relevant for the clinical diagnosis of perennial allergic con-. Allergic conjunctivitis: a national cross-sectional study of clinical characteristics and quality of life.
Eur J Ophthalmol 2010 ; 20 ( 2 ): 257 - 264
ORIGINAL ARTICLE
Allergic conjunctivitis: a national cross-sectional study of clinical characteristics and quality of life Jorge Palmares1, Luis Delgado2, Manuela Cidade3, Maria J. Quadrado4, Helena P. Filipe5, on behalf of The Season Study Group Ophthalmology Department, Hospital S. João, Porto Immunology Department, Faculty of Medicine, Universidade do Porto, Porto 3 Ophthalmology Department, Hospital de Almada, Almada 4 Ophthalmology Department, Hospitais da Universidade de Coimbra, Coimbra 5 Ophthalmology Department, Instituto Gama Pinto, Lisboa - Portugal 1
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Purpose. Ocular allergy is one of the most common ocular problems in clinical practice and, although easily identified and frequently a mild to moderate condition, it has relevant direct and indirect costs. To characterize clinical and demographic aspects of allergic conjunctivitis in Portugal, using a structured questionnaire. As a secondary outcome, patient’s initial therapeutic and health care options, self-perception of health, and work/school absenteeism were also evaluated. Methods. A cross-sectional study, in 16 ophthalmology departments of central or regional hospitals, in patients diagnosed with allergic conjunctivitis during the spring of 2006. Results. A total of 220 patients were enrolled (mean age of 31.4±18.5 years). A quarter of these patients had >5 episodes of ocular allergy in the past year, 59.3% all year-round episodes, and most presented associated comorbidities (allergic rhinitis 45.9%, asthma 15.5%). They had significant impairment of their overall quality of life during an acute episode (45.6% ≥6 in a 10-point severity scale). Only 19.4% had an appointment with an ophthalmologist as a first action and most (56.1%) started with self treatment measures. Only 37.2% had a previous allergy diagnostic evaluation. Conclusions. In this cross-sectional study of allergic conjunctivitis patients seen in ophthalmology departments, we found a significant impairment of self-rated health status during an ocular allergy episode. Moreover, most patients had year-round episodes and started ocular allergy management with self treatment measures. (Eur J Ophthalmol 2010; 20: 257-64) Key Words. Epidemiology, Ocular allergy, Quality of life, Treatment Accepted: September 14, 2009
INTRODUCTION Allergy is one of the most common ocular problems in clinical practice and includes a group of diseases that may affect different areas of the external ocular surface: conjunctiva, cornea, lids, lachrymal glands, and tear film. The clinical characteristics of ocular allergy are easily identified, and include itching, tearing, conjunctival hyperemia, and chemosis (edema). However, several clinical “red eye” situations may mimic ocular allergy, making the ophthalmo-
logic examination crucial to establish the correct diagnosis (1, 2). Seasonal allergic conjunctivitis (SAC) is the most frequent form of ocular allergy, reaching 50% of cases (1) and affecting 16% to 20% of the general population (3). However, other less frequent but more severe forms, such as vernal keratoconjunctivitis (VKC), may also present a seasonal pattern but can be readily identified through the ophthalmologic examination and its clinical characteristics (4). The coexistence of comorbid atopic diseases is also relevant for the clinical diagnosis of perennial allergic con-
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allergy episodes, and previous diagnostic evaluation of allergy were also questioned. Together with the descriptive questionnaire and to build a composite picture of the respondent’s health status for each enrolled patient, the QOL impact of the allergic conjunctivitis episode was compared to asymptomatic periods using the EQ-5D visual analogue scale (VAS) (7). The EQ-5D VAS records the respondent’s self-rated health status on a 0–100 graduated vertical scale, on which the best state is marked 100. Descriptive statistics were used and categorical variables are summarized in terms of frequencies and percentages, and for each continuous variable, the mean and standard deviation are presented. The Student t-test for independent variables and χ2 analysis were applied, with a significance level set at p10 years), and 90.1% were employed or active.
Eye symptoms Most patients (n = 191, 86%) reported allergic eye symptoms during the previous year, including itching (94.2%), tearing (84.3%), photophobia (67.4%), and half of them also referred ocular pain (51.1%). The mean age at the first episode of allergic conjunctivitis in this population was 21.1±17.3 years. A quarter of this population had more than 5 episodes of ocular allergy in the past year. Perennial symptoms (in the past year) were reported by 124 patients (59.3%) while 77 (36.8%) had seasonal complains (spring and/or summer). However, in the South region of Portugal (Alentejo and Algarve), seasonal episodes were significantly more prevalent (64.0%) than in the rest of the country (Yates corrected chi-square 6.59, p
