PURPOSE: We report a case of toxic keratoconjunctivitis resulting from the self-application of human breast milk as a traditional folk remedy for allergic conjunctivitis. CASE SUMMARY: An 82-year-old woman presented with pain and conjunctival hyperemia in the right eye that had been worsening for three days. Two months previously, she was treated with antiallergic eye drops for allergic conjunctivitis at another eye clinic. However, the symptoms did not improve. She applied her daughter-in-law's breast milk into her right eye as a folk remedy for three days. The pain and conjunctival hyperemia worsened. At the initial visit, her corrected visual acuity was 0.3 in the right eye. Slit lamp examination demonstrated conjunctival hyperemia, punctate epithelial erosion at the central cornea, corneal keratic precipitates and white-colored deposits in the peripheral cornea combined with irregularly shaped small nodules. There was no anterior chamber inflammation. There was no medical history of rheumatoid arthritis or tuberculosis. Blood tests for serum and other infectious and inflammatory levels for infection and inflammatory markers were performed followed by application of topical steroids and antibiotics with artificial tears. After 3 weeks of treatment, conjunctival hyperemia and corneal deposits had almost resolved and best-corrected visual acuity improved to 1.0. CONCLUSIONS: The self-application of human breast milk may cause toxic keratoconjunctivitis. Therefore, efforts should be made, actively, to inform and educate the elderly in rural areas not to use human breast milk as a folk remedy.
Aged ; Aged, 80 and over ; Anterior Chamber ; Anti-Bacterial Agents ; Arthritis, Rheumatoid ; Breast ; Conjunctivitis, Allergic ; Cornea ; Female ; Hematologic Tests ; Humans ; Hyperemia ; Inflammation ; Keratoconjunctivitis ; Lubricant Eye Drops ; Medicine, Traditional ; Milk, Human ; Ophthalmic Solutions ; Slit Lamp ; Steroids ; Tuberculosis ; Visual Acuity

BACKGROUND: The most common surgical treatment for paralytic lagophthalmos is the placement of a weight implant in the upper eyelid; however, this technique confers the risks of implant visibility, implant extrusion, and entropion. In this study, we present a new technique of placing platinum weight implants between the levator aponeurosis and inner septum to decrease such complications. METHODS: A total of 37 patients with paralytic lagophthalmos were treated between March 2014 and January 2017 with platinum weight placement (mean follow-up, 520.1 days). After dissecting through the orbicularis oculi muscle, the tarsal plate and levator aponeurosis were exposed. The platinum weights (1.0–1.4 g) were fixed to the upper margin of the tarsal plate and placed underneath the orbital septum. RESULTS: Five patients could partially close their eye after surgery. The average distance between the upper eyelid and the lower eyelid when the eyes were closed was 1.12 mm. The rest of the patients were able to close their eye completely. Three patients patient developed allergic conjunctivitis after platinum weight insertion, which was managed with medication. None of the patients complained of discomfort in the upper eyelid after surgery. Visibility or extrusion of the implant were observed in three patients. CONCLUSIONS: Postseptal weight placement is a safe and reproducible method in both primary and secondary upper eyelid surgery for patients with paralytic lagophthalmos. It is a feasible method for preventing implant visibility, implant exposure, and entropion. Moreover, platinum is a better implant material than gold because of its smaller size and greater thinness.
Conjunctivitis, Allergic ; Entropion ; Eyelid Diseases ; Eyelids* ; Facial Paralysis ; Follow-Up Studies ; Humans ; Methods ; Orbit ; Platinum* ; Prostheses and Implants ; Thinness ; Weights and Measures

