Epidemiological characterization and risk factors of rhinitis and rhinoconjunctivitis among preschool children in Shanghai, China.

BACKGROUND: Previous studies have reported an increasing prevalence of childhood allergic rhinitis in developing countries. There is still a lack of the recent epidemiology of allergic rhinitis among Chinese preschool children. Therefore, this study explored the prevalence of rhinitis symptoms and identified their associations with potential risk factors among children at the age of 3-6 in Shanghai, China. METHODS: Validated International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was adopted to collect information about rhinitis symptoms and potential risk factors. Univariate and multivariate logistic regression analyses were used to assess associations between risk factors and allergic rhinitis and rhinoconjunctivitis. RESULTS: A total of 6183 questionnaires were included in our study. The prevalence of rhinitis ever, current rhinitis, and physician-diagnosed rhinitis were 32.6%, 29.2%, and 14.3%, respectively, while the prevalence of current rhinoconjunctivitis was 11.3%. The higher prevalence was observed in boys than in girls in terms of rhinitis ever, current rhinitis, current rhinoconjunctivitis and doctor-diagnosed rhinitis. Autumn had the highest prevalence among four seasons. In our multivariate logistic regression analyses, history of allergic diseases and paracetamol use in the last year showed positive associations with the increased risk of both current rhinitis and rhinoconjunctivitis, and antibiotic use was an independent significant risk factor only for current rhinitis. Genetic factors, including maternal and paternal rhinitis, asthma, and eczema, were significantly associated with the prevalence of current rhinitis. Similar associations were seen between these factors and current rhinoconjunctivitis, except for paternal eczema. Among environmental factors, smoking exposure at home, heavy truck traffic in home's street, floor heating system were independent risk factors for both current rhinitis and rhinoconjunctivitis in the adjusted model, while cleaning the house less than once a week was only associated with current rhinitis. CONCLUSION: The prevalence of current rhinitis was 29.2% among children aged 3-6 in Shanghai, China. Sex differences and seasonal variations were observed in the prevalence of rhinitis symptoms. The identified risk factors would provide a basis for policy makers and medical experts to take intervention measures to prevent allergic rhinitis and rhinoconjunctivitis.

Allergic Diseases and Chronic Adenotonsillar Diseases: A Mendelian Randomization Study.

OBJECTIVE: The existing epidemiological evidence regarding the intricate relationship between allergic diseases and chronic adenotonsillar diseases (CATD) remains inconclusive. Herein, the objective of our study is to explore the causal association using Mendelian randomization (MR). METHODS: Employing data from large genome-wide association studies, a comprehensive two-sample bidirectional MR study was conducted. The studied traits encompassed allergic rhinitis (cases n = 9707, controls n = 331173), allergic asthma (cases n = 8525, controls n = 193857), allergic conjunctivitis (cases n = 18321, controls n = 324178), atopic dermatitis (cases n = 11964, controls n = 306909), and CATD (cases n = 38983, controls n = 258553). All the patients were of European descent and participants in cohort studies. The primary analysis was executed using inverse-variance-weighted MR. Furthermore, six additional MR methods (MR-Egger, weighted median, simple mode, weighted mode, MR pleiotropy residual sum and outlier, MR robust adjusted profile score) were employed to ensure the reliability and detect potential horizontal pleiotropy within the results. The estimates obtained from the MR analysis were factored into the overall effect calculation. RESULTS: Genetically anticipated outcomes demonstrated a significant association between CATD risk and allergic rhinitis (OR = 1.141, p = 6.30E-06), allergic asthma (OR = 1.115, p = 8.31E-05), allergic conjunctivitis (OR = 1.197, p = 8.69E-07), and a suggestive association with atopic dermatitis (OR = 1.053, p = 0.040). However, no substantial correlation was observed in the reverse direction. CONCLUSIONS: Findings of our study provide evidence supporting a causal role of allergic diseases in the development of CATD, whereas the converse relationship does not appear to hold true. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:2653-2658, 2024.

