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Allergic conjunctivitis
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==Pathophysiology== [[File:01-09-11 0222.jpg|thumb|250px|right|Eye with mild allergic conjunctivitis]] The ocular allergic response is a cascade of events that is coordinated by [[mast cells]].<ref>{{cite book |vauthors=Liu G, Keane-Myers A, Miyazaki D, Tai A, Ono SJ | title = Immune Response and the Eye | chapter = Molecular and cellular aspects of allergic conjunctivitis | journal = Chem. Immunol. | volume = 73 | pages = 39β58 | year = 1999 | pmid = 10590573 | doi = 10.1159/000058748 | series = Chemical Immunology and Allergy | isbn = 978-3-8055-6893-7 }}</ref> Beta [[chemokine]]s such as [[eotaxin]] and [[CCL3|MIP-1 alpha]] have been implicated in the priming and activation of mast cells in the ocular surface. When a particular allergen is present, sensitization takes place and prepares the system to launch an antigen specific response. [[T helper cell|TH2 differentiated]] [[T cell]]s release cytokines, which promote the production of antigen specific [[immunoglobulin E]] (IgE). IgE then binds to IgE receptors on the surface of mast cells. Then, mast cells release [[histamine]], which then leads to the release of cytokines, [[prostaglandin]]s, and [[platelet-activating factor]]. Mast cell intermediaries cause an allergic inflammation and symptoms through the activation of inflammatory cells.<ref name="Cunningham"/> When [[histamine]] is released from mast cells, it binds to [[histamine H1 receptor|H1 receptors]] on nerve endings and causes the ocular symptom of itching. Histamine also binds to H1 and [[histamine H2 receptor|H2 receptors]] of the conjunctival vasculature and causes [[vasodilatation]]. Mast cell-derived cytokines such as chemokine interleukin [[Interleukin 8|IL-8]] are involved in recruitment of [[neutrophil]]s. TH2 cytokines such as [[Interleukin 5|IL-5]] recruit eosinophils and [[Interleukin 4|IL-4]], [[Interleukin 6|IL-6]], and [[Interleukin 13|IL-13]], which promote increased sensitivity. Immediate symptoms are due to the molecular cascade. Encountering the allergen a patient is sensitive to leads to increased sensitization of the system and more powerful reactions. Advanced cases can progress to a state of chronic allergic inflammation.<ref name="Cunningham"/>
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