[Evaluation of the efficacy of subjective symptoms, objective findings, and of a total tear IgE detection kit in diagnosis of allergic conjunctival diseases].
OBJECTIVE
To evaluate the efficacy of subjective symptoms, objective findings, and of a total tear IgE test kit in the diagnosis of allergic conjunctival diseases (ACD).


METHODS
The subjects were 223 patients with ACD, diagnosed according to the clinical practice guidelines for allergic conjunctival diseases in 28 medical facilities in Japan. The ACD patients were divided into the following five groups: 84 patients with seasonal allergic conjunctivitis (SAC), 52 patients with perennial allergic conjunctivitis (PAC), 41 patients with atopic keratoconjunctivitis (AKC), 38 patients with vernal keratoconjunctivitis (VKC) and 8 patients with giant papillary conjunctivitis (GPC). All cases were examined for clinical ACD, subjective symptoms, objective findings by the clinical score and by a total tear IgE test. An eosinophil examination by conjunctival smear was also performed in 87 ACD patients.


RESULTS
The most prevalent subjective symptoms were itching (81.6%) and hyperemia (77.6%). The clinical scores of the objective findings in the patients with SAC, PAC, AKC, VKC and GPC were 16.3 +/- 3.8 (mean +/- SD) points, 16.2 +/- 2.8, 19.8 +/- 6.5, 23.1 +/- 5.3, and 21.4 +/- 3.9, respectively. In the total tear IgE test 72.2% of the ACD patients were positive; i.e., the ratios were 61.9% in SAC, 65.4% in PAC, 80.5% in AKC, 94.7% in VKC, and 75.0% in GPC. In the examination of eosinophils in the 87 ACD patients, 42.5% (37 eyes) were positive, i.e., the ratio was 20.0% in SAC, 36.8% in PAC, 53.3% in AKC, 75.0% in VKC and 33.3% in GPC. The rate of agreement between the total tear IgE test and the examination of eosinophils was kappa = 0.28 (Cohen kappa coefficient).


CONCLUSIONS
Because of the high positive ratio in patients quasi-definitively diagnosed with ACD, we conclude that the total tear IgE test is useful as an auxiliary method for diagnosing ACD.
Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, Tokyo, Japan.
Jun
J
Shojio
Eiichi
E
Uchio
Nobuyuki
N
Ebihara
Yuichi
Y
Ohashi
Shigeaki
S
Ohno
Shigeki
S
Okamoto
Naoki
N
Kumagai
Yoshiyuki
Y
Satake
Kenichi
K
Namba
Kazumi
K
Fukagawa
Atsuki
A
Fukushima
Hiroshi
H
Fujishima
Etsuko
E
Takamura
D000293:Adolescent; D000328:Adult; D003233:Conjunctivitis, Allergic / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000032:analysis*; D007637:Keratoconjunctivitis / Q000175:diagnosis; D008297:Male; D011933:Reagent Kits, Diagnostic; D013666:Tears / Q000276:immunology*
D011933:Reagent Kits, Diagnostic; D007073:Immunoglobulin E