Association of Allergic Conjunctivitis With Health-Related Quality of Life in Children and Their Parents

Abstract

IMPORTANCE Allergic conjunctivitis (AC) is one of the most common allergic diseases and is especially problematic in children and adolescents. The course of AC is generally prolonged and often recurs. Understanding the health-related quality of life (QOL) of both children with AC and their parents would be useful.OBJECTIVE To evaluate the association between AC and health-related QOL in children and their parents. DESIGN, SETTING, AND PARTICIPANTSA prospective case-control study was conducted at Zhongshan Ophthalmic Center, a single tertiary referral center, from November 16, 2019, through January 20, 2020. Participants comprised 92 children aged 5 to 18 years with AC and their parents and 96 healthy, age-matched children who served as controls and their parents. The 92 children in the AC group were subdivided into cohorts with vernal keratoconjunctivitis (VKC) (23 [25.0%]) or atopic keratoconjunctivitis (AKC) (7 [7.6%]) and seasonal allergic conjunctivitis (SAC) (26 [28.3%]) or perennial allergic conjunctivitis (PAC) (36 [39.1%]). EXPOSURES Allergic conjunctivitis.MAIN OUTCOMES AND MEASURES Pediatric Quality of Life Inventory, version 4.0 (PedsQL), scores for children and their parents. Scores range from 0 to 100, with higher scores indicating better health-related QOL and fewer negative aspects. RESULTSIn the AC group, 77 of 92 (83.7%) participants were boys, and 67 (72.8%) of the parents were women. Of the individuals in the control group, 55 of 96 (57.3%) of the children were girls and 76 (79.2%) of the parents were women. Median total PedsQL scores were reduced in both children with AC (69.6 [interquartile range [IQR], 66.3-72.8 vs 96.7; IQR, 92.7-98.9; P < .001) and their parents (68.8; IQR, 63.9-71.4 vs 96.5; IQR, 95.1-97.9; P < .001). The reduction in health-related QOL was more severe in children with VKC/AKC than in those with SAC/PAC (difference, -3.3; 95% CI, -5.4 to -1.1; P = .004) and their parents (difference, -4.3; 95% CI, -7.1 to -2.1; P < .001). In the AC group, a higher corneal fluorescein staining score was associated with lower QOL in children (β, -1.16; 95% CI, -1.80 to -0.52; P = .001); higher corneal fluorescein staining scores (β, -1.12; 95% CI, -1.74 to -0.50; P = .001) and multiple clinical consultations (β, -3.96; 95% CI, -7.34 to -0.57; P = .02) were associated with lower QOL in parents. The parents' QOL scores were correlated with their children's QOL scores (correlation coefficient, r = 0.59; P < .001).CONCLUSIONS AND RELEVANCE These findings suggest AC has a negative association with health-related QOL for children and their parents, especially in children with VKC/AKC or higher corneal fluorescein staining scores.

Impact of Vision Impairment and Ocular Morbidity and Their Treatment on Depression and Anxiety in Children

“…Another study reported that children with allergic conjunctivitis experienced reduced quality of life. 62 Additionally, 1 recent study using commercial insurance claims data including 12 005 189 participants found that children younger than 18 years with strabismus have higher odds of mental illnesses, including anxiety and depression, than children without strabismus. However, 64.5% and 46.0% in the strabismus and control group, respectively, also harbored at least 1 systemic comorbid condition, such as cancer of the brain and nervous system or leukemia, which was adjusted for in the multivariate analysis.…”

Drawing Attention to the Burden of Allergic Conjunctivitis in Children and Their Families

“…Data on allergic rhinitis, asthma, food allergy, eczema, and atopic dermatitis 7 -all diseases that often coexist-report similar findings as noted in this study. 1 Better understanding the outcomes associated with AC in adolescents compared with young children and adults and development of pediatric AC QOL questionnaires that can be compared with other eye disease QOL questionnaires are just a few interesting areas of possible future investigation that may improve health care outcomes of patients with AC.…”

“…There were significantly more boys in the AC group than in the control group (83.7% vs 42.7%). 1 Boys are more commonly affected by vernal keratoconjunctivitis, so it is not surprising that more boys than girls were represented in the disease group. However, not controlling for this discrepancy in the control group potentially introduces a confounding effect.…”

Morphological and Functional Changes of Meibomian Glands in Pediatric and Adult Patients with Allergic Conjunctivitis

“…The major symptoms of AC are itching, swelling, and tearing, and in some severe cases, photophobia and pain could develop due to the involvement of the cornea [ 5 , 6 ]. Patients suffering from AC have a lower health-related quality of life and impaired socioeconomic status [ 7 , 8 , 9 , 10 ].…”