Total IgE levels in tears are a more accurate marker of severity and prognosis of the disease in patients with seasonal allergic conjunctivitis compared to serum total IgE levels, as per a study reported in the journal Clinical and Translational Allergy.¹

Fifty-five patients with seasonal allergic conjunctivitis were enrolled between March and August 2020 in this prospective, nonrandomized study to investigate the utility of measuring the total IgE in tears in determining the severity of the disease. Ten age-matched and sex-matched healthy individuals were selected as controls. The mean age of the study group was 31 years with ages ranging between 7 and 56 years. Pollen levels in the areas where the participants resided were also measured. Three study visits were scheduled two weeks apart when patients were instructed to complete questionnaires. Simultaneously, 3 µl of tears were also collected. Blood samples to measure serum total IgE levels were collected at the time of the first visit. Three telephone consultations were then conducted once in two months. The participants were also given topical anti-allergy eye drops.

Patients with dry eye, atopic eyelid conjunctivitis, atopic keratoconjunctivitis, vernal keratoconjunctivitis, history of cataract surgery/ corneal refractive surgery, infectious conjunctivitis or other allergic diseases, including allergic rhinitis, allergic dermatitis and allergic asthma, contact lens users were not included in the study.

Compared to the healthy participants, those with seasonal allergic conjunctivitis had high baseline levels of total IgE in tears and serum. A significant positive association between total IgE levels in tears and pollen concentration and severity of the eye symptoms with increase in symptom scores for tearing, itching, redness, foreign body sensation and burning sensation was observed, but no such associations were seen for serum total IgE.

More than half (52.72%) of the study participants had recurrence of the disease after stopping treatment. The total IgE in tears were considerably raised in these patients compared to those who did not have recurrence of the disease and recovered. Again, there were no significant between-group differences with regard to serum total IgE concentrations. Patients with higher total IgE in tears at the first visit were likely to show delayed improvement with treatment.

The total IgE in tears showed a significant decline with improvement in symptoms following treatment. This reduction was more evident in patients who improved within one week of treatment than in those who showed improvement after one week. However, the serum total IgE concentrations were comparable between the two groups.

These findings show that total IgE levels in tears of patients with seasonal allergic conjunctivitis more accurately correlated with severity of the ocular symptoms as well as prognosis than serum total IgE levels. Hence, the study authors suggest that measuring total IgE levels in tears could not only serve as a rapid, noninvasive and convenient diagnostic aid but changes in the levels were also predictive of the severity and disease prognosis. They write, “As SAC is a disease with predominantly ocular symptoms, testing for the tear total IgE is more relevant”.

Reference

1. Bao J, et al. Total IgE in tears accurately reflects the severity and predicts the prognosis of seasonal allergic conjunctivitis. Clin Transl Allergy. 2022 Mar;12(3):e12139. doi: 10.1002/clt2.12139.