Implementing changes and technology in the management of allergic rhinoconjunctivitis

Image Credit: AdobeStock/DraganaGordic

Do you remember during the height of mask wearing in the COVID-19 pandemic when patients would mention that their allergies were not as bad that year, and that it also helped prevent allergic eye symptoms? We did have the downside of mask-associated dry eye syndrome and an increase in hordeola, but on the other hand, some allergy sufferers have returned to wearing masks when it is very windy or if they are out in the garden to prevent allergic reactions.

Environmental allergens such as pollen, dust, and dander can cause IgE-mediated inflammation leading to allergic conjunctivitis and allergic rhinitis. These 2 often overlap and are now referred to as allergic rhinoconjunctivitis. Why is this? The conjunctiva and the nasal mucosa have the same type of epithelium. Therefore, when an allergen is breathed into the nose, the allergic reaction will also be present in the ocular conjunctiva and the mucosa of the sinuses. The anatomical connection between the eyes, nose, sinus, and airway perpetuates the reaction.

How common is allergic conjunctivitis? A study from Switzerland of 509 allergic patients found rhinoconjunctivitis in 87.3% of cases, conjunctivitis without rhinitis in only 8% of cases and the small percentage left were rhinitis without conjunctivitis.¹ Another study with 200 participants diagnosed with allergic rhinitis stated that approximately 90% also had ocular symptoms.² Essentially, allergens can accumulate on the ocular surface or in the nasal passages, inducing the symptoms of sneezing, runny nose, and itchy eyes, causing increased mucus production.

How can we intervene to prevent this? We advise patients on measures to reduce exposure to allergens in their environment including avoidance as the first step. The following steps can complement medical treatment and help alleviate allergy symptoms:

1. Avoid the yard with the freshly-cut grass (and wear that mask).
2. Do not pet that dog.
3. Do not rub your eyes.
4. Do not open your windows during peak allergy times.
5. Do not wear your contact lenses when allergen counts are high.
6. Wear wraparound sunglasses, or even better, the ones with the foam insert to keep out air flow.
7. Wash your hair and shower at bedtime.
8. Change your bedding often and consider using a mattress and pillow protector if you are sensitive to dust (mites).

These behavioral modifications are tips we give to our patients every day. I also suggest quality air purifiers and vacuum cleaners as recently recommended by Wirecutter,^3,4 although some say a vacuum steamer is better. A bagged vacuum cleaner is also a good option, as it will not repollute the air once a bagless vacuum canister is dumped into the trash.

In addition to traditional treatment methods and avoidance and behavioral modifications, incorporating technology can enhance our ability to provide effective care. Let us explore how we can recommend patients use and implement technology to manage rhinoconjunctivitis.

Telehealth and remote monitoring

Technology has revolutionized health care delivery and optometry is no exception, although significant limitations remain in providing successful telehealth options for other ocular conditions. Implementing telehealth solutions allows us to remotely monitor patients with allergic conjunctivitis who may have difficulty visiting the clinic often. Through telehealth or smartphone photos sent through the patient portal, we can assess their signs and symptoms, provide guidance on medication management, and address any concerns the patient may have.

Mobile applications

Mobile applications offer valuable tools for patients to monitor and manage their allergies. Apps can provide real-time pollen and allergen alerts, allowing patients to be proactive in avoiding triggers. Some apps can also track environmental factors such as air quality and humidity, providing insights into potential allergen exposure that patients can use to make informed decisions about certain activities and environments. Many of these apps also allow the subscriber to add how they are feeling and their symptoms to analyze trends. Some of the top-rated allergen apps available include My Pollen Forecast, klarify, AllergyCast (Zyrtec), Allergy Plus (pollen.com), and IQAir AirVisual Air Quality, which also has pollution information.

Allergy-specific eye drop reminder systems

Adherence to prescribed medications is crucial for effective treatment. Technology can help patients stay on track by providing reminder systems designed for allergy-specific eye drops. These reminders can be delivered through mobile apps (EyeDropAlarm), smartwatches, or setting daily alarms, ensuring that patients do not miss their doses and experience optimal relief from their allergy symptoms.

Smart home integration

Integrating smart home devices into the management of eye allergies can create a more allergen-controlled environment for patients. Stand-alone air purifiers and heating, ventilating, and air-conditioning (HVAC) filter systems can be programmed to filter allergens effectively, as both remove allergens from the air. Additionally, stand-alone units can provide concentrated allergen removal in a small area of your home. They use high-efficiency particulate air (HEPA) filters and UV sterilization to purify the surrounding air, with a unit’s square-foot purification radius dependent on its size and power.⁵ HEPA filters are designed to capture and trap microscopic particles, including dust mites, pollen, pet dander, and other common allergens. These filters are highly effective, capable of removing up to 99.97% of particles as small as 0.3 µm in size.⁶ Stand-alone air purifiers are required in every room to provide optimal allergy relief, whereas HVAC air filters provide whole-home filtration by reducing the allergens circulating through your system and across your entire home. Your central HVAC system can move tons of air every day,⁷ offering the greatest chance to remove and reduce indoor allergens. However, they do not provide the concentrated relief of a stand-alone unit. In-unit air purifiers, like the iWave (air ionization) or the Air Scrubber Plus (disinfecting molecules released to neutralize viruses in air and on surfaces) provide the best of both worlds—cleansing allergens from the air like a stand-alone unit while keeping the whole-home capacity of an HVAC filter.⁸

An important HVAC maintenance task is having the air ducts cleaned every 3 to 5 years by a National Air Duct Cleaners Association–certified air duct cleaning company.⁹ More regular cleaning may be required if any construction or remodeling is done within the house.

Also make sure your patients are cleaning their fans or air conditioners. It is recommended to clean before the sweltering of summer begins and then check the filter monthly. Furnace filters need to be changed every 90 days.

Another technology to consider is a robotic vacuum cleaner. By incorporating HEPA filters into their systems, robotic vacuum cleaners can significantly improve indoor air quality and reduce allergy triggers. There are a few on the market such as the Roomba (iRobot), RoboVac (Eufy), and Roborock that offer an app to let you map your home faster and provide an on-spot cleaning option for areas that you missed or increased cleaning across carpets with pet hair. These technologies, when combined with patient education on proper maintenance, can significantly reduce allergen exposure within the home.

Data analytics and artificial intelligence to come

Data analytics and artificial intelligence (AI) can enable patients and providers to improve treatment outcomes by analyzing large data sets. This could include location, which allergens the patient is most sensitive to,¹⁰ medical management, and how the patient rates their well-being, along with the other modifications previously listed. AI algorithms can provide personalized recommendations for treatment plans, ensuring optimal management of rhinoconjunctivitis. This technology holds the potential to enhance the precision and effectiveness of our interventions.

Incorporating technology and implementing changes for the management of rhinoconjunctivitis for patients can significantly improve treatment outcomes and patient satisfaction. Telehealth, mobile applications, smart home integration, and data analytics offer innovative solutions that complement traditional treatment methods. As eye care providers, we should inform our patients about these technological advancements and provide our patients with the most comprehensive and effective care possible, ensuring optimal management of their health.

References:

1. Iordache A, Boruga M, Mușat O, Jipa DA, Tătaru CP, Mușat GC. Relationship between allergic rhinitis and allergic conjunctivitis (allergic rhinoconjunctivitis) - review. Rom J Ophthalmol. 2022;66(1):8-12. doi:10.22336/rjo.2022.3

2. Berger W, Abelson MB, Gomes PJ, et al. Effects of adjuvant therapy with 0.1% olopatadine hydrochloride ophthalmic solution on quality of life in patients with allergic rhinitis using systemic or nasal therapy. Ann Allergy Asthma Immunol. 2005;95(4):361-371. doi:10.1016/S1081-1206(10)61155-6

3. Heffernan T. The best air purifier. Wirecutter. Updated December 19, 2023. Accessed April 16, 2024. https://www.nytimes.com/wirecutter/reviews/best-air-purifier/

4. Heinlein S. The best vacuum cleaners. Wirecutter. Updated April 5, 2024. Accessed April 16, 2024. https://www.nytimes.com/wirecutter/reviews/best-vacuum-cleaner/

5. How does an air purifier work? Filtrete. Accessed April 16, 2024. https://www.filtrete.com/3M/en_US/filtrete/home-tips/full-story/~/why-you-should-purify-your-air/?storyid=eb519632-1671-4947-8ee6-af8daa7cb00b

6. What is a HEPA filter? US Environmental Protection Agency. Updated March 5, 2024. Accessed April 16, 2024. https://www.epa.gov/indoor-air-quality-iaq/what-hepa-filter

7. McCabe L. How much energy does an air conditioner use? EnergySage. Updated March 22, 2024. Accessed April 16, 2024. https://www.energysage.com/electricity/house-watts/how-many-watts-does-an-air-conditioner-use/

8. Bennert A. What is the best central air purifier? Air Oasis. August 18, 2022. Accessed April 16, 2024. https://www.airoasis.com/blogs/articles/best-central-air-purifier

9. Proper cleaning methods. NADCA. Accessed April 16, 2024. https://nadca.com/homeowners/proper-cleaning-methods

10. Vanderhoof SL. Looking forward to improving and lessening the allergic response. Opt Times. Epub Jan 29, 2024. 2024 Jan;16(01). Accessed April 22, 2024. https://www.optometrytimes.com/view/looking-forward-to-improving-and-lessening-the-allergic-response