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Diagnosing and managing allergic conjunctivitis in childhood: The allergist's perspective
1CHU Clermont-Ferrand, Consultation d'Ophtalmologie et Allergologie de l'enfant, Unité d'Allergologie de l'enfant, CHU Estaing, Clermont-Ferrand Cedex1, France.
Insights
Childhood allergic conjunctivitis diagnosis and management can be challenging. This study highlights key findings from a French cohort survey on ocular allergy, offering insights for allergists and ophthalmologists.
Area of Science:
- Ophthalmology
- Allergology
- Pediatrics
Background:
- Allergic conjunctivitis in children presents diagnostic and management challenges.
- Ocular allergy diagnosis and treatment require collaboration between ophthalmology and pediatric allergy specialists.
- Seasonal allergic rhinoconjunctivitis is common, but isolated conjunctivitis warrants further investigation.
Purpose of the Study:
- To present key diagnostic and management strategies for childhood ocular allergies.
- To outline approaches for differentiating various forms of allergic conjunctivitis.
- To discuss treatment options from non-pharmacological to advanced therapies.
Main Methods:
- A large cohort survey conducted in a French teaching hospital.
- Joint evaluation by ophthalmology and pediatric allergy departments.
- Review of diagnostic techniques including IgE-mediated hypersensitivity assessment and conjunctival allergen provocation tests.
Main Results:
- Seasonal allergic conjunctivitis is often manageable when co-occurring with rhinitis.
- Perennial allergic conjunctivitis, vernal keratoconjunctivitis, and atopic keratoconjunctivitis require specialist consultation.
- Chronic blepharoconjunctivitis is a common non-IgE-mediated allergy, often presenting with dry eye symptoms.
- Effective treatments include preservative-free dual-action eye drops, short-term steroids for flare-ups, and cyclosporine for severe cases.
Conclusions:
- Accurate diagnosis is crucial for effective management of childhood allergic conjunctivitis.
- A stepwise treatment approach, from non-pharmacological measures to advanced therapies, is recommended.
- Specialized follow-up is essential for severe allergic keratoconjunctivitis and for patients on disease-modifying treatments like cyclosporine.
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.