BACKGROUND: Allergic rhinitis (AR) is a global health problem and is characterised by one or more symptoms, including sneezing, itching, nasal congestion and rhinorrhea. OBJECTIVE: We investigated the features of AR and the physician's approach to the management of AR patients in four geographical regions. METHODS: In this cross-sectional study, a questionnaire survey concerning AR was completed by Honorary and Corresponding Members of the Italian Society of Rhinology from different countries among 4 world geographical regions—Asia, Europe, the Americas, and Africa. RESULTS: The prevalence of AR was reported to be 15%–25%. Children and adolescents, as well as young adults, were the age groups more affected by AR with comorbidities of asthma, sinusitis, conjunctivitis, and nasal polyposis. Nasal symptoms of AR were more intense in the spring (51.92%) and autumn (28.85%). The most common aero-allergens were pollen and mites (67.31%), animal dander and pollutants (23.08%), and fungal allergens (21.15%). Allergen-specific immunotherapy was prescribed for both perennial and seasonal allergens (32.69%) via sublingual swallow (46.15%) and subcutaneous (32.69%) routes. For the AR patients, the most prescribed drugs were intranasal corticosteroids (86.54%) and oral H₁-antihistamines (82.69%). CONCLUSION: A network of experts can improve our knowledge concerning AR epidemiology, and together with guidelines, could assist practitioners and otolaryngologists in standardising the diagnosis and treatment of AR.
Adolescent ; Adrenal Cortex Hormones ; Africa ; Allergens ; Americas ; Animals ; Asthma ; Child ; Comorbidity ; Conjunctivitis ; Cross-Sectional Studies ; Dander ; Diagnosis ; Epidemiology ; Estrogens, Conjugated (USP) ; Europe ; Global Health ; Humans ; Immunotherapy ; Mites ; Pollen ; Prevalence ; Pruritus ; Rhinitis, Allergic ; Seasons ; Sinusitis ; Sneezing ; Sublingual Immunotherapy ; Young Adult

Allergic conjunctivitis is characterized by specific immunologic responses known as type 1 hypersensitivity, resulting in corneal and conjunctival inflammation. Histamine plays an important role in the pathophysiologic mechanism of allergic conjunctivitis. Five subtypes of allergic conjunctivitis have been defined according to specific signs and symptoms: seasonal allergic conjunctivitis, perennial allergic conjunctivitis, vernal keratoconjunctivitis, atopic keratoconjunctivitis and giant papillary conjunctivitis. Above all, avoidance of the offending antigen is the primary behavioral modification used to treat all types of allergic conjunctivitis. However, this may be difficult for practical reasons; therefore, a range of medical treatment options, such as topical antihistamines, mast cell stabilizers, non-steroidal anti-inflammatory drugs, and corticosteroids are prescribed in clinical practice.
Adrenal Cortex Hormones ; Conjunctivitis, Allergic* ; Histamine ; Histamine Antagonists ; Hypersensitivity ; Inflammation ; Keratoconjunctivitis ; Mast Cells ; Seasons

PURPOSE: To report a successful case of intractable vernal keratoconjunctivitis treated by papillectomy and amniotic membrane transplantation. CASE SUMMARY: A 20-year-old female patient presented with repeated vernal keratoconjunctivitis in both eyes since the age of 14. Despite medical therapy, she developed severe itching, burning and foreign body sensations, and limbal nodules with mutiple giant papillae of the upper tarsal plate. Surgical resection of the giant papillae and amniotic membrane transplantation in her left eye was performed. One month later, the same procedure was performed in her right eye. The patient's symptoms then improved. Neither recurrence nor serious complication were observed during the 6 months follow up period after surgery. CONCLUSIONS: In intractable vernal keratoconjunctivitis, papillectomy with amniotic membrane transplantation may potentially be a good treatment option for better clinical outcome and low recurrence rates.
Amnion* ; Burns ; Conjunctivitis, Allergic* ; Female ; Follow-Up Studies ; Foreign Bodies ; Humans ; Pruritus ; Recurrence ; Sensation ; Young Adult

PURPOSE: Rhinitis is a nasal inflammatory disease in children and adolescents. However, little is known about the phenotypes and characteristics of allergic rhinitis (AR) in Korean children and adolescents. The objective of this study was to analyze the symptoms and comorbidities of rhinitis, to compare AR to non-allergic rhinitis (NAR), and to reveal the phenotypes and features of AR in a Korean pediatric population. METHODS: Patients under 18 years of age with rhinitis symptoms were recruited from January 2013 to January 2015 by pediatric allergists. We analyzed symptoms, phenotypes, comorbidities, and allergen sensitization in this cross-sectional, multicenter study. RESULTS: Medical records were collected from 11 hospitals. The AR group has 641 (68.3%) patients, with 63.2% of boys and 7.5 (±3.4) years of mean age. The NAR group has 136 (14.5%) patients, with 55.1% of boys and 5.5 (±2.9) years of mean age. Moderate-severe persistent AR affected 41.2% of AR patients. Nasal obstruction was more common in NAR patients (P<0.050), whereas AR patients sneezed more (P<0.050) and more commonly had conjunctivitis, asthma, and otitis media (P<0.050). Sinusitis was the most common comorbidity in both groups. Allergen sensitization was caused by house dust mites (HDMs) (90.2%), pollen (38.7%), and animal dander (24.8%) in AR patients. Pollen and animal dander sensitization significantly increased age-dependently (P<0.050), but 91.9% of AR patients were already sensitized to HDMs before 5 years old. CONCLUSIONS: Our study revealed that AR was more prevalent than NAR and that 41.2% of AR presented with moderate-severe disease in Korean pediatric populations. Sinusitis was the most common comorbidity, and sleep disturbance was associated with the severity of rhinitis. The majority of AR patients were sensitized to HDMs in preschool ages. Further studies, including nationwide and longitudinal data, will help understand the relationship between these diseases.
Adolescent* ; Animals ; Asthma ; Child* ; Comorbidity* ; Conjunctivitis ; Dander ; Humans ; Medical Records ; Nasal Obstruction ; Otitis Media ; Phenotype* ; Pollen ; Pyroglyphidae ; Rhinitis* ; Rhinitis, Allergic ; Sinusitis

