[Vernal keratoconjunctivitis in the child. Clinical and complementary study apropos of 22 cases].
OBJECTIVE
Vernal kératoconjunctivitis was studied in a population of 22 children aged 3 to 14 years and followed up in an allergy and ophthalmology outpatient clinic. The role of allergy and the severity of inflammation where assessed by a systematic exploration, which combined a detailed allergy evaluation and blood and lacrimal sampling.


METHODS
Allergy criteria chosen and recorded in 9 cases are: an increase of total IgE over the higher limit for the age, a positive skin prick test to one allergen, a positive serum specific IgE dosage (> 0.35 IU/mL) of specific IgE. Conjunctival allergy was present in 6 of the 9 children with a positive allergenic provocation test, or with a high local production of total IgE and a lacrimal/serum eosinophilic cationic protein ratio greater than one.


RESULTS
Criteria used for supporting the IgE mediated hypersensitivity diagnosis are discussed: they have to be very strict to eliminate false positive results. Allergen involvement can only be evidenced by a specific provocation test. When evidenced as described, limbic or palpebral conjunctivitis had the same frequency. Lacrimal ICAM 1 levels seemed to be higher (p < 0.05) in the severe limbal forms (24.7 +/- 3 pg/mL) than in the palpebral ones (8.1 +/- 6.5 pg/mL). Interpretation of biological parameters evidencing conjunctival inflammation is more difficult.


CONCLUSIONS
Allergic involvement in child vernal keratoconjunctivitis can only be assessed through a detailed evaluation, leading to a specialised ophthalmic and allergic management. A specific treatment can then be established, based on allergen eviction and possibly on specific immunotherapy (5 cases). H1 antihistamin treatments are dedicated only to children with a positive allergic evaluation.
Dalens
H
H
Consultation d'Ophtalmologie et Allergie de l'enfant, Hôtel-Dieu, CHRU, Clermont-Ferrand.
Fauquert
J L
JL
Chatron
P
P
Beaujon
G
G
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003233:Conjunctivitis, Allergic / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D018799:Intercellular Adhesion Molecule-1 / Q000378:metabolism; D007428:Intradermal Tests; D008297:Male; D011237:Predictive Value of Tests; D013666:Tears / Q000276:immunology
D018799:Intercellular Adhesion Molecule-1; D007073:Immunoglobulin E