians)

Allergic rhinoconjunctivitis is a chronic inflammatory IgE-mediated reaction to relevant allergens encountering nasal mucosa and conjunctiva. Allergen-specific IgE binds to high-affinity Fcε receptors (Fcε RI) expressed by ocular and nasal mast cells. Therefore, nasal mucosa and conjunctiva have common mechanisms of antigen recognition. Detailed clinical history and examination provide correct diagnosis, relevant allergen identification, symptom severity assessment, and therapeutic algorithm. Recently, an assay for the measurement of specific IgE antibodies against numerous (120) allergens in human blood, ImmunoCAP, was developed. Conventional allergic rhinoconjunctivitis treatment includes allergen avoidance, pharmacotherapy, and allergen-specific immune therapy. Four major classes of drugs are used for the treatment, i.e., antihistamines, corticosteroids, mast cell stabilizers, and vasoconstrictor agents (or decongestants). Occasionally, muscarinic receptor antagonists, antileukotrienes, and immunemodulators are used. Therapeutic strategy is determined by the effect of a drug on certain symptoms and allergy clinical course, adverse reaction and complication risks, age limitations, and costs. Stepwise approach to the treatment of allergic rhinoconjunctivitis should be based on
symptom severity. Full-text clinical guidelines are available on the official website of Russian Rhinologic Society (http://www.rhinology.ru / index1. php?id_page = 3&id_text2 = 43&num_text2 = 1).

1. [Clinical references on diagnostics and treatment of an allergic rhinitis. A grant for doctors. Under the editorship of A. S. Lopatin]. Klinicheskie rekomendatsii po diagnostike i lecheniyu allergicheskogo rinita. Posobie dlya vrachei. Pod red. A. S. Lopatina. SPb, 2004. (in Russ.)

2. Lopatin A. S. [Rinit: pathogenetic mechanisms and principles of a pharmacotherapy]. Rinit: patogeneticheskie mekhanizmy i printsipy farmakoterapii. M.: Litterra, 2013. (in Russ.)

3. Maychuk Yu. F. Vakhova E. S. [Complex therapy of a Chlamidia conjunctivitis. The medical technology approved by Ministry of Health of the Russian Federation]. Kompleksnaya terapiya khlamidiinykh kon’yunktivitov. Meditsinskaya tekhnologiya, utverzhdennaya Minzdravom RF. М.; 2009. (in Russ.)

4. Biellory L. Allergic diseases of the eye. Med. Clin. N. Am. 2006; 90:129‑148.

5. Ono S. L., Abelson M. B. Allergic conjunctivis: update on pathophysiology andprospects forfuture treatment. J. AllergyClin. Immunol.2055; 1: 118‑122.

6. Maichuk Yu. F. [Allergic diseases of eyes]. Allergicheskie zabolevaniya glaz. М. 1983. (in Russ.)

7. Maichuk Yu. F. [Conjunctivitis Modern Medicinal Therapy. Short guide for doctors]. Kon’yunktivity Sovremennaya Lekarstvennaya Terapiya. Kratkoe posobie dlya vrachei. М. 2013. (in Russ.)

8. Maichuk Yu. F. [Modern aspects of a pharmacotherapy of eye allergoses]. Sovremennye aspekty farmakoterapii glaznykh allergozov. [Annals of ophthalmology]. Vestnik oftal’mologii 2000:5: 10‑14. (in Russ.)

9. [Allergology and immunology. ed. A. A, Baranov, R. M, Haitov]. Allergologiya i immunologiya. Pod obshchei red. A. A,Baranova, R. M, Khaitova М., 2011. (in Russ.)

10. M. A. Kovalevskaya, D. Yu. Maichuk, V. V. Brzheskii [Sindrom of «red eye»: management for doctors — ophthalmologists]. Sindrom «krasnogo glaza»: Prakt. rukovodstvo dlya vrachei- oftal’mologov. М., 2010. (in Russ.)

11. Brzheskii V. V. Brzhesky V. V. [Sindrom of «dry eye»]. Sindrom «Sukhogo glaza». V kn. «Sindrom krasnogo glaza» pod red. D. Yu. Maichuka [In book. «Syndrome of red eye» ed. D. Yu. Maychuk] М. 2010; 14‑17. (in Russ.)

12. ARIA. [Allergic rhinitis and its influence on bronchial asthma]. Allergicheskii rinit i ego vliyanie na bronkhial’nuyu astmu. [Allergology] 2001 (Appendix) Allergologiya 2001 (Prilozhenie); 3: 43‑56. (in Russ.)

13. Maychuk of Yu, Kurenkov V. V., Kashnikova O. A. [In book. Topical issues of inflammatory diseases of eyes]. V kn. Aktual’nye voprosy vospalitel’nykh zabolevanii glaz. М. 2001; 232‑234. (in Russ.)

14. Мaichuk Yu. F. Maychuk Yu. F. [Allergic conjunctivitis]. Allergicheskie kon’yunktivity Russian medical journal 2002; 3 (1): 6‑9. (in Russ.)

15. Lopatin A. S. [Rinit: the management for doctors]. Rinit: rukovodstvo dlya vrachei. M.: Litterra 2010. (in Russ.)

16. Lopatin A. S., Gushchin I. S., Yemelyanov A. V. [Clinical references on diagnostics and treatment of an allergic rhinitis]. Klinicheskie rekomendatsii po diagnostike i lecheniyu allergicheskogo rinita [Consilium medicum]. Consilium medicum. 2001.Pril. 2001. Enc.: 33‑44. (in Russ.)

17. Lopatin A. S. [Vasoconstrictive preparations: action mechanism, clinical application and side effects]. Sosudosuzhivayushchie preparaty: mekhanizm deistviya, klinicheskoe primenenie i pobochnye effekty. [Russian rhinology] Rossiiskaya rinologiya 2007; 1: 43‑49. (in Russ.)

18. Maichuk Yu. F. [Modern therapy of a conjunctivitis at children]. Sovremennaya terapiya kon’yunktivitov u detei. [Consilium medicum. Pediatrics]. Consilium medicum. Pediatriya. 2007; 2: 80‑87. (in Russ.)

19. [Allergology and immunology. National management]. Allergologiya i immunologiya. Natsional’noe rukovodstvo M.: GEOTAR-media, 2009. (in Russ.)

20. Piskunov G. Z., Piskunov S. Z. [Clinical rhinology. The management for doctors]. Klinicheskaya rinologiya. Rukovodstvo dlya vrachei. 2 — e izd. M.: Meditsinskoe informatsionnoe agentstvo, 2nd prod. M. [Medical news agency] 2006; 183, 190, 202‑205. (in Russ.)