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Shozo Sueda - One of the best experts on this subject based on the ideXlab platform.
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Transitional changes of acetylcholine spasm Provocation Test procedures
Cardiovascular Intervention and Therapeutics, 2019Co-Authors: Shozo Sueda, Hiroaki KohnoAbstract:Intracoronary acetylcholine (ACh) Testing has become popular in the world as a spasm Provocation Test as well as an ergonovine Test. Intracoronary ACh Test based on the Japanese Circulation Society guidelines is necessary to insert a temporary pace maker (PM). We analyzed the ACh spasm Provocation Test procedures retrospectively. We performed 1829 ACh spasm Provocation Testing during 28 years. We investigated the procedural approach sites of artery and vein. Femoral artery and vein approach, brachial artery and femoral vein approach, brachial artery and vein approach, radial artery and brachial vein approach, radial artery and femoral vein approach were performed in 292 patients (16.0%), 498 patients (27.2%), 589 patients (32.2%), 252 patients (13.8%), and 175 patients (9.6%), respectively. We could perform the ACh Testing by the femoral artery and brachial artery in all patients, while the success rate of radial artery approach was 97.1%. We could also insert the temporary PM by the brachial vein in 94.8% (841/887) of the study patients, whereas we could insert the temporary PM in all femoral vein approach [100% (965/965)]. We experienced the pulmonary embolism by the femoral artery and vein approach in two patients, while we also had the arterio-venous fistula necessary for surgical repair in two patients by the brachial artery and vein approach. Although there was no difference about the procedure-related major complications among the various procedures, we had no pulmonary embolism or arterio-venous fistula by the radial artery and brachial vein approach. Considering the disinfection with povidone iodine, procedural performance or procedure-related complications by the ACh Testing, we recommend that radial artery and brachial vein approach is more comfortable method of the future ACh Testing not only for patients but also for operators.
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Acetylcholine spasm Provocation Test by trans-radial artery and brachial vein approach.
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, 2018Co-Authors: Shozo Sueda, Kaori Fujimoto, Yasuhiro Sasaki, Tomoki Sakaue, Hirokazu Habara, Hiroaki KohnoAbstract:BACKGROUND Temporary pace maker is necessary because of transient block or bradycardia during the intracoronary acetylcholine spasm Provocation Tests based on the Japanese Circulation Society guidelines. OBJECTIVES We examined the feasibility and safety of the acetylcholine spasm Provocation Test via the radial artery and brachial vein approach. METHODS We tried to perform the acetylcholine spasm Provocation Tests in 252 patients via the radial artery and brachial vein approach procedures during 5 years. Acetylcholine was injected in incremental doses of 20/50/80 μg into the right coronary artery (RCA) and 20/50/100/200 μg into the left coronary artery (LCA). Back-up pacing rate was set at 40 beats/min. Positive spasm was defined as transient ≥90% luminal narrowing and ischemic electrocardiographic change or usual chest pain. RESULTS The procedure success of radial artery and brachial vein access was 94.4% (238/252) and 93.3% (235/252), respectively. We performed 221 patients (87.7%) with acetylcholine Tests by radial artery and brachial vein approach. We changed to the brachial approach due to the failures of radial artery access in 14 patients. We also changed to the femoral vein in 11 patients and internal jugular vein in two patients. Back-up pace maker rhythm was observed in 92.1% (232/252) of all study patients, while it was significantly higher in the RCA Testing than that in the LCA Tests (84.9% (191/225) vs. 52.2% (131/251), P < 0.001). No irreversible complication was found. CONCLUSIONS We recommend the radial artery and brachial vein approach for safety and convenience when performing the acetylcholine spasm Provocation Tests.
