Nasal ocular reflexes and eye symptoms in patients with allergic rhinitis.
BACKGROUND
Allergic patients often complain of eye symptoms during the allergy season. A possible mechanism for these eye symptoms is a nasal ocular reflex.


OBJECTIVE
To demonstrate eye symptoms after nasal allergen challenge.


METHODS
In a double-blind, placebo-controlled, crossover, clinical trial, 20 patients with seasonal allergic rhinitis were challenged in 1 nostril with antigen, and the response was monitored in both nostrils and in both eyes. Symptoms were recorded. Filter paper disks (intranasally) and Schirmer strips (intraocularly) were used for collecting secretions, which were subsequently eluted for the measurement of histamine and albumin levels. Patients were treated once topically at the site of challenge with azelastine or placebo.


RESULTS
After placebo treatment, ipsilateral nasal challenge caused nasal symptoms and an increase in secretion weights; both were blocked by treatment with azelastine. Histamine and albumin levels increased only at the site of nasal challenge. Azelastine pretreatment inhibited the increase in albumin but not histamine levels. Symptoms of itchy and watery eyes increased significantly compared with symptoms with sham challenge after nasal allergen and were blocked by azelastine use. Ocular secretion weights increased bilaterally after placebo use and were not inhibited by azelastine use.


CONCLUSIONS
Nasal allergen challenge releases histamine at the site of the challenge, which probably initiates a nasonasal and a nasal ocular reflex. This reflex is reduced by an H1-receptor antagonist applied at the site of the challenge. The eye symptoms associated with allergic rhinitis probably arise, in part, from a naso-ocular reflex.
Baroody
Fuad M
FM
Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, The University of Chicago, Chicago, Illinois 60637, USA.
Foster
Kimberly A
KA
Markaryan
Adam
A
deTineo
Marcy
M
Naclerio
Robert M
RM
D000328:Adult; D000418:Albumins / Q000032:analysis; D000485:Allergens / Q000276:immunology; D018926:Anti-Allergic Agents / Q000627:therapeutic use*; D003233:Conjunctivitis, Allergic / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005123:Eye / Q000276:immunology / Q000503:physiopathology; D005260:Female; D006636:Histamine Release; D006801:Humans; D008297:Male; D009297:Nasal Mucosa / Q000276:immunology / Q000378:metabolism / Q000503:physiopathology; D009299:Nasal Provocation Tests; D012018:Reflex; D006255:Rhinitis, Allergic, Seasonal / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology
D000418:Albumins; D000485:Allergens; D018926:Anti-Allergic Agents