Allergic conjunctivitis (AC), which may be acute or chronic, is associated with rhinitis in 30%–70% of affected individuals, hence the term allergic rhinoconjunctivitis (AR/C). Seasonal and perennial AC is generally milder than the more chronic and persistent atopic and vernal keratoconjunctivitis. Natural allergens like house dust mites (HDM), temperate and subtropical grass and tree pollen are important triggers that drive allergic inflammation in AC in the Asia-Pacific region. Climate change, environmental tobacco smoke, pollutants derived from fuel combustion, Asian dust storms originating from central/north Asia and phthalates may also exacerbate AR/C. The Allergies in Asia Pacific study and International Study of Asthma and Allergies in Childhood provide epidemiological data on regional differences in AR/C within the region. AC significantly impacts the quality of life of both children and adults, and these can be measured by validated quality of life questionnaires on AR/C. Management guidelines for AC involve a stepped approach depending on the severity of disease, similar to that for allergic rhinitis and asthma. Topical calcineurin inhibitors are effective in certain types of persistent AC, and sublingual immunotherapy is emerging as an effective treatment option in AR/C to grass pollen and HDM. Translational research predominantly from Japan and Korea involving animal models are important for the potential development of targeted pharmacotherapies for AC.
Adult ; Allergens ; Asia ; Asian Continental Ancestry Group ; Asthma ; Calcineurin Inhibitors ; Child ; Climate Change ; Conjunctivitis, Allergic ; Desensitization, Immunologic ; Drug Therapy ; Dust ; Epidemiology ; Humans ; Hypersensitivity ; Inflammation ; Japan ; Korea ; Models, Animal ; Poaceae ; Pollen ; Pyroglyphidae ; Quality of Life ; Rhinitis ; Rhinitis, Allergic ; Seasons ; Smoke ; Sublingual Immunotherapy ; Tobacco ; Translational Medical Research ; Trees

BACKGROUND: Pollen allergens are one of the main contributors to the development and/or aggravation of allergic rhinitis, allergic conjunctivitis, and asthma. OBJECTIVE: An examination of the airborne pollen in residential areas should be conducted to aid the diagnosis and treatment of allergic diseases. METHODS: Airborne pollen samples were collected from 2 sites in Incheon and 2 in Seoul from 2015 to 2016. RESULTS: The highest monthly concentration of airborne pollen was observed in May and September each year. Pollen from 32 families and 50 genera was identified over the 2 years; of these, Pinus spp. showed the highest pollen concentration (41.6%), followed by Quercus spp. (25.3%), and Humulus spp. (15.3%), the latter of which had the highest concentration among weed pollen. The total pollen concentration was significantly higher in Incheon than in Seoul (p = 0.001 in 2015, p < 0.001 in 2016) and higher in 2016 than in 2015. The concentrations of pollen from weed species (Cupressaceae, Humulus spp., Artemisia spp., Ambrosia spp., and Chenopodiaceae) and grass species (Gramineae) were significantly higher (p < 0.001) than those from tree species. Pollen was distributed from February to November. The first pollen identified in both regions in each year was Alnus spp. Overall, the total concentration of Quercus spp., Betula spp., Humulus spp., Artemisia spp., Ambrosia spp., and Chenopodiaceae pollen increased significantly over the 2 years. CONCLUSION: Region-specific differences exist in the pollen of major allergenic plants. Continuous monitoring of pollen is thus essential for management of pollen-related allergic disorders in each region.
Allergens ; Alnus ; Ambrosia ; Artemisia ; Asthma ; Betula ; Chenopodiaceae ; Conjunctivitis, Allergic ; Diagnosis ; Humans ; Humulus ; Hypersensitivity ; Incheon ; Pinus ; Poaceae ; Pollen ; Quercus ; Rhinitis, Allergic ; Seoul ; Trees