Corneal topometric indices and proclivity toward corneal ectasia in vernal keratoconjunctivitis.

PURPOSE: To investigate changes in topometric corneal indices and proclivity toward corneal ectasia, as well as keratometric indices and anterior chamber dimensions in palpebral vernal keratoconjunctivitis (VKC). METHODS: This study included 80 patients with clinically established symptoms of grade 0 or grade 1 palpebral VKC (group 1) and 66 healthy participants (group 2). After a comprehensive ophthalmic examination including best-corrected visual acuity, intraocular pressure measurements and slit-lamp biomicroscopy, pachymetric indices and anterior chamber dimensions were measured using the Pentacam HR rotating Scheimpflug device. Topometric indices, which are particularly useful for determining proclivity toward corneal ectasia, were extracted from a topometric map. RESULTS: In groups 1 and 2, the mean ages were 13.11±5.22 and 16.45±5.09 years, respectively. The mean age at disease onset in group 1 was 10.09±5.03 years, and the mean disease duration was 36.23±8.43 months. Group 1 had significantly higher mean topometric indices than group 2, particularly the index of surface variance (P=0.001), index of vertical asymmetry (P=0.007), center keratoconus index (P=0.050), and Belin/Ambrosio enhanced ectasia total deviation value (P=0.032). Mean posterior corneal astigmatism differed significantly between groups 1 and 2 (P=0.003). CONCLUSIONS: Significantly higher mean topometric indices in VKC indicate a proclivity for corneal ectasia, which could be attributed to general changes in the corneal ultrastructure caused by persistent itching-induced eye rubbing.

Management of vernal keratoconjunctivitis: Navigating a changing treatment landscape.

Vernal keratoconjunctivitis (VKC) is a chronic, progressive, and potentially sight-threatening form of ocular inflammatory disease that primarily affects children and young adults. Prevalence varies by region, ranging from <2 per 10,000 in the United States to as high as 1,100 per 10,000 in parts of Africa. The rarity of VKC in developed countries can make differential diagnosis challenging, and treatment is often delayed until the disease is advanced, and symptoms are significantly impacting patients' quality of life. Although once viewed primarily as an immunoglobulin E-mediated condition, approximately 50% of patients with VKC do not exhibit allergic sensitization. It is now recognized that the immunopathology of VKC involves multiple inflammatory pathways that lead to the signs, symptoms, and conjunctival eosinophilic and fibroproliferative lesions that are a hallmark of the disease. We examine the evolution of our understanding of the immunopathology of VKC, the expanding VKC treatment armamentarium, the clinical implications of emerging treatment approaches, and future directions for VKC research and practice.

Examining the Correlation between Allergic Conjunctivitis and Allergic Rhinitis.

Objective: This study aims to assess the correlation between allergic conjunctivitis (AC) and allergic rhinitis (AR). Methods: A total of 462 patients diagnosed with either allergic conjunctivitis or allergic rhinitis and treated at our hospital from January 2018 to December 2020 were included. Patients were categorized into two groups, the AC group and the AR group, based on their initial department of consultation. The AC group comprised 232 patients diagnosed with allergic conjunctivitis in the ophthalmology department, while the AR group consisted of 230 patients diagnosed with allergic rhinitis in the ENT department. Allergen analysis was conducted on patients presenting with both AC and AR and conjunctival and nasal mucosal scrapings were performed to examine eosinophil presence. The study analyzed the association between allergic AC and AR. Results: In the AC group, 174 patients (75.00%) had concurrent AR, while in the AR group, 169 patients (73.48%) had concurrent AC. Inhalant allergen testing among patients with concurrent AC and AR revealed that the primary inhalant allergens were dust mites, house dust, and fungi, with specific immunoglobulin E (IgE) positivity of 91.23%. Testing for food allergens identified fish, shrimp, and crab as ingestive allergens, with a specific IgE positivity of 58.58%. Eosinophil presence was assessed through conjunctival and nasal mucosal scrapings in patients with concurrent AC and AR. Eosinophils were detected in 188 cases (54.81%) through conjunctival scraping and 197 cases (57.43%) through nasal mucosal scraping, with no significant differences observed (P > .05). Conclusions: AC and AR share a common pathophysiological process and allergen profile, with the conjunctiva and nasal mucosa serving as sites of allergic reactions. This study suggests the integration of AC prevention and treatment into AR prevention strategies.

