Wed. Dec 6th, 2023

The eye allergies has experienced a significant increase in our country in recent years, largely motivated by the direct and indirect consequences of climate change and the increase in environmental pollution. Classically, it was estimated that approximately 20% of the Spanish population suffered from some type of ocular allergy, a rate that currently sits above 30% In our country. The problem worries and occupies ophthalmologists, as has been highlighted in the XX Annual Meeting of the Spanish Society of Ocular and Corneal Surface (SESOC), which has brought together some 500 professionals from all over Spain in Madrid and which, in this edition, has had the collaboration of the Spanish Society of Allergology and Clinical Immunology (SEAIC). And it is that, to face this problem, the interdisciplinary cooperation of ophthalmologists and allergists is key“this being essential to stop the spread of ocular allergies and optimize their detection and therapeutic management”, according to the Dr. Jose Manuel Benitez del Castillo, President of the SESOC, who has highlighted the success of this event, “both due to the number of congressmen and for achieving that practically half of the speakers are allergists, taking a further step in our objective of getting closer to these specialists, with whom we must work more closely to put a fence on eye allergies”, a mission with which the Dr. Ignacio Davilapresident of the SEAIC.

Eye allergies, to the head

Ocular allergies are inflammatory processes of immunological origin of the ocular surface. His clinical spectrum is very varied, including from allergic conjunctivitis (seasonal or perennial), to vernal keratoconjunctivitis and atopic keratoconjunctivitis. Of all of them, as Dr. Benítez del Castillo points out, “the most common are seasonal allergic conjunctivitis that, in most cases, they are mild”; however, “there are up to 10% of patients with eye allergies presenting more severe formssuch as vernal or atopic keratoconjunctivitis, which can cause serious disorders and compromise vision.
Itching, redness and stinging are the most common and frequent symptoms of these ocular allergies, which are usually associated with allergic rhinitis and other clinical manifestations. Given these continued symptoms, as recommended by the Dr. Pedro Arriola, co-organizer of this meeting and who works in the Ophthalmology Service of the San Carlos Clinical Hospital (Madrid), “you have to go to the doctor, these clinical manifestations should not be trivialized, they must be evaluated and treated by an ophthalmologist who, in the most serious forms, diagnostic confirmation and therapeutic guidance from allergists should also be supported”. The increase in cases of ocular allergies is mainly due to greater immunogenetic susceptibility, greater allergen exposure, and greater environmental complexity. “Our current lifestyles, the increased environmental pollution and the prevalence of a ‘bubble’ way of lifewhich avoids regular exposure to some allergens, are driving eye allergies, which are more common in urban settings and mainly affect adults of working age but also have a significant impact on children”, as highlighted by the president of the SESOC.

Economic impact and quality of life

Apart from the concern caused by the increase in the incidence of these eye allergies, the experts gathered in this forum wanted to remind us that, despite the common belief that these disorders are usually mild in nature, they represent a great impact on the quality of life of patients (and even their relatives, especially in the case of pediatric patients) and have a huge economic impact. Quality of life studies show that patients with ocular allergies report a worse general state of perceived health and poorer visual function. But, in addition, it is known that these allergies have a negative impact on direct, indirect, intangible and opportunistic costs. As the Dr. daisy cabanasfrom the Ophthalmology Service of the Virgen del Rocío University Hospital, “the fact that allergic processes are increasing has, among many other consequences, an unstoppable growth in pharmaceutical spendinga elevation of comorbidity (frequently, the presence of ocular allergy is associated with other disorders, such as asthma, rhinitis, polyposis, dry eye, food allergies, other allergies,…) and a greater unproductiveness (due, above all, to the increase in work absenteeism, since most cases of ocular allergy occur in the working-age population)”. All this without taking into account that, according to experts, the number of cases of ocular allergy is underestimated, which generates a high rate of undertreatment. This reveals another of the deficits that subsist in relation to these diseases, such as high rate of unsupervised self-treatment. For example, the frequent use of OTC medications and non-pharmacological remedies is noted, as well as the risk of using suboptimal treatments, which increases the risk of exacerbations and the chances of chronification of some of these eye allergies and even increases the risk of corneal involvement and visual loss. For this reason, as the experts gathered in this forum have claimed, it is necessary to put more means and greater attention to facilitate the detection and control of cases of ocular allergy“which would mean not only benefits in terms of health and quality of life, but also great savings for the Spanish health system,” says Dr. Benítez del Castillo, betting on measures such as the implementation of prevention campaigns, carrying out carry out new studies, agree on approach protocols and encourage multidisciplinary collaboration.

Eye allergies: a 360º review

The main coordination of the XX Meeting has fallen to the doctors Francisco Arnalich and Pedro Arriola, which make a very satisfactory balance, “having offered very useful training for the daily clinical practice of ophthalmologists and allergists”. About five thematic blocks, ophthalmologists and allergists of national and international reference have presented news and discussed the bases of ocular allergy, delving into concepts of immunopathology, pathological anatomy and biomarkers. The different clinical forms of ocular allergy have also been evaluated. However, the central part of the event has focused on diagnostic procedures and the different treatments available and in development (all from an interdisciplinary perspective), as well as the economic impact and quality of life. Most of the sessions and conferences have been based on the presentation and discussion of complex, controversial and illustrative clinical cases. Especially significant has been the contribution made by international speakers, “two of the most reputable European ophthalmologists with the largest number of bibliographic references on ocular allergy”, according to Dr. Arnalich, who works in the Hospital’s Ophthalmology Service. Ramón y Cajal University (Madrid). The doctor. andrea leonardi, from the University of Padua, has offered his particular vision on the epidemiology of ocular allergy, the different phenotypes and endotypes, and on its therapeutic management. For her part, the teacher Dominique Bremond-Cignacfrom the Necker Enfants Malades Hospital in Paris, has carried out an exhaustive review of the diagnostic and therapeutic management of ocular allergy in children.

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