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gender differences in sensitivity of acetylcholine and ergonovine to coronary spasm Provocation Test
Heart and Vessels, 2016Co-Authors: Shozo Sueda, Tomoki Sakaue, Hirokazu Habara, Toru Miyoshi, Ysuhiro Sasaki, Hiroaki KohnoAbstract:We examined the sex difference concerning the coronary artery response between ACh and ER in this study. We already reported the difference of coronary response between acetylcholine (ACh) and ergonovine (ER). We performed both ACh and ER Tests of 461 patients (male 294 patients, female 167 patients, mean age 64.4 ± 11.3 years) during 23 years. Positive coronary spasm was defined as >99 % transient luminal narrowing with usual chest pain and/or ischemic ECG changes. Firstly, ACh was administered in incremental doses of 20/50/(80) μg into the RCA and 20/50/100/(200) μg into the LCA over 20 s. Secondly, ER was administered in a total dose of 40 μg into the RCA and of 64 μg into the LCA over 2–4 min. Intracoronary injection of ACh and ER provoked spasm in 221 patients consisting of 160 male patients and 61 female patients. In female patients, the spasm provoked by ACh was almost perfect except in two patients (59 patients, 96.7 %), while ER provoked spasm in only 20 patients (32.8 %). In male patients, provoked spasm by ACh (129 patients, 80.6 %) was significantly higher than ER (97 patients, 60.6 %). As a spasm Provocation Test, ACh is more sensitive than ER in both sexes and especially in females. We may select two pharmacological agents by sex differences to provoke coronary artery spasm in the cardiac catheterization laboratory in the future.
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Safety and optimal protocol of Provocation Test for diagnosis of multivessel coronary spasm
Heart and Vessels, 2016Co-Authors: Shozo Sueda, Yasuhiro Sasaki, Tomoki Sakaue, Hirokazu Habara, Toru Miyoshi, Hiroaki KohnoAbstract:We examined the safety of acetylcholine (ACh) and ergonovine (ER) Tests retrospectively and investigated the optimal protocol of Provocation Test for diagnosis of multivessel coronary spasm. We performed 1546 ACh Tests and 1114 ER Tests during 23 years. ACh was injected in incremental doses of 20/50/80 μg into the right coronary artery (RCA) and of 20/50/100/200 μg into the left coronary artery (LCA) over 20 s. ER was administered in total doses of 40 μg into the RCA and of 64 μg into the LCA over 2–4 min. When a coronary spasm was induced and did not resolve spontaneously within 3 min after the completion of ACh/ER injection, or when hemodynamic instability due to coronary spasms occurred, 2.5–5.0 mg of nitrate was administered into the responsible vessel. To relive provoked spasm, it is necessary to administer nitrate in 31 cases by ACh and in 76 cases by ER (2.0 vs. 6.8 %, p
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maximal acetylcholine dose of 200 μg into the left coronary artery as a spasm Provocation Test comparison with 100 μg of acetylcholine
Heart and Vessels, 2015Co-Authors: Shozo Sueda, Yasuhiro Sasaki, Tomoki Sakaue, Hiroaki Kohno, Toru Miyoshi, Hirokazu HabaraAbstract:As a spasm Provocation Test of acetylcholine (ACH), incremental dose up (20/50/100 μg) into the left coronary artery (LCA) is recommended in the guidelines established by Japanese Circulation Society. Recently, Ong et al. reported the ACOVA study which maximal ACH dose was 200 μg in the LCA. We compared the angiographic findings between ACH 100 μg and ACH 200 μg in the LCA and also examined the usefulness and safety of ACH 200 μg in Japanese patients without variant angina. As a spasm Provocation Test, we performed intracoronary injection of ACH 200 μg after ACH 100 μg in 88 patients (55 males, 68.4 ± 11.7 years old) including 59 ischemic heart disease (IHD) patients and 29 non-IHD patients. Positive spasm was defined as >99 % transient stenosis (focal spasm) or 90 % severe diffuse vasoconstriction (diffuse spasm). Positive spasm by ACH 200 μg was significantly higher than that by ACH 100 μg (36 pts: 40.9 % vs. 17 pts: 19.3 %, p < 0.01). Diffuse distal spasm on the left anterior descending artery was more recognized in ACH 200 μg than in ACH 100 μg (30.7 vs. 13.6 %, p < 0.01). In 29 rest angina patients, positive spasm by ACH 200 μg (19 pts) was significantly higher than that by ACH 100 μg (7 pts) (65.5 vs. 24.1 %, p < 0.01). No serious irreversible complications were found during ACH 200 μg. Administration of ACH 200 μg into the LCA was safe and useful. We may reexamine the maximal ACH dose into the LCA.
Hiroaki Kohno - One of the best experts on this subject based on the ideXlab platform.