Comprehensive evaluation of ocular complications in atopic dermatitis: insights from a contemporary cohort study in Korean population.

BACKGROUND: Atopic dermatitis (AD) is a chronic inflammatory skin disorder associated with various systemic and ocular complications. This study aimed to investigate the prevalence, risk factors, and clinical characteristics of ocular complications in a cohort of Korean AD patients. METHODS: A retrospective review of medical records was conducted for AD patients who visited the dermatology and ophthalmology clinics at the same institution. Demographic data, clinical characteristics, and types of ocular complications were recorded. Logistic regression analysis was performed to identify factors associated with ocular complications. RESULTS: A total of 212 AD patients were included in the study. The intraocular complications had a prevalence of 1.9%, whereas ocular surface diseases were observed more frequently, with prevalence of 13.2%. Among the ocular complications, blepharitis was the most prevalent, followed by atopic keratoconjunctivitis. Subcapsular cataract, atrophic hole, and retinal detachment were also observed. The head and neck score in the Eczema Area and Severity Index (EASI) emerged as a significant predictor for intraocular complications, independent of age, gender, total EASI score, and family history. No significant association was found between total EASI score and ocular surface disease. CONCLUSION: This study provides insights into the prevalence and risk factors of ocular complications in Korean AD patients. The head and neck score in EASI was identified as a significant predictor for intraocular complications. These findings emphasize the importance of comprehensive evaluation and interdisciplinary care for AD patients, particularly in identifying and managing potential vision-threatening complications.

Nonlinear effects of humidex on risk of outpatient visit for allergic conjunctivitis among children and adolescents in Shanghai, China: A time series analysis.

Background: Various epidemiological studies have focused on the adverse health outcomes of meteorological factors. However, there has been little research on the impact of humidex on allergic conjunctivitis, especially in child and adolescent populations. We aimed to explore the impact of humidex, a comprehensive index of relative humidity and temperature, on child and adolescent allergic conjunctivitis admissions. Methods: Outpatient visit data for allergic conjunctivitis, meteorological factors and air pollutants in Shanghai for the 2017-2022 period were retrieved. For the purpose of analysing the nonlinear connection and lag impact between humidex and admissions for paediatric and adolescent allergic conjunctivitis, the distributed lag nonlinear model (DLNM) was fitted. Results: A total of 147 090 cases were included in our cohort. We found a significantly nonlinear effect on humidex and allergic conjunctivitis. In the single-day lag pattern, the relative risks (RR) of allergic conjunctivitis were significant at lag 0 (RR = 1.08, 95% confidence interval (CI) = 1.05-1.11) to lag 2 (RR = 1.01, 95% CI = 1.00-1.01), lag 5 (RR = 1.01, 95% CI = 1.00-1.01) to lag 9 (RR = 1.01, 95% CI = 1.00-1.01), and lag 14 (RR = 1.02, 95% CI: 1.01-1.03). In the cumulative-lag day pattern, the RR of allergic conjunctivitis were significant at lag 0-0 (RR = 1.08, 95% CI = 1.05-1.11) to lag 0-14 (RR = 1.21, 95% CI = 1.13-1.28). We found that boys, children aged 7-17 years, and children in the warm season were more vulnerable to humidex. In addition, the highest attributable fraction (AF) and attributable number (AN) of humidex are at lag 0-14 (AF = 0.17, AN = 25 026). Conclusions: Humidex exposure markedly increased the risk of allergic conjunctivitis, especially in highly high humidex. Appropriate public health management is needed for disease management and early intervention.

Incidence of Food allergy among patients with allergic conjunctivitis.

The prevalence of ocular allergy is increasing worldwide. Skin prick test is widely recognized as the most reliable method for diagnosing the incriminating allergen as regards type I hypersensitivity reactions. Food allergy results as immunological response to food protein which leads to occurrence of allergic conjunctivitis (AC), allergic rhinitis, asthma, atopic dermatitis, and eosinophilic esophagitis. There is a scarcity of research investigating the association between food allergy and AC. This retrospective cohort study aimed to determine the incidence of food allergy within AC patients and its linkage to disease intensity and to compare the response to sublingual immunotherapy after 4 months of therapy. The study included 240 individuals diagnosed with AC. Of these patients, only 214 (89.16%) cases exhibited positive skin prick test results and showed incidence of food allergy of 29.6 %. After 4 months of sublingual allergen immunotherapy, the total serum IgE level and the grades of severity decreased significantly (p 0.001 for each). On comparing patients with food allergy on sublingual immunotherapy and patients without food allergy and on sublingual immunotherapy, the change in total serum IgE concentration and the grade of severity did not differ among the two groups (p value was 0.63 and 1.00 respectively). In conclusion, food allergies can contribute to the development of AC. Sublingual allergen immunotherapy can be proposed as a promising therapeutic option for AC patients.

Associations between long-term exposure to PM2.5 chemical constituents and allergic diseases: evidence from a large cohort study in China.

BACKGROUND: Exposure to air pollutants may cause immune responses and further allergic diseases, but existing studies have mostly, if not all, focused on effects of short-term exposure to PM2.5 on allergic diseases. OBJECTIVES: We estimated associations of long-term exposure to PM2.5 chemical constituents with allergic disease risks and effect modification. METHODS: We used the baseline of a newly established, provincially representative cohort of 51,480 participants in southwest China. The presence of allergic rhinitis, allergic asthma, urticaria, and allergic conjunctivitis was self-reported by following a formed questionnaire in face-to-face interviews. The average concentrations of PM2.5 chemical constituents (NO3-, SO42-, NH4+, organic matter [OM], and black carbon [BC]) over participants' residence were estimated using machine learning models. Logistic regression with double robust estimator and weighted quantile sum regression were used to estimate the effects of PM2.5 chemical constituents on allergic disease risks, as well as relative importance of each PM2.5 chemical constituent. RESULTS: Per interquartile range increase in the concentration of all PM2.5 chemical constituents was associated with the elevated risks for allergic asthma (OR = 1.79 [1.41-2.26]), allergic conjunctivitis (1.54 [1.19-2.00]), urticaria (1.36 [1.25-1.48]), and allergic rhinitis (1.18 [1.11-1.26]). NO3- contributed more to risks for allergic asthma (weight = 46.05 %), urticaria (72.29 %), and allergic conjunctivitis (47.65 %), while NH4+ contributed more to allergic rhinitis (78.07 %). OM contributed most to the risks for allergic asthma (30.81 %) and allergic conjunctivitis (31.40 %). BC was also associated with allergic rhinitis, urticaria, and allergic conjunctivitis, only with a considerable weight for urticaria (24.59 %). Joint effects of PM2.5 chemical constituents on risks for allergic rhinitis and urticaria were stronger in minorities and farmers than their counterparts. CONCLUSION: Long-term exposure to PM2.5 chemical constituents was associated with the increased allergic disease risks, with NO3- and NH4+ accounting for the largest variance of the associations. Our findings would serve as scientific evidence for developing more explicit strategies of air pollution control.

Air Pollution and Meteorological Conditions Significantly Associated With Vernal Keratoconjunctivitis Exacerbations.

