Allergic Sensitization Status and Its Association With Severe Epiphora (Suspected Lacrimal Duct Obstruction): Insights From NHANES

BackgroundLacrimal duct obstruction (LDO) is a prevalent cause of epiphora, traditionally attributed to involutional stenosis or infection. The role of systemic atopy in the pathogenesis of LDO remains unclear. This study aims to investigate the association between specific allergic sensitization and severe epiphora/suspected LDO using a nationally representative sample.MethodsThis cross-sectional study analyzed data from 5420 adults in the national health and nutrition examination survey (NHANES) ranging from 2005 to 2006. Severe epiphora, serving as a clinical proxy for suspected LDO, was defined by frequent tearing (ie, epiphora) in the absence of acute infection. Allergic sensitization was assessed via serum specific IgE (sIgE) to 19 aeroallergens and food allergens. Weighted logistic regression and restricted cubic splines (RCS) were used to evaluate associations.ResultsThe weighted prevalence of suspected LDO was 14.2%. Any allergic sensitization (sIgE ≥ 0.35 ku/l) was significantly associated with suspected LDO (OR 1.48, 95% CI 1.21-1.82). Specifically, sensitization to aeroallergens conferred a 56% increased risk, whereas food sensitization showed no significant association. A J-shaped nonlinear dose-response relationship was observed between total IgE levels and suspected LDO risk. Subgroup analyses revealed stronger associations in adults aged < 60 years.ConclusionSystemic allergic sensitization is an independent risk factor associated with severe epiphora/suspected LDO. Chronic mucosal inflammation driven by aeroallergens may compromise nasolacrimal patency. Anti-allergic management should be considered in patients with epiphora who exhibit signs of atopy.