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Transitional changes of acetylcholine spasm Provocation Test procedures
Cardiovascular Intervention and Therapeutics, 2019Co-Authors: Shozo Sueda, Hiroaki KohnoAbstract:Intracoronary acetylcholine (ACh) Testing has become popular in the world as a spasm Provocation Test as well as an ergonovine Test. Intracoronary ACh Test based on the Japanese Circulation Society guidelines is necessary to insert a temporary pace maker (PM). We analyzed the ACh spasm Provocation Test procedures retrospectively. We performed 1829 ACh spasm Provocation Testing during 28 years. We investigated the procedural approach sites of artery and vein. Femoral artery and vein approach, brachial artery and femoral vein approach, brachial artery and vein approach, radial artery and brachial vein approach, radial artery and femoral vein approach were performed in 292 patients (16.0%), 498 patients (27.2%), 589 patients (32.2%), 252 patients (13.8%), and 175 patients (9.6%), respectively. We could perform the ACh Testing by the femoral artery and brachial artery in all patients, while the success rate of radial artery approach was 97.1%. We could also insert the temporary PM by the brachial vein in 94.8% (841/887) of the study patients, whereas we could insert the temporary PM in all femoral vein approach [100% (965/965)]. We experienced the pulmonary embolism by the femoral artery and vein approach in two patients, while we also had the arterio-venous fistula necessary for surgical repair in two patients by the brachial artery and vein approach. Although there was no difference about the procedure-related major complications among the various procedures, we had no pulmonary embolism or arterio-venous fistula by the radial artery and brachial vein approach. Considering the disinfection with povidone iodine, procedural performance or procedure-related complications by the ACh Testing, we recommend that radial artery and brachial vein approach is more comfortable method of the future ACh Testing not only for patients but also for operators.
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Acetylcholine spasm Provocation Test by trans-radial artery and brachial vein approach.
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, 2018Co-Authors: Shozo Sueda, Kaori Fujimoto, Yasuhiro Sasaki, Tomoki Sakaue, Hirokazu Habara, Hiroaki KohnoAbstract:BACKGROUND Temporary pace maker is necessary because of transient block or bradycardia during the intracoronary acetylcholine spasm Provocation Tests based on the Japanese Circulation Society guidelines. OBJECTIVES We examined the feasibility and safety of the acetylcholine spasm Provocation Test via the radial artery and brachial vein approach. METHODS We tried to perform the acetylcholine spasm Provocation Tests in 252 patients via the radial artery and brachial vein approach procedures during 5 years. Acetylcholine was injected in incremental doses of 20/50/80 μg into the right coronary artery (RCA) and 20/50/100/200 μg into the left coronary artery (LCA). Back-up pacing rate was set at 40 beats/min. Positive spasm was defined as transient ≥90% luminal narrowing and ischemic electrocardiographic change or usual chest pain. RESULTS The procedure success of radial artery and brachial vein access was 94.4% (238/252) and 93.3% (235/252), respectively. We performed 221 patients (87.7%) with acetylcholine Tests by radial artery and brachial vein approach. We changed to the brachial approach due to the failures of radial artery access in 14 patients. We also changed to the femoral vein in 11 patients and internal jugular vein in two patients. Back-up pace maker rhythm was observed in 92.1% (232/252) of all study patients, while it was significantly higher in the RCA Testing than that in the LCA Tests (84.9% (191/225) vs. 52.2% (131/251), P < 0.001). No irreversible complication was found. CONCLUSIONS We recommend the radial artery and brachial vein approach for safety and convenience when performing the acetylcholine spasm Provocation Tests.
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gender differences in sensitivity of acetylcholine and ergonovine to coronary spasm Provocation Test
Heart and Vessels, 2016Co-Authors: Shozo Sueda, Tomoki Sakaue, Hirokazu Habara, Toru Miyoshi, Ysuhiro Sasaki, Hiroaki KohnoAbstract:We examined the sex difference concerning the coronary artery response between ACh and ER in this study. We already reported the difference of coronary response between acetylcholine (ACh) and ergonovine (ER). We performed both ACh and ER Tests of 461 patients (male 294 patients, female 167 patients, mean age 64.4 ± 11.3 years) during 23 years. Positive coronary spasm was defined as >99 % transient luminal narrowing with usual chest pain and/or ischemic ECG changes. Firstly, ACh was administered in incremental doses of 20/50/(80) μg into the RCA and 20/50/100/(200) μg into the LCA over 20 s. Secondly, ER was administered in a total dose of 40 μg into the RCA and of 64 μg into the LCA over 2–4 min. Intracoronary injection of ACh and ER provoked spasm in 221 patients consisting of 160 male patients and 61 female patients. In female patients, the spasm provoked by ACh was almost perfect except in two patients (59 patients, 96.7 %), while ER provoked spasm in only 20 patients (32.8 %). In male patients, provoked spasm by ACh (129 patients, 80.6 %) was significantly higher than ER (97 patients, 60.6 %). As a spasm Provocation Test, ACh is more sensitive than ER in both sexes and especially in females. We may select two pharmacological agents by sex differences to provoke coronary artery spasm in the cardiac catheterization laboratory in the future.
