Tear cytokine levels in allergic rhinitis without ocular symptoms

Published:January 22, 2019DOI:



      To compare cytokine levels in the pre-corneal tear film between patients with allergic rhinitis, allergic rhinoconjunctivitis and the normal population.


      A comparative cross sectional study.


      Patients were divided into Group 1 (allergic rhinitis without conjunctivitis), Group 2 (allergic rhinoconjunctivitis), and Group 3 (normal population).


      A comparative cross-sectional study was conducted. Patients were divided into; Group 1 (allergic rhinitis without conjunctivitis), Group 2 (allergic rhinoconjunctivitis), and Group 3 (normal controls). Tears were collected using Schirmer strips and cytokine analysis performed using enzyme linked immunosorbent assay.


      There were a total of 68 subjects. Median values of cytokines in the allergic rhinitis group were as follows; TNFa (45.34 pg/ml), IL-4 (61.91 pg/ml), IL-5 (8.92 pg/ml), IL-6 (538.37 pg/ml) and IL-8 (1438.72 pg/ml). Cytokine levels in the group with allergic rhinoconjunctivitis were approximately two-fold higher than in the group with allergic rhinitis only. The median cytokine level in the control group was lowest. A significant inter-group difference was observed for TNF-alpha, IL-4, IL-6 and IL-8 levels, with allergic rhinoconjunctivitis patients demonstrating significantly elevated cytokines compared to those with allergic rhinitis only (p<0.001). These four cytokines were also significantly higher in those with allergic rhinitis than in controls (p<0.005). Although the group with allergic rhinoconjunctivitis had the highest levels of IL-5, no statistically significant inter-group difference was noted (p=0.479).


      This study demonstrated the presence of raised tear film inflammatory cytokines even in allergic rhinitis patients without ocular symptoms. These patients may be at increased risk of developing allergic conjunctivitis. These findings not only substantiate the immunological theory of the naso-ocular reflex, but have clinical and therapeutic implications for the holistic management of allergic rhinitis and conjunctivitis.



      Comparer le taux de cytokines du film lacrymal précornéen chez le sujet présentant une rhinite allergique, chez le sujet souffrant de rhinoconjonctivite allergique et chez le sujet sain.


      Étude transversale comparative.


      Les 68 sujets ont été répartis en 3 groupes: rhinite allergique sans conjonctivite, rhinoconjonctivite allergique et population saine.


      On a procédé à une étude transversale comparative au cours de laquelle les patients ont été répartis en 3 groupes: groupe 1 (rhinite allergique sans conjonctivite), groupe 2 (rhinoconjonctivite allergique) et groupe 3 (sujets témoins). On a recueilli des larmes au moyen d'un ruban de papier filtre afin de réaliser un test de Schirmer. L'analyse des cytokines a été réalisée par essai immuno-enzymatique ELISA (enzyme linked immunosorbent assay).


      Chez l'ensemble des 68 sujets, le taux médian de cytokines dans le groupe rhinite allergique se chiffrait comme suit: TNF-α (45,34 pg/mL), IL-4 (61,91 pg/mL), IL-5 (8,92 pg/mL), IL-6 (538,37 pg/mL) et IL-8 (1438,72 pg/mL). Le taux de cytokines dans le groupe rhinoconjonctivite allergique était approximativement 2 fois plus élevé que le taux enregistré dans le groupe rhinite allergique seule. Le taux médian de cytokines était le moins élevé dans le groupe témoin. On a noté une différence inter-groupe significative quant au taux de TNF-α, d'IL-4, d'IL-6 et d'IL-8; le taux de cytokines était significativement plus élevé chez les patients du groupe rhinoconjonctivite allergique comparativement à ceux du groupe rhinite allergique seule (p < 0,001). Le taux de ces 4 cytokines était en outre significativement plus élevé chez les sujets qui souffraient de rhinite allergique comparativement aux sujets témoins (p < 0,005). Bien que le taux d'IL-5 ait été le plus élevé dans le groupe rhinoconjonctivite allergique, on ne note aucune différence inter-groupe statistiquement significative à ce chapitre (p = 0,479).


      Cette étude met au jour une hausse du taux des cytokines inflammatoires dans le film lacrymal même chez les patients souffrant de rhinite allergique sans symptômes oculaires. Ces sujets sont peut-être exposés à un risque plus élevé de conjonctivite allergique. Nos résultats étayent la théorie immunologique du réflexe naso-oculaire, sans compter qu'ils font ressortir les répercussions cliniques et thérapeutiques de la prise en charge globale de la rhinite et de la conjonctivite allergique.
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