Specific immunoglobulin E antibodies in tear secretions of patients with vernal conjunctivitis

Twenty-two patients with vernal conjunctivitis (VC) were studied by radioallergosorbent test (RAST) for specific IgE antibodies to the inhalant pollen allergens in tear secretions. Specific IgE antibodies were detected in the tear secretions of 12 (54.5%) patients with VC. Six patients had a positive tear RAST, but the corresponding serum RAST and immediate skin test reactivity were negative. The specific tear IgE antibodies appeared to correlate with the seasonal prevalence of the pollen in the environment and the period of maximal symptomatology. Six patients had both positive serum and tear RAST determinations. A double ratio formula with transferrin as a marker for the leakage of plasma proteins into tear secretions and the “specific activity” ratios of IgE antibody to total IgE between the tear secretions and the serum indicated that almost all (79% to 99%) of the tear IgE antibodies were locally produced. IgE antibodies were also detected in the tears of four of 10 patients with allergic conjunctivitis (AC) and of three with allergic rhinitis (AR). However, the “specific activity” ratio in the patients with AC and AR with measurable tear IgE suggested that the IgE antibodies were derived from the leakage of serum proteins into the tear secretions. These findings suggest that the pathogenesis of VC may be IgE mediated in some patients and lends support to the concept that specific IgE antibodies can be produced locally by the target organ, i.e., conjunctival tissues.