Papain is a proteolytic enzyme which is widely used in food industry, pharmaceuticals, and cosmetics. Occupational and non-occupational papain allergies have previously been documented; however, there are limited publications about papain allergy with its relative fruit allergy. Here, we present a case of occupational, IgE-mediated papain allergy with kiwi fruit and fig fruit allergy. A 53-year-old man suffered from rhinitis for several years, with the onset of his symptoms coinciding with the time he started to work at a sausage processing plant where papain is often used as a meat tenderizer. He began to experience symptoms of chest tightness, shortness of breath and wheezing shortly after starting work 5 years ago. Furthermore, he experienced several episodes of oral itching, and tongue and oropharyngeal angioedema after injestion of kiwi fruit and fig fruit. The patient had a lifelong history of allergic conjunctivitis, allergic rhinitis, and childhood asthma. Specific IgE was positive to kiwi fruit, papain and chymopapain (2.95 kUA/L, >100 kUA/L, and 95.0 kUA/L, respectively). Similar bands at 10-15 kDa in blotting with papain and kiwi fruit extracts were found. This patient showed a potential association between papain allergy and sensitization to kiwi fruit. We also reviewed 13 patients with papain allergy published in the literature, with 85% (11/13) of the patients sensitized through the respiratory tract, and 40% (4/11) having atopy. Further studies should focus on the determination of cross-reactive allergens between papain and its fruit relatives, and the prevalence of food allergy in patients with papain allergy should be investigated in a relatively large cohort.
Allergens ; Angioedema ; Asthma ; Asthma, Occupational* ; Chymopapain ; Cohort Studies ; Conjunctivitis, Allergic ; Dyspnea ; Food Hypersensitivity ; Food Industry ; Fruit ; Humans ; Hypersensitivity* ; Immunoglobulin E ; Meat ; Middle Aged ; Papain* ; Plants ; Prevalence ; Pruritus ; Respiratory Sounds ; Respiratory System ; Rhinitis ; Thorax ; Tongue

INTRODUCTIONWhile corticosteroids are an effective choice of treatment for severe vernal keratoconjunctivitis (VKC), their long-term use is restricted due to side effects. This study was conducted to evaluate the efficacy and safety of topical cyclosporine A (CsA) 0.05% in the treatment of VKC.

METHODSA total of 30 patients with VKC that was resistant to topical corticosteroids, antihistamines and mast cell stabilisers were treated with topical CsA 0.05%. Patients were evaluated at Weeks 4, 8 and 12 after the initiation of therapy. Symptoms and signs observed before and after treatment were recorded and scores were assigned. Scores for symptoms and signs, the need for topical corticosteroids and ocular side effects were evaluated.

RESULTSAt baseline, the median values of the symptom and sign scores were 10.0 (range 5.0-18.0) and 6.0 (range 2.0-13.0), respectively. At Week 4 of treatment with topical CsA 0.05%, the median values of the symptom and sign scores were 3.0 (range 0-14.0) and 3.0 (range 0-8.0), respectively. The reductions in the symptom and sign scores were statistically significant. The reduction in the need for corticosteroid was statistically significant by Week 12 of therapy. No significant side effects were reported.

CONCLUSIONTopical CsA 0.05%, which can help to reduce corticosteroid usage, is an effective and safe alternative for the treatment of resistant VKC. Further studies are needed to determine the optimal duration of therapy and possibility of recurrence.

Administration, Topical ; Adolescent ; Adrenal Cortex Hormones ; administration & dosage ; Adult ; Child ; Cohort Studies ; Conjunctivitis, Allergic ; drug therapy ; Cornea ; drug effects ; Cyclosporine ; administration & dosage ; Drug Administration Schedule ; Eye ; drug effects ; Female ; Humans ; Immunosuppressive Agents ; administration & dosage ; Male ; Recurrence ; Young Adult