Where eye meets body part 1: uniting allergy pathways in ocular and nasal disease – IgE on the offense

PURPOSE OF REVIEW: This review explores the shared immunologic mechanisms and clinical distinctions between seasonal and perennial allergic rhinitis (SAR, PAR) and their ocular counterparts, seasonal and perennial allergic conjunctivitis (SAC, PAC). These IgE-mediated diseases often coexist, reflecting overlapping triggers, mast cell activation, and mucosal immune responses. By comparing their epidemiology, pathophysiology, genetics, and treatments, this review highlights how nasal and ocular allergic pathways intersect and diverge. RECENT FINDINGS: SAC and SAR frequently co-occur, with up to 71% of SAR patients reporting conjunctival symptoms and 75% of SAC patients experiencing rhinitis; in children, 42% with allergic rhinitis also have PAC. Recent studies suggest possible shared genetic and metabolic contributors across these conditions. Therapeutically, oral and intranasal antihistamines remain a mainstay for SAR, while combination intranasal corticosteroid-antihistamine regimens offer enhanced control in PAR. Topical dual-action antihistamine-mast cell stabilizers are commonly used in SAC and serve as first-line therapy for PAC. Novel ocular delivery systems, such as dexamethasone intracanalicular inserts, show promise for PAC. SUMMARY: These findings emphasize the overlap in episodic and chronic nasal and ocular allergies, with shared mechanisms, genetics, and treatment approaches, yet with site-specific nuances. Ongoing research into genetic and therapeutic differentiation remains crucial to advancing personalized allergy care.