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Safety and optimal protocol of Provocation Test for diagnosis of multivessel coronary spasm
Heart and Vessels, 2016Co-Authors: Shozo Sueda, Yasuhiro Sasaki, Tomoki Sakaue, Hirokazu Habara, Toru Miyoshi, Hiroaki KohnoAbstract:We examined the safety of acetylcholine (ACh) and ergonovine (ER) Tests retrospectively and investigated the optimal protocol of Provocation Test for diagnosis of multivessel coronary spasm. We performed 1546 ACh Tests and 1114 ER Tests during 23 years. ACh was injected in incremental doses of 20/50/80 μg into the right coronary artery (RCA) and of 20/50/100/200 μg into the left coronary artery (LCA) over 20 s. ER was administered in total doses of 40 μg into the RCA and of 64 μg into the LCA over 2–4 min. When a coronary spasm was induced and did not resolve spontaneously within 3 min after the completion of ACh/ER injection, or when hemodynamic instability due to coronary spasms occurred, 2.5–5.0 mg of nitrate was administered into the responsible vessel. To relive provoked spasm, it is necessary to administer nitrate in 31 cases by ACh and in 76 cases by ER (2.0 vs. 6.8 %, p
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maximal acetylcholine dose of 200 μg into the left coronary artery as a spasm Provocation Test comparison with 100 μg of acetylcholine
Heart and Vessels, 2015Co-Authors: Shozo Sueda, Yasuhiro Sasaki, Tomoki Sakaue, Hiroaki Kohno, Toru Miyoshi, Hirokazu HabaraAbstract:As a spasm Provocation Test of acetylcholine (ACH), incremental dose up (20/50/100 μg) into the left coronary artery (LCA) is recommended in the guidelines established by Japanese Circulation Society. Recently, Ong et al. reported the ACOVA study which maximal ACH dose was 200 μg in the LCA. We compared the angiographic findings between ACH 100 μg and ACH 200 μg in the LCA and also examined the usefulness and safety of ACH 200 μg in Japanese patients without variant angina. As a spasm Provocation Test, we performed intracoronary injection of ACH 200 μg after ACH 100 μg in 88 patients (55 males, 68.4 ± 11.7 years old) including 59 ischemic heart disease (IHD) patients and 29 non-IHD patients. Positive spasm was defined as >99 % transient stenosis (focal spasm) or 90 % severe diffuse vasoconstriction (diffuse spasm). Positive spasm by ACH 200 μg was significantly higher than that by ACH 100 μg (36 pts: 40.9 % vs. 17 pts: 19.3 %, p < 0.01). Diffuse distal spasm on the left anterior descending artery was more recognized in ACH 200 μg than in ACH 100 μg (30.7 vs. 13.6 %, p < 0.01). In 29 rest angina patients, positive spasm by ACH 200 μg (19 pts) was significantly higher than that by ACH 100 μg (7 pts) (65.5 vs. 24.1 %, p < 0.01). No serious irreversible complications were found during ACH 200 μg. Administration of ACH 200 μg into the LCA was safe and useful. We may reexamine the maximal ACH dose into the LCA.
Giorgio Walter Canonica - One of the best experts on this subject based on the ideXlab platform.
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Protective effect of loratadine on specific conjunctival Provocation Test.
International archives of allergy and applied immunology, 1991Co-Authors: Giorgio Ciprandi, S. Buscaglia, Giampaola Pesce, E. Marchesi, Giorgio Walter CanonicaAbstract:The protective effect of loratadine (anti-H1 antagonist) on clinical and cellular processes following the early phase of specific conjunctival Provocation Test was assessed in 20 patients a
Yoshio Kobayashi - One of the best experts on this subject based on the ideXlab platform.
