Assessment of corneal alterations by confocal microscopy in vernal keratoconjunctivitis

Abstract Background: Vernal keratoconjunctivitis (VKC) is a bilateral chronic, seasonally exacerbated inflammation of the ocular surface that especially affects male children and young boys. Aim: To evaluate the corneal microscopic features of patients affected by VKC and to assess whether some corneal changes were associated with specific ocular symptoms and/or signs. Methods: 20 children aged between 4 and 14 years were enrolled. All patients underwent corneal confocal microscopy by Confoscan CS3 (Nidek). 350 images of the central cornea of each eye were obtained with a ×40 noncontact lens 3,5 micron gap in automode. Results: Some alterations of the sub-basal and stromal corneal nerves were detected. These alterations were more evident in patients with higher severity of photophobia. On the other hand, there were scarce other signs of the anterior segment of the eye. Conclusions: Our preliminary findings show that there is another group of patients affected by VKC, characterized by an intense photophobia caused by corneal damage and without other significant ocular alterations. Therefore confocal microscopy may be useful for an early identification of corneal alterations before the onset of severe ocular symptoms and to set an appropriate therapeutic management

Indagine epidemiologica nella città di Roma sulle malattie respiratorie ed allergiche in bambini di età prescolare

In Italia non sono mai stati condotti studi epidemiologici sulle malattie allergiche e respiratorie nei bambini di 3-5 anni. Lo scopo del nostro studio è quindi di valutare la prevalenza delle malattie respiratorie ed allergiche nei bambini in questa fase di età

Is oxidative stress involved in vernal keratoconjunctivitis? Results from a pilot study in children

Abstract Background: Vernal keratoconjunctivitis (VKC) is a rare chronic conjunctivitis characterized by a predominantly eosinophil-mediated inflammatory disorder that could develop critical complications such as blindness. Oxidative stress plays a pivotal role in the pathogenesis of several allergic diseases. The role of oxidative stress has been hypothesized in VKC, but no study explored this issue. Furthermore, cyclosporine A (CsA) exerts an anti-inflammatory and antioxidant action on the conjunctiva. This study aimed to assess the oxidative stress in VKC patients and controls and to study the effect of CsA on oxidative stress in these subjects. Methods: Thirty-six consecutive children, including 12 VKC (nine males, 75%; mean age 10.17; SD ± 2.48) patients without treatment, 12 VKC patients treated with CsA (nine males, 75%; mean age 9.08; SD ± 2.75), and 12 controls (CT) (seven males, 58%; mean age 8.58; SD ± 1.78), were recruited. A cross-sectional study was performed to compare H2O2 in the serum with that in the tears of these children. Results: Compared with CT and VKC children treated with CsA, VKC untreated children had significantly higher values of hydrogen peroxide (H2O2) in the serum and the tears. No significant differences were observed between CT and VKC treated with CsA. A significant correlation was found at the linear regression analysis between serum and tear H2O2 levels. Conclusion: This study provides the first report attesting that patients with VKC have high oxidative stress; furthermore, it suggests that CsA could have an anti-inflammatory and antioxidant action that could be useful to prevent the poor VKC outcome

Pathogenesis of vernal keratoconjunctivitis and associated factors

Aim: To investigate the role of some variables, including allergy and autoimmunity, in the pathogenesis of vernal keratoconjunctivitis (VKC). The VKC is a chronic and often severe form of bilateral keratoconjunctivitis. Usually, it begins during the first decade and disappears during the end of the second decade of life. Materials and methods: 26 patients with VKC were selected. The diagnosis was performed by the ophthalmologist through a score based on ocular signs and subjective symptoms before and after administration of 1% cyclosporine A (Cy) eyedrops. Each variable was graded: 0 = absent; 1 = mild; 2 = moderate; 3 = severe. Patients with a total score ≥7 were included in the study. Blood samples were collected at the initial time for the determination of autoimmunity by total IgE and antinuclear antibodies (ANA). A Skin Prick Test (SPT) was performed on each patient to common inhalants and food allergens. Results: 53.8% of the children resulted atopic. The most important allergens were house dust mites and grasses. 46.1% of the patients showed total IgE >100 UI/ml and 30.8% had ANA positivity at the first determination. The photophobia occurred in 42.3% of children, most frequently with respect to other symptoms like secretion or tearing (30.8%), foreign body sensation (15.4%), itching and conjunctival hyperemia (11.5%). Conclusions: Fortunately all children improved their symptoms after Cy eyedrop therapy. Moreover, there was an elevated percentage (30.8%) of children with ANA positivity compared with the values in the general pediatric population. Despite the fact that it is a non-specific autoantibody, its high presence in a population of children with VKC may have an important role in clarifying etiopathogenesis and chronic inflammation

