Prevalence of allergic sensitization with vernal keratoconjunctivitis: A systematic review with meta‐analyses

Abstract

To determine the prevalence of allergic sensitization in patients with vernal keratoconjunctivitis (VKC) and to provide an overview of published studies on this topic. We systematically searched 11 literature databases on 24 May 2021, for studies with cross‐sectional data on the prevalence of positive allergy tests in patients with VKC. Our main outcome of interest was the prevalence of allergic sensitization and the allergens involved. Prevalence meta‐analyses were made to provide summary estimates. We identified 33 eligible studies for qualitative review with 2122 patients with VKC. Studies were predominantly based on patients seen in ophthalmology clinics. Overall, studies reported that the most prevalent positive allergen tests were the inhaled allergens house dust mites and pollen. Twenty‐nine studies were eligible for the quantitative analysis. Here, we calculated the prevalence of allergen‐positive patients to 57.7% (95% confidence interval: 52.5%–62.8%). Subgroup analyses of pooled estimates on sensitization based on specific testing methods found prevalence estimates of 51.4% for conjunctival provocation test, 68.7% for total tear IgE, 58.9% for specific tear IgE, and 58.2% for skin prick test. The prevalence of allergic sensitization in patients with VKC is 57.7%, and mostly towards inhaled allergens. The most frequent positive allergens are house dust mites and pollen. Identifying possible clinically relevant allergens provide information that may aid in managing VKC, such as environmental allergy‐avoidance or allergy‐specific treatment.

Vernal Keratoconjunctivitis: A Systematic Review

“…of VKC patients Median age Outcome Results Amstar score Leonardi et al [ 21 ] 2020 Italy 13 N/A N/A To identify efficacy endpoints being proposed in clinical trials for VKC Penalty-adjusted corneal staining score at month X is calculated as follows: corneal fluorescein staining (CFS) (baseline) − CFS (month X) + penalty/ies (+ 1 penalty for rescue medication, and + 1 penalty for corneal ulceration). This score is a reliable method to assess corneal modification during time and to evaluate the efficacy of novel drugs Low Rasmussen et al [ 22 ] 2022 Denmark 29 2122 N/A To determine the prevalence of allergic sensitization in patients with VKC The prevalence of allergic sensitization in patients with VKC is 57.7% and mostly toward inhaled allergens. The most frequent positive allergens are house dust mites and pollen High N/A non-available information …”

“…Roumeau et al [ 99 ] and Rasmussen et al [ 22 , 100 ] conducted a detailed meta-analysis of the literature. One author conducted all literature searches and collated the abstracts.…”

“…The risk of bias is described in detail. The two systematic reviews of Rasmussen et al [ 22 , 100 ] performed an excellent meta-analysis of the literature and described in detail the risk of bias. However, both Roumeau et al [ 99 ] and Rasmussen et al [ 22 , 100 ] do not provide a list of the excluded studies.…”

A Patient-Centered Approach to Vernal Keratoconjunctivitis (VKC): A Podcast

“…So, there’s lots of things we don’t know, but we do know that if you test specifically within the tears of the eye, you’ll find a much higher rate of allergies. But that’s impossible to do on kids [ 17 , 20 – 22 ].…”

“…Furthermore, we tell our patients to wash their hands and face if they come in from being outside playing, because then they can wash the allergens away.... If they have asthma or rhinoconjunctivitis, it makes total sense because then you can also treat their nose and their asthma more sufficiently [ 10 , 20 , 21 ].…”