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Feasibility and safety of outpatient cardiac catheterization with intracoronary acetylcholine Provocation Test
Heart and Vessels, 2018Co-Authors: Yuichi Saito, Hideki Kitahara, Toshihiro Shoji, Satoshi Tokimasa, Takashi Nakayama, Kazumasa Sugimoto, Yoshihide Fujimoto, Yoshio KobayashiAbstract:Intracoronary acetylcholine (ACh) Provocation Test is useful to diagnose vasospastic angina. Although outpatient coronary angiography has been widely performed in current clinical settings, the feasibility and safety of ACh Provocation Test in outpatient services are unclear. A total of 323 patients, who electively underwent ACh Provocation Test in hospitalization and outpatient services, were included. Coronary angiography was performed after insertion of a temporary pacing electrode in the right ventricle. The positive diagnosis of intracoronary ACh Provocation Test was defined as total or subtotal coronary artery narrowing accompanied by chest pain and/or ischemic electrocardiographic changes. Cardiac complications defined as composite of death, ventricular fibrillation or sustained ventricular tachycardia, myocardial infarction, cardiogenic shock, and cardiac tamponade, were evaluated. There were 201 patients (62%) in the hospitalization group and 122 patients (38%) in the outpatient group. The incidence of positive ACh Provocation Test was similar between the 2 groups (47 vs. 54%, p = 0.21). Coronary angiography in the outpatient group was performed through the radial artery, mostly (98%) with a 4 F sheath. Venous access site was not significantly different between the 2 groups, and the sheath size was 5 F in all cases. There were 2 cases (1.0%) of cardiac complications in the hospitalization group, whereas 1 case (0.8%), which led to unexpected hospitalization, occurred in the outpatient group. In conclusion, intracoronary ACh Provocation Test for the diagnosis of vasospastic angina in outpatient services was feasible and safe in selected patients.
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Safety and usefulness of acetylcholine Provocation Test in patients with no culprit lesions on emergency coronary angiography
International journal of cardiology, 2018Co-Authors: Kazuya Tateishi, Yuichi Saito, Hideki Kitahara, Toshihiro Shoji, Takashi Nakayama, Yoshihide Fujimoto, Tadayuki Kadohira, Yoshio KobayashiAbstract:Abstract Background Vasospastic angina (VSA), which often causes acute coronary syndrome (ACS), can be diagnosed by intracoronary acetylcholine (ACh) Provocation Test. However, the safety and usefulness of ACh Provocation Test in ACS patients on emergency coronary angiography (CAG) compared to non-emergency settings are unclear. Methods A total of 529 patients undergoing ACh Provocation Test during emergency or non-emergency CAG were included. Patients with resuscitated cardiac arrest were excluded. The primary endpoint was adverse events defined as a composite of death, ventricular fibrillation or sustained ventricular tachycardia, myocardial infarction, cardiogenic shock, cardiac tamponade, and stroke within 24 h after ACh Provocation Test. Results There were no significant differences of the clinical characteristics between the groups of emergency (n = 84) and non-emergency (n = 445) ACh Provocation Test. The rate of positive ACh Provocation Test was similar between the 2 groups (50% vs. 49%, p = 0.81). Similarly, the incidence of adverse events in patients with emergency and non-emergency ACh Provocation Test did not significantly differ (1.2% vs. 1.3%, p = 1.00). Conclusion ACh Provocation Test can be safely performed in ACS patients with no obstructive culprit lesions on emergency CAG, and may be useful to diagnose VSA in those patients.
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usefulness and safety of acetylcholine Provocation Test in patients with no culprit lesions in emergency coronary angiography
Journal of the American College of Cardiology, 2018Co-Authors: Kazuya Tateishi, Hideki Kitahara, Takashi Nakayama, Yoshihide Fujimoto, Yuichi Saitoh, Tadayuki Kadihira, Yoshio KobayashiAbstract:There are a certain number of patients who undergo emergency coronary angiography (CAG) due to suspected acute coronary syndrome (ACS), but have no culprit lesions, raising suspicion of vasospastic angina (VSA). However, Acetylcholine (ACh) Provocation Test to diagnose VSA during emergency CAG has
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Abstract 20200: Feasibility and Safety of Intracoronary Acetylcholine Provocation Test in an Outpatient Department
Circulation, 2017Co-Authors: Yuichi Saito, Hideki Kitahara, Toshihiro Shoji, Takashi Nakayama, Yoshihide Fujimoto, Yoshio KobayashiAbstract:Introduction: Intracoronary acetylcholine (ACh) Provocation Test is useful to diagnose vasospastic angina, which causes myocardial infarction, ventricular arrhythmia, or sudden cardiac arrest. Hypothesis: Although outpatient coronary angiography has been widely performed in the current clinical settings, feasibility and safety of ACh Provocation Test in an outpatient department are unclear. Methods: A total of 326 patients who electively underwent ACh Provocation Test in the hospitalization and an outpatient department were included. Coronary angiography was performed after insertion of a temporary pacing electrode in the right ventricle. The positive diagnosis of intracoronary ACh Provocation Test was defined as total or subtotal coronary artery narrowing accompanied by chest pain and/or ischemic electrocardiographic changes. Cardiac complications defined as composite of death, ventricular fibrillation or sustained ventricular tachycardia, myocardial infarction, cardiogenic shock and cardiac tamponade. I...
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feasibility of omitting Provocation Test with 50 μg of acetylcholine in left coronary artery
Heart and Vessels, 2017Co-Authors: Yuichi Saito, Hideki Kitahara, Toshihiro Shoji, Satoshi Tokimasa, Takashi Nakayama, Kazumasa Sugimoto, Yoshihide Fujimoto, Yoshio KobayashiAbstract:According to the Japanese Circulation Society guideline of vasospastic angina, incremental doses of acetylcholine (ACh) are prescribed for coronary spasm Provocation: 20 and 50 μg for the right coronary artery (RCA), and 20, 50 and 100 μg for the left coronary artery (LCA). However, Provocation by low doses of ACh in patients with low vasoreactivity may be less needed, and the requirement of 50 μg of ACh for the LCA in these patients has not been evaluated. In the present study, patients who underwent ACh Provocation Test for both the RCA and LCA were included. The positive diagnosis of intracoronary ACh Provocation Test was defined as total or subtotal coronary artery narrowing (i.e., angiographic coronary artery spasm) accompanied by chest pain and/or ischemic electrocardiographic changes. Coronary artery constriction was visually evaluated and defined as coronary artery diameter reduction <25 or 25–90% in patients without angiographic coronary artery spasm by 20 µg of ACh in the LCA. There were 33 out of 249 patients (13%) with LCA spasm by 20 µg of ACh. In subjects without LCA spasm by 20 µg of ACh, patients with coronary constriction <25% (n = 101) by 20 µg of ACh in the LCA rarely showed coronary artery spasm induced by 50 μg of ACh in the LCA, in comparison to those with coronary constriction 25–90% (n = 115) (2.6 vs. 32.7%, p < 0.001). None of the patients with coronary constriction <25% by 20 µg of ACh in the LCA had cardiac complications associated with administration of ACh. In conclusion, omission of 50 µg of ACh in the LCA may be possible when there is little coronary artery constriction by 20 µg of ACh in the LCA during Provocation Test, leading to less contrast and shortens overall procedure time.
F Spertini - One of the best experts on this subject based on the ideXlab platform.
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Comparison of effects of topical levocabastine and nedocromil sodium on the early response in a conjunctival Provocation Test with allergen.
The Journal of allergy and clinical immunology, 1996Co-Authors: C Hammann, R Kämmerer, M Gerber, F SpertiniAbstract:Multiple ocular challenges or seasonal trials have demonstrated the efficacy of levocabastine and nedocromil sodium in the treatment of allergic conjunctivitis. This study was designed to compare the protective effect of levocabastine eye drops with that of nedocromil in a conjunctival Provocation Test with allergen. Twenty-four patients with allergic conjunctivitis to grass pollen were recruited. After a preliminary Provocation to determine conjunctival reaction threshold (erythema of at least 50% of the conjunctiva with ocular itching), patients were randomized to receive either topical levocabastine (0.05%) or nedocromil (2%) 15 minutes before Provocation. Erythema and pruritus intensity were recorded at each concentration of allergen up to the reaction threshold. The allergen concentration level necessary to reach reaction threshold was increased (p < 0.001) after treatment with both drugs. Comparison between screening and each treatment indicated that the shift in allergen concentration was significantly greater after levocabastine treatment than after nedocromil treatment (p = 0.019). Conjunctival itching (symptom score) and erythema (percent conjunctival surface) were also better controlled by levocabastine than by nedocromil during Provocation (p < 0.05). In a Provocation Test with allergen, levocabastine and nedocromil were both effective in increasing the conjunctival tolerance to allergen, with better protection provided by levocabastine.
