title: Association between atopy and herpetic eye disease: results from the pacific ocular inflammation study.
abstract: OBJECTIVE
  Immune dysregulation in patients with atopy has been hypothesized to increase susceptibility to viral infections. Herpetic eye disease (due to herpes simplex and herpes zoster) is a significant cause of visual impairment, and data on an association between this sight-threatening disease and atopy are limited.
  
  
  OBJECTIVE
  To assess the association between atopy and herpetic eye disease, including herpes simplex virus (HSV) ocular disease and herpes zoster ophthalmicus (HZO).
  
  
  METHODS
  Retrospective, population-based case-control study from January 1, 2006, through December 31, 2007, at Kaiser Permanente Hawaii, a multispecialty managed care organization serving approximately 15% of the general Hawaiian population. Participants were 217,061 patients enrolled in the Kaiser Permanente Hawaii health plan during the study period.
  
  
  METHODS
  Clinical diagnosis of HSV ocular disease or HZO during the study period determined by an initial search of the electronic medical record of Kaiser Permanente Hawaii and then confirmed through individual medical record review by a uveitis and cornea fellowship-trained ophthalmologist. Atopic disease status was determined based on International Classification of Diseases, Ninth Revision codes for patients with HSV ocular disease or HZO and 2 control groups, each randomly selected at a 4:1 ratio of controls to cases.
  
  
  RESULTS
  One hundred fourteen patients with HSV ocular disease and 137 patients with HZO were identified. Using the age- and sex-matched controls, patients who had atopy had a 2.6-fold (95% CI, 1.6-4.2; P < .001) higher odds of having HSV ocular disease compared with patients who did not have atopy. Similarly, patients with atopy had a 1.8-fold (95% CI, 1.2-2.8; P = .01) increased odds of having HZO. Patients with 2 or more atopic conditions had an 8.9-fold (95% CI, 3.5-22.6; P < .001) higher odds of having HSV ocular disease and a 2.9-fold (95% CI, 1.1-7.7; P = .04) higher odds of having HZO.
  
  
  CONCLUSIONS
  AND RELEVANCE The association between atopy and herpetic eye disease may be explained by various factors, including immunologic dysfunction in patients with atopy. Clinically, these results could help support the diagnosis of herpetic eye disease in these patients.
authors.affiliation: F. I. Proctor Foundation, University of California, San Francisco.
authors.forename: Durga S
authors.initials: DS
authors.lastname: Borkar
authors.affiliation: F. I. Proctor Foundation, University of California, San Francisco.
authors.forename: John A
authors.initials: JA
authors.lastname: Gonzales
authors.affiliation: Department of Ophthalmology, Kaiser Permanente Hawaii, Honolulu.
authors.forename: Vivien M
authors.initials: VM
authors.lastname: Tham
authors.affiliation: F. I. Proctor Foundation, University of California, San Francisco.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Esterberg
authors.affiliation: Center for Health Research, Kaiser Permanente Hawaii, Honolulu.
authors.forename: Aleli C
authors.initials: AC
authors.lastname: Vinoya
authors.affiliation: Center for Health Research, Kaiser Permanente Hawaii, Honolulu.
authors.forename: John V
authors.initials: JV
authors.lastname: Parker
authors.affiliation: Center for Health Research, Kaiser Permanente Hawaii, Honolulu.
authors.forename: Aileen
authors.initials: A
authors.lastname: Uchida
authors.affiliation: F. I. Proctor Foundation, University of California, San Francisco4Department of Ophthalmology, University of California, San Francisco.
authors.forename: Nisha R
authors.initials: NR
authors.lastname: Acharya
mesh_terms: D001249:Asthma / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D016022:Case-Control Studies; D003876:Dermatitis, Atopic / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006254:Hawaii / Q000453:epidemiology; D006563:Herpes Zoster Ophthalmicus / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D016849:Keratitis, Herpetic / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data; D008875:Middle Aged; D012189:Retrospective Studies; D065631:Rhinitis, Allergic; D012221:Rhinitis, Allergic, Perennial / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology