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Cytological changes in tears during the secondary conjunctival response induced by nasal allergy
  1. Zdenek Pelikan
  1. Correspondence to Professor Dr Zdenek Pelikan, Allergy Research Foundation, Effenseweg 42, 4838 BB Breda, The Netherlands; zpelikan{at}


Purpose Allergic conjunctivitis (AC) can be caused by an allergic reaction localised exclusively in the conjunctivae and initiated by direct exposure of conjunctivae to an allergen (primary AC form) or it can be induced secondarily by an allergic reaction occurring primarily in the nose (secondary AC form).

Objectives To investigate the cellular profiles in tears accompanying the particular types of secondary conjunctival response (SCR).

Methods In 53 seasonal AC or perennial AC patients developing 53 positive SCRs (17 immediate, 21 late, 15, delayed) and 31 negative responses to the nasal provocation test with allergen (NPT), the NPTs were repeated and supplemented with, cytological examination of the tears.

Results The immediate SCRs (p<0.01), appearing 10–120 min after the NPT, were associated with increased eosinophil and mast cell counts. The late SCRs (p<0.01), occurring 5–12 h, were accompanied by increased eosinophil, neutrophil, basophil and epithelial cell counts. The delayed SCRs (p<0.05), appearing 24–48 h, were associated with increased lymphocyte, neutrophil, monocyte, epithelial and goblet cell counts.

Conclusions The secondary immediate, late and delayed conjunctival responses, induced by nasal allergy, were associated with different cellular profiles in the tears. The cells, except mast, epithelial and goblet cells, displaying no intracellular changes, had probably migrated from conjunctival capillaries, affected by factors released during the initial nasal allergic reaction, without participating in the allergy processes. In AC patients demonstrating insufficient therapeutic compliance, the role of nasal allergy should be examined.

  • Allergic conjunctivitis
  • secondary conjunctival response types
  • nasal challenge with allergen
  • cytology of tears
  • lacrimal drainage
  • conjunctiva
  • cornea
  • diagnostic tests/investigation
  • immunology

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  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the ethical committee of the Institute of Medical Science "De Klokkenberg", Breda, The Netherlands. The study has been carried out according to the Declaration of Helsinki and the study protocol was approved by the local ethics committee and informed consent was obtained from all study participants.

  • Provenance and peer review Not commissioned; externally peer reviewed.