What is Allergic Conjunctivitis in Children?
Allergic conjunctivitis is an allergic inflammation of the conjunctiva of the eye, which is caused by a causative allergen and is manifested by eyelid hyperemia, itching and tearing.
Types of conjunctivitis in children:
- acute atopic
- acute unspecified
- other types of acute conjunctivitis
15% of the population (adults and children) suffer from allergic conjunctivitis. Because this disease is considered an important issue in ophthalmology. Allergic conjunctivitis is essentially a manifestation of an allergic disease. 80 to 90 allergies out of 100 have eye damage. Often this disease occurs in children with confirmed pollen hypersensitivity.
It is believed that a child’s allergy will be in half the cases if his father and mother suffer from allergies. ¼ Children who have either a dad or mom with allergies also suffer from this disease.
Causes of Allergic Conjunctivitis in Children
Conjunctivitis occurs when there is an increased, genetically incorporated sensitivity of the organism to any allergen.
Pathogenesis During Allergic Conjunctivitis in Children
Allergies in children in the scientific literature are also called hypersensitivity reactions. They are of the following types:
- immediate (the reaction manifests itself after 30 minutes or less after exposure to the body of the allergen);
- slowed down (the reaction is manifested only after a day, two days or more after the body is in contact with one or another allergen).
With an immediate reaction, biologically active mediators from mast cells are released into the conjunctiva. Fat cells of the conjunctiva – the source of the entire spectrum of mediators of allergy. The reaction arises from the interaction of an allergen (for example, pollen) with allergic antibodies (from the IgE class). These antibodies are produced by B cells.
When the allergen again enters the conjunctiva, IgE-dependent activation of mast cells occurs, which results in the release of inflammatory mediators: histamine, tryptase, bradykinin, prostaglandins, leukotrienes, and so on. The mediators, when released, cause the child to have tearing, photophobia, itching of the eyelids, hyperemia and swelling of the mucous membrane of the eye.
In the delayed type of allergic reaction, arachidonic acid metabolites and, presumably, platelet activation factor play an important role.
Symptoms of Allergic Conjunctivitis in Children
- Itchy eyes
- Strong burning in the eyes
- Swelling and redness of the conjunctiva
- Watery, liquid discharge in large quantities (with seasonal and year-round conjunctivitis in children)
- The eyeball may look puffy
- Visual impairment (in some cases)
- Runny nose (in most cases)
- Thick, mucus-like discharge from the eyes (with spring conjunctivitis)
- Painful ulcers (with spring conjunctivitis)
- Persistent decrease in vision (in spring conjunctivitis)
In most cases, the symptoms appear in both eyes, but sometimes one eye may be less affected than the other.
Diagnosis of Allergic Conjunctivitis in Children
In some cases, history and symptoms clearly indicate allergic conjunctivitis in children. But still, specific allergological methods of research are often needed to diagnose the disease. Doctors should take a history of whether the parents of the child were allergic. Conduct elimination and exposure tests.
In ophthalmic practice, skin tests such as the prick test, application test, scarification application, scarification test are used. In very rare cases, such provocative tests as nasal, conjunctival, and hypoglossal are taken for use. They are valid only in the period of remission of the disease. In the acute period, it is also not advised to conduct laboratory allergy diagnosis. In some cases, identification of eosinophils in conjunctival scrapings is required.
Allergic conjunctivitis in a child also occurs:
- seasonal (exacerbated in spring and summer)
- year-round (not dependent on season)
Causes of seasonal and year-round conjunctivitis in children
Clinical course – Factors-causes
Seasonal conjunctivitis, usually acute – Pollen of trees, grass, weeds, fungi
Round-bodied conjunctivitis, usually chronic – Drugs and their preservatives, animal dander, house dust, fluff, feather, cosmetic, household products, industrial pollution, contact lenses and their care products, food allergens (products, spices, etc.)
Mandatory laboratory tests for suspected allergic conjunctivitis:
- Blood test one time (if changes are revealed – repeat once in 10 days)
- RW, HIV
- Cytological examination of discharge from the eyes
Additional laboratory methods are considered virological research, bacteriological examination of discharge from the eyes, biochemical examination of blood. In the study of blood biochemistry determine the content of bilirubin, AST, ALT, glucose and urea. Mandatory allergy testing is atopic skin tests. Sometimes they additionally carry out allergological immunological examinations, determining specific IgE and total serum IgE.
The child must be examined by an allergist, immunologist, oculist, and otolaryngologist.
Treatment of Allergic Conjunctivitis in Children
Treatment of allergic conjunctivitis begins with the appointment of an elimination, hypoallergenic diet. It is necessary to change the lifestyle of a sick child, given the causes of allergies.
As a drug therapy for acute allergic heavy and moderate conjunctivitis take first-generation antihistamines. Choose, as a rule, hifenadine, chloropyramine (suprastin), clemastine. They should be taken once a day, 1 tablet. The course is 10-14 days. Ketotifen is also suitable, the treatment regimen is the same, the course is longer.
Sometimes, second-generation antihistamine systemic drugs, such as loratadine, as well as the third generation (fexofenadine), are necessary for the treatment of allergic conjunctivitis in a child. They take 1 tablet per day, a course of 10 to 14 days.
Also, the child needs treatment with eye drops – cromoglyceic acid drugs. Kromoheksal, hi-chrome and optikrom drip 3-4 times a day, 2 drops in the eye, the course of treatment is long.
If a child is diagnosed with severe allergic conjunctivitis, treatment is to take topical glucocorticosteroids. Oftan-dexamethazone drops, hydrocortisone eye drops will do. The dosage is strictly individual, according to the recommendation of the doctor.
Antihistamine topical preparations, such as levocabastine or azelastine, are also prescribed. They are dropped into the eye 2 drops 2 times a day.
In most cases, children are treated on an outpatient basis for 10 to 14 days. A child can be put on medical check-up with a allergist-immunologist.
Prevention of Allergic Conjunctivitis in Children
Maximum isolate the child from allergens that cause him an allergic reaction.