Diagnosing and managing allergic conjunctivitis in childhood: The allergist’s perspective

Abstract

Allergic conjunctivitis in childhood often poses problems of diagnosis and management for the allergist. We present the salient points concerning the diagnosis and treatment of ocular allergy emerging from a large cohort survey conducted jointly in the departments of ophthalmology and paediatric allergy in a French teaching hospital. Seasonal acute conjunctivitis is a common disorder and not overly difficult to diagnose and treat when associated with rhinitis leading to allergic rhinoconjunctivitis. An ophthalmologist should be consulted when conjunctivitis occurs alone and if another form of conjunctivitis is suspected, such as perennial allergic conjunctivitis, vernal keratoconjunctivitis or atopic keratoconjunctivitis. When IgE‐mediated hypersensitivity assessment does not establish aetiological diagnosis, a conjunctival allergen provocation test can be performed. The principal non‐IgE‐mediated allergy is chronic blepharoconjunctivitis. The main problem for differential diagnosis is the presence of signs suggestive of dry eye. Management includes non‐pharmacological treatments, such as lacrimal substitutes, avoidance measures and protection of the ocular surface. Second‐line treatment consists of eye drops, preferably single dose or without additives and with dual local action, mast cell stabilizer action and antihistaminic action. Third‐line treatment is reserved for severe forms. Short‐lasting local steroid therapy can control flare‐ups of allergic keratoconjunctivitis, which should have specialized follow‐up. Cyclosporine is a disease‐modifying treatment, which is both effective and well tolerated.

The Role of Th17 Cells and IL-17 in Th2 Immune Responses of Allergic Conjunctivitis

“…en, in late-phase response, activated eosinophils result in the release of inflammatory cytokines including eosinophil cationic protein (ECP), eosinophil peroxidase, neutrophil toxic oxygen free radicals, proteases, and 2 lymphocytes, among others, some such as major basic proteins (MBP) and ECP are toxic to the corneal epithelium [44,45] (Figure 1).…”

Antibiotic use favors early‐life allergies, intrauterine blood flow may influence respiratory allergies, and features of hyper‐IgE syndrome

“…Jean-Luc Fauquert, one of the very few experts having triple expertise in pediatrics, allergy, and ophthalmology, reviews diagnosis and management of the various presentation of allergic conjunctivitis and provides very practical advice which will undoubtedly update your clinical practice. 1 The second educational article is a rostrum addressing oral immunotherapy (OIT) for treatment of food allergy, a topic that has been extensively studied in the latest articles published in this journal. [2][3][4][5] In addition, a recent position statement of the European Academy (EAACI) has evaluated the scientific evidence behind OIT and concluded that "Overall, trials have found substantial benefit for patients undergoing OIT".…”

“…Two educational articles begin this issue: the first addressing one of the most common clinical challenge practicing pediatric allergists are facing, allergic conjunctivitis. Jean‐Luc Fauquert, one of the very few experts having triple expertise in pediatrics, allergy, and ophthalmology, reviews diagnosis and management of the various presentation of allergic conjunctivitis and provides very practical advice which will undoubtedly update your clinical practice . The second educational article is a rostrum addressing oral immunotherapy (OIT) for treatment of food allergy, a topic that has been extensively studied in the latest articles published in this journal .…”

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

“…Allergic conjunctivitis (AC) is one of the most common ocular disorders in clinical practice [ 1 ], with a 28% incidence in China [ 2 ], a nearly 25% incidence in children in Europe [ 3 ], and between 20% and 30% incidence in the United States [ 4 ]. 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 ].…”