Purpose: Vernal keratoconjunctivitis (VKC) is a severe chronic allergic inflammation of the ocular surface with episodes of acute exacerbations, that primarily affects children and young adults. Although the etiology and pathogenesis of VKC remain unclear, studies have suggested that environmental factors may be involved. This study aims to investigate the association between exposure to meteorological and environmental factors and the incidence of VKC exacerbations. Methods: This study was conducted in southern Israel, which is a semi-arid, hot, and dry climate with frequent dust storms. Patients diagnosed with VKC were recruited for the study. VKC exacerbations were identified as the need for medical intervention. Pollutants measured included nitrogen dioxide (NO2), ozone (O3), particulate matter (PM10 and PM2.5), sulfur dioxide (SO2), relative humidity (RH), temperature, and solar radiation (SR). To assess the association between VKC exacerbations and exposure to different pollutants, a case-crossover analysis was conducted. We also stratified the analysis by sex, age, ethnicity, immigration status, and social state score. Results: Our results demonstrated that the pollutants NO2, O3, and PM10 were associated with VKC exacerbations with odds ratio (OR) = 2.17 (95% confidence interval [CI] =1.40 to 3.04), OR = 2.28 (95% CI = 1.30 to 3.39), and OR = 1.89 (95% CI = 1.06 to 2.74). Other pollutants PM2.5, temperature, and solar radiation were also independently associated with incidence of exacerbations with OR = 1.15 (95% CI = 0.87 to 1.50), OR = 1.75 (95% CI = 1.16 to 2.65), and OR = 1.37 (95% CI = 1.01 to 1.63) and had varying effects in different demographic strata. Conclusions: The environmental parameters, NO2, O3, PM10, PM2.5, temperature, and solar radiation were found to be significantly associated with VKC exacerbations, with NO2, O3, and PM10 showing the strongest associations. Our findings suggest that environmental factors should be considered when developing strategies to prevent and manage VKC exacerbations.

Association between keratoconus and allergic conjunctivitis in children attending a Tertiary Hospital in Nigeria.

Objective: To ascertain an association between keratoconus and allergic conjunctivitis and to know if it is necessary to investigate all patients with allergic conjunctivitis for keratoconus. Methods: A hospital-based prospective study in which the eyes of children presenting with ocular allergic diseases were examined. Social demographics and clinical data were captured in a questionnaire. All the patients underwent keratometry using the autorefractor-keratometer and the pachymeter was used to measure the central corneal thickness. Data analysis was done with IBM SPSS version 28 for Windows. Frequency and chi-square were used as descriptive statistics to determine the association between dependent and independent variables. Inferential statistics using one-way ANOVA and t-test. P - Value at <0.05 was considered statistically significant. Results: 121 children with allergic conjunctivitis were reviewed. Males were 72 and females 49. The visual acuity was 6/ 6-6/ 18 in 116, and mild visual impairment - 6/ 18-6/ 60 in 5. The most common complaint was frequent itching in 109 (90.1%). Keratometry was normal in 120 (99.5%), while probable keratoconus was found by keratometry in only one patient (0.5%). Central corneal thickness was within the normal range in 33 (27.3%) children, 43 (35.5%) had thin corneas, while 45 (37.2%) had cornea thickness of more than 560 microns. Discussion: Pediatric keratoconus tends to be more aggressive than adult keratoconus with an increased risk of corneal opacities and subsequent keratoplasty. As a result of these negative impacts, early detection and prompt treatment are mandatory. Conclusion: The prevalence of keratoconus was not found to be high in this study population, but with facts emerging between the association of allergic conjunctivitis, and increased prevalence of keratoconus, it is pertinent to integrate keratoconus screening as part of the management of allergic conjunctivitis using an appropriate tool such as video keratography and slit lamp biomicroscope. Abbreviations: KC = Keratoconus, CLEK = Collaborative Longitudinal Evaluation of Keratoconus, SAC = Seasonal Allergic Conjunctivitis, PAC = Perennial Allergic Conjunctivitis, VKC = Vernal Keratoconjunctivitis, IOP = Intraocular Pressure, CCT = Central Corneal Thickness, TNF-α = Tumor Necrosis Factor-Alpha, IL = Interleukin.

Prevalence and clinical characteristics of vernal keratoconjunctivitis in sub-Saharan Africa.

PURPOSE OF REVIEW: Vernal keratoconjunctivitis (VKC) is a chronic bilateral allergic inