Sánchez-Hernández M Cesárea, Navarro Ana M, Colás Carlos, Del Cuvillo Alfonso, Sastre Joaquín, Mullol Joaquim, Valero Antonio
Department of Allergy, Hospital Universitario Virgen Macarena, Seville, Spain.
Department of Allergy, Hospital El Tomillar, Dos Hermanas, Seville Spain.
Clin Transl Allergy. 2020 Oct 23;10:43. doi: 10.1186/s13601-020-00349-4. eCollection 2020.
Allergic conjunctivitis (AC) is usually associated to allergic rhinitis (AR), but the severity and control of ocular symptoms should be assessed independently to improve diagnosis and treatment. The criteria from the Spanish consensus document on allergic conjunctivitis (DECA) aimed to be used as a patient-reported instrument for AC management. Here we validate these criteria for classifying AC severity and defining its control following COSMIN guidelines recommendations.
Patients with moderate or severe AR [reflective total nasal symptom score (rTNSS) score ≥ 8] and concomitant AC were recruited from hospitals in Spain. Patients were classified according to the severity of ocular symptoms as mild, moderate, or severe, and classified with respect to control as controlled and non-controlled, using the DECA criteria. To validate these criteria, comparisons with the validated modified allergic rhinitis and its impact on asthma (mARIA), reflective total ocular symptom score (rTOSS), rhinitis control assessment test (RCAT), ESPRINT-15 questionnaires, a conjunctival hyperemia scale and a visual analogue scale (VAS) for ocular symptoms were performed.
A total of 128 patients participated in the validation. Mean age was 34.4 ± 12.1 years; 72.7% were women. The DECA criteria showed a good discriminant validity, reflecting a high capacity to differentiate between mild, moderate, and severe patients, and controlled from uncontrolled patients. A strong association between AC and AR was reflected in the comparison between the DECA and the mARIA criteria (p < 0.0001). The DECA criteria for severity and control presented satisfactory properties for longitudinal validity and responsiveness.
Validation of the DECA criteria for severity and control of AC suggested that it can be useful in the evaluation of eye symptoms and follow-up of therapies.
过敏性结膜炎（AC）通常与过敏性鼻炎（AR）相关，但眼部症状的严重程度和控制情况应独立评估，以改善诊断和治疗。西班牙过敏性结膜炎共识文件（DECA）中的标准旨在用作AC管理的患者报告工具。在此，我们按照COSMIN指南建议对这些用于AC严重程度分类和控制定义的标准进行验证。
从西班牙医院招募中度或重度AR（反射性总鼻症状评分[rTNSS]≥8）且伴有AC的患者。使用DECA标准，根据眼部症状的严重程度将患者分为轻度、中度或重度，并根据控制情况分为控制组和非控制组。为验证这些标准，将其与经过验证的改良过敏性鼻炎及其对哮喘的影响（mARIA）、反射性总眼症状评分（rTOSS）、鼻炎控制评估测试（RCAT）、ESPRINT - 15问卷、结膜充血量表以及眼部症状视觉模拟量表（VAS）进行比较。
共有128名患者参与验证。平均年龄为34.4±12.1岁；72.7%为女性。DECA标准显示出良好的判别效度，反映出其在区分轻度、中度和重度患者以及控制组与非控制组患者方面具有很高的能力。DECA与mARIA标准的比较反映出AC和AR之间存在很强的关联（p<0.0001）。DECA的严重程度和控制标准在纵向效度和反应性方面表现出令人满意的特性。
对AC严重程度和控制的DECA标准的验证表明，它在评估眼部症状和治疗随访中可能有用。
