Allergy and infections: long-term improvement of vernal keratoconjunctivitis following viral conjunctivitis.
OBJECTIVE
Vernal keratoconjunctivitis (VKC) is a severe, chronic allergic inflammatory disease of the ocular surface poorly responsive to antiallergic treatments and possibly leading to permanent visual impairment. VKC, because of mast cell, eosinophil, and Th2-type inflammation, polyclonal IgE activation, and tissue remodeling, is considered to be a typical Th2- driven disease. Viral infection stimulates a Th1 type immune response, potentially attenuating allergen-induced inflammation. The purpose of this report is to describe the effect of viral keratoconjunctivitis in a patient with VKC.


METHODS
The authors report on a patient with a severe form of VKC, poorly responsive to antiallergic treatments, who developed a viral keratoconjunctivitis. Signs, symptoms, and cytologic findings were recorded during the 5-year follow-up period.


RESULTS
The authors observed a prompt and permanent improvement of signs and symptoms of the allergic condition after the viral infection. Conjunctival scraping confirms that the inhibition of the eosinophilic inflammation lasts at least for 5 years.


CONCLUSIONS
In this case, the viral infection seemed to induce a clinical recovery of allergic disease, suggesting that an immune deviation induced by Th1-polarizing agents may revert an ongoing Th2 inflammation.
Sgrulletta
R
R
Interdisciplinary Center for Biomedical Research (CIR), Laboratory of Ophthalmology, University of Roma 'Campus Bio-Medico' and G.B. Bietti Eye Foundation, IRCCS, Roma--Italy.
Bonini
S
S
Lambiase
A
A
Bonini
S
S
D002648:Child; D003233:Conjunctivitis, Allergic / Q000276:immunology / Q000503:physiopathology*; D003236:Conjunctivitis, Viral / Q000276:immunology / Q000503:physiopathology*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D018417:Th1 Cells / Q000276:immunology