title: Conjunctival allergen provocation test : guidelines for daily practice.
abstract: Conjunctival allergen provocation test (CAPT) reproduces the events occurring by instilling an allergen on the ocular surface. This paper is the compilation of a task force focussed on practical aspects of this technique based on the analysis of 131 papers. Main mechanisms involved are reviewed. Indications are diagnosing the allergen(s)-triggering symptoms in IgE-mediated ocular allergy in seasonal, acute or perennial forms of allergic conjunctivitis, especially when the relevance of the allergen is not obvious or in polysensitized patients. Contraindications are limited to ongoing systemic severe pathology, asthma and eye diseases. CAPT should be delayed if receiving systemic steroids or antihistamines. Local treatment should be interrupted according to the half-life of each drug. Prerequisites are as follows: obtaining informed consent; evidencing of an allergen by skin prick tests and/or serum-specific IgE dosages; being able to deal with an unlikely event such as acute asthma exacerbation, urticaria or anaphylaxis, or an exacerbation of allergic conjunctivitis. Allergen extracts should be diluted locally prior to administration. Positive criteria are based on itching or quoted according to a composite score. An alternative scoring is based on itching. CAPT remains underused in daily practice, although it is a safe and simple procedure which can provide valuable clinical information.
authors.affiliation: Unité d'Allergologie de l'enfant, CHU Estaing, Clermont-Ferrand Cedex 1, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Fauquert
authors.affiliation: Department of Immunology, Rheumatology, and Allergy, Medical University of Lodz, Lodz, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Jedrzejczak-Czechowicz
authors.affiliation: Allergy Unit, Regional University Hospital of Malaga, IBIMA, UMA, Malaga, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Rondon
authors.affiliation: Department of Ocular Biology & Therapeutics (ORBIT), UCL Institute of Ophthalmology, London, UK.
authors.forename: V
authors.initials: V
authors.lastname: Calder
authors.affiliation: Serviço de Imunoalergologia, Centro Hospitalar São João, E.P.E., Porto, Portugal.
authors.forename: D
authors.initials: D
authors.lastname: Silva
authors.affiliation: Pediatric Department, Oestfold Hospital Trust, Fredrikstad, Norway.
authors.forename: B K
authors.initials: BK
authors.lastname: Kvenshagen
authors.affiliation: Clinical Immunology, Department of Microbiology and Immunology, Catholic University of Leuven, Leuven, Belgium.
authors.forename: I
authors.initials: I
authors.lastname: Callebaut
authors.affiliation: Allergic Conjunctivitis Unit, Ocular Inflammatory Diseases Referral Center, Rapallo Hospital Ophthalmological Dep., Genova, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Allegri
authors.affiliation: Serviço de Imunoalergologia, Centro Hospitalar São João, E.P.E., Porto, Portugal.
authors.forename: N
authors.initials: N
authors.lastname: Santos
authors.affiliation: Service d'Ophtalmologie, Hôpital Bichat and Fondation A. de Rothschild, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Doan
authors.affiliation: Servicio de Oftalmologia, Hospital Universitario de Torrejon, Madrid, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Perez Formigo
authors.affiliation: Service d'Ophtalmologie, CHU Montpied, Clermont-Ferrand Cedex 1, France.
authors.forename: F
authors.initials: F
authors.lastname: Chiambaretta
authors.affiliation: Department of Immunology, Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: L
authors.initials: L
authors.lastname: Delgado
authors.affiliation: Ophthalmology Unit, Department of Neuroscience, University of Padua, Padua, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Leonardi
mesh_terms: D000485:Allergens / Q000008:administration & dosage / Q000276:immunology*; D003233:Conjunctivitis, Allergic / Q000175:diagnosis* / Q000276:immunology*; D000075202:Contraindications; D019468:Disease Management; D006801:Humans; D017410:Practice Guidelines as Topic; D012882:Skin Tests / Q000009:adverse effects / Q000379:methods
chemical_list: D000485:Allergens
keywords: allergen challenge; conjunctivitis; in vivo diagnosis; ocular surface; ocular surface diagnosis; provocation test