Vernal keratoconjunctivitis: atopy and autoimmunity

BACKGROUND: Vernal Keratoconjunctivitis (VKC) is a rare chronic ocular inflammatory disease and it mainly affects boys in the first decade of life. Although it is a self-limiting disease, patients may present many phases characterized by an exacerbation of inflammatory symptoms with a consequent decline of the quality of life. PURPOSE: define the clinical and immunological profile of patients affected by VKC and investigate their familiar history of autoimmune disorders and their autoimmunity pattern. PATIENTS AND METHODS: 28 children were enrolled (20 males, 71%) aged between 4 and 14 years of life affected by VKC. Family history of allergic and immunological diseases was collected for each patient. In particular, it was asked whether some components of their families were affected by Hashimoto's thyroiditis, type I diabetes, psoriasis or rheumatoid arthritis and Systemic Lupus Erythematosus (SLE). All VKC children underwent a serological evaluation of antinuclear antibodies (ANA). RESULTS: A family history of immunological disorders was found in 46% of patients, 28% of Hashimoto's thyroiditis, 14% of type I diabetes, 14% of psoriasis, and 1 of Systemic Lupus Erythematosus. Furthermore, 35% of patients was ANA positive and they corresponded to patients with a higher ocular score and with the most important clinical symptoms. CONCLUSIONS: the detection of ANA positivity and of a familiar history of autoimmune disorders in a high percentage of children with VKC may help us to better understand the association of this ocular inflammatory disease with systemic autoimmune disorders and atopic condition

Selective IgA deficiency and the risk of asthma

Body: Introduction:Selective IgA deficiency (IgAD), the most frequent primary immunodeficiency is associated with a wide variety of clinical manifestations including an increased frequency of allergic manifestations such us asthma. Objective: To describe the prevalence of allergies and asthma in a selected population of children with IgAD. Materials and Methods: We included 27 children(15 males)with a diagnosis of IgA deficiency with a mean age of onset of symptoms 37.58 ± 29 months. Each subject was investigate about clinical presentation at the time of the diagnosis and allergic skin tests for food allergens and inhalants were performed. Results: At the beginning children with IgAD presented principally infections of the upper and lower airways, 5/27(18,5%)had pneumonia.16/27(59,3%) had Prick test positivity with associated allergic diseases. Among the allergens house dust mites were the most frequent (22,2%) followed by grass pollens(11,1%).7/27(25,9%) presented asthma symptoms and 6/27(22%) rhinoconjunctivitis and atopic eczema. The prevalence of asthma symptoms is more higher in our population of children with IgAD respect to the general pediatric population, respectively 25.9 vs 7.9 (Tozzi AE Pediatric Allergy Immunol 2011) and the difference is statistically significant (p<0,01%) Conclusions: Children with selective IgA deficiency seem to have an increased risk of having recurrent infections and allergic manifestations respect to general pediatric population. Observations that IgAD is associated with an increased prevalence of atopy suggest a possible role of IgA in asthma pathogenesis. The mucosal antigen exposure seems to be increased in the absence of IgA, causing an increased production of IgE against allergens

Immunogenetic investigation in vernal keratoconjunctivitis

Vernal keratoconjunctivitis has been considered a multifac- torial condition resulting from complex interactions among genetic, immunologic, and environmental factors. The research of genetic characteristics and the identification of a specific HLA haplotype as a possible predictor of disease may contribute to elucidate the pathogenesis of the disease and to point out the VKC as a complex immunologic disorder rather than as a mere allergic disease. The identification of a specific haplotype associated with VKC might be helpful to identify children predisposed to develop this ocular disease and patients with a specific outcome

SEVERE ASTHMA IS REALLY UNCOMMON

We describe the case of a 10-year-old girl with a history of severe persistent asthma and exercise-induced-asthma, controlled using an appropriate treatment with inhaled corticosteroid-long-acting beta-2 adrenergic agonists (ICS+LABA) and leukotriene receptor antagonists. She was healthy until the age of 8 years, when she presented two episodes of radiologically diagnosed pneumonia. After that, she began to present persistent cough, also nocturnal, stridor, dyspnea and respiratory distress and she was sent by pediatrician to our hospital. She performed a global spirometry which shows an obstructive and restrictive phenotype (FEV1: 75,3% and MEF50: 57,6%), without a significantly dilatation after inhaled salbutamol (400 mcg). She underwent to a systemic therapy with oral corticosteroid, with not benefit. She had no fever neither upper respiratory tract infections. We excluded gastro-oesophageal reflux disease, cystic fibrosis, Mycoplasma and Chlamydia pneumonia. Cardiological examination was negative. During hospitalization, she spontaneously expectorated a thick fibrinous mucoid formation. A chest X ray and a computed tomography (CT) scan showed atelectasis of both lung, widespread hyperlucency, and occlusion of the right main bronchus, compatible with a diagnosis of plastic bronchitis. Plastic bronchitis is a rare disease characterized by the formation of large gelatinous or rigid branching airway casts. The prevalence and etiology of plastic bronchitis are still unknown and the symptoms may also overlap with those of other diseases such as severe asthma, in the severe mucus plugging sometimes seen in allergic bronchopulmonary Aspergillosis (ABPA) or in middle lobe syndrome. In the pathogenesis of the disease the inflammation is usually present and initiates cast formation. Treatment includes bronchodilators, inhaled and oral corticosteroids, mucolytics, airway clearance therapy and antibiotics. Other therapies can include inhaled heparin, urokinase, tissue plasminogen activator (TPA), dornase alfa and oral macrolide antibiotics as mucoregulatory therapy2. Conclusions: The presence of asthmatic symptoms without clinical improvement after appropriate therapy is not always suggestive of severe asthma. Therefore, for the appropriate diagnosis, we have to exclude the other lung diseases and, among the differential diagnoses, is possible to consider also plastic bronchitis

Assessing the relationship between serum resistin and nasal obstruction in children with allergic rhinitis

Background: Nasal obstruction has been reported as a "key symptom" of allergic rhinitis (AR) because it is deeply associated with impaired quality of life and it reflects more directly the allergic inflammation in the nasal mucosa. Resistin is known to be involved in inflammatory processes exerting an important role in the regulation of cytokine production even though its effective proinflammatory activity at nasal level has never been fully established. This study investigates the relationship between resistin levels and nasal obstruction assessed by an objective method such as active anterior rhinomanometry. Methods: Fifty-three children between 4 and 10 years of age affected by persistent allergic rhinitis (PAR) were enrolled and subdivided in two groups. Serum resistin levels were detected in all children. The same day patients underwent rhinomanometry, which was considered negative (no nasal obstruction) when the fraction of predicted values (p.v.'s) was between 71 and 100% and it was considered positive when the fraction of p. v. was <= 70%. Results: The serum resistin levels were significantly higher in children with moderate-severe PAR than in patients with mild PAR (p<0.03). Furthermore, serum resistin levels were significantly higher in children with positive rhinomanometry compared with negative rhinomanometry (p<0.03). The fraction of p.v.'s of nasal flows in patients with nasal obstruction had a significant negative correlation with serum resistin levels (p<0.001). Conclusion: This study provides evidence that resistin levels are increased in children with severe nasal obstruction measured by an objective and quantitative approach