Vitamin D serum levels in children with vernal keratoconjunctivitis and disease control

Abstract

The aim of this study was to evaluate whether the control of ocular symptoms with cyclosporine or with tacrolimus in eye drops allows to improve sun exposure and therefore serum level of vitamin D (VD; 25OHD), in the more severe forms of vernal keratoconjunctivitis (VKC). Out of 242 children followed for active VKC, 94 were treated with 1% cyclosporine or 0.1% tacrolimus eye drops, while the other 148 with mild VKC did not need to be treated with immunomodulators. VD serum levels were measured in spring and autumn in 71 children. In total, 60 of them were treated with cyclosporine eye drops (first group) and 11 (not responding to cyclosporine therapy previously) with 0.1% tacrolimus eye drops (second group) between March and November 2016. Pre-treatment median values of VD were 23.7 ng/mL in the first group and 23.8 in the second group, and post-treatment values increased up to 32.8 and 32.9 ng/mL, respectively. Before treatment, 33% presented a deficiency (25OHD < 20 ng/mL), and at the end of summer, only 4% were deficient. The overweight children had lower improvement in VD serum levels than children with a body mass index (BMI) lower than 85th percentile. Children in therapy with cyclosporine, but requiring the administration of local steroid therapy during the summer for control of the symptoms, showed a greater improvement in 25OHD serum levels in ng/mL (23–37 ng/mL) than children who did not require steroid therapy (24–35 ng/mL). Furthermore, there was a significant difference in change of 25OHD in children presenting limbal VKC (21–41 ng/mL) versus tarsal VKC (24–35 ng/mL) ( P = 0.04). Our study suggests that ocular treatment carried out with immunomodulator eye drops could allow for an improvement in 25OHD serum levels. In children with active VKC and at risk of 25OHD deficiency, likely due to avoidance of sun exposure, the role of other risk factors (BMI, phototype and treatment) on 25OHD serum levels should be considered.

Serum vitamin D levels and body mass index in children with vernal keratoconjunctivitis

“…VKC is a severe eye disease that activates both immunoglobulin E (IgE)-mediated and non-IgE-mediated immune mechanisms. Elevated levels of allergy-specific antibodies and eosinophil counts are encountered in VKC patients, suggesting that VKC clinically resembles the pathophysiology of the allergic response (16). Along with its role in bone development, vitamin D is involved in various immune functions (17)(18)(19)(20).…”

“…Along with its role in bone development, vitamin D is involved in various immune functions (17)(18)(19)(20). Therefore, vitamin D deficiency is common among VKC patients (16).…”

“…The participants were divided into 5 groups based on the serum vitamin D level (severe deficiency: <10 ng/mL, deficiency: 10-20 ng/mL, insufficiency: 20-30 ng/mL, normality: 30-100 ng/mL) (16). The height and weight of the individuals were recorded and the BMI values were calculated as weight (kg)/height (m) squared (9).…”

Vitamin D, the Vitamin D Receptor, Calcitriol Analogues and Their Link with Ocular Diseases

“…Furthermore, studies indicate that treatment with 1% cyclosporine or 0.1% tacrolimus as eye drops may contribute to the improvement of VKC signs and symptoms, and that these changes are associated with an increase of 25-hydroxyvitamin D level in serum. This rise was higher in the children with limbal VKC than the tarsal form and could result from the fact that limbal VKC is less symptomatic [ 161 , 165 ]. The above data require confirmation and verification through large-scale clinical trials; however, their findings may provide a greater insight into the pathogenesis of VKC and creation of customized therapy.…”

Serum vitamin D levels in patients with vernal keratoconjunctivitis and its relationship with disease severity

“…The prevalence of VKC is high in Africa (6% in Ethiopia), low in Western Europe (like Italy) with a prevalence rate of 3.2 per 10,000 persons and almost 0% in Scandinavian countries. [1][2][3] VKC involves the patients from 1-month-old to more than 70 years of age, but one-half of the patients in most studies are between 5 and 25 years of age. 4 In most patients, the disease resolves spontaneously within 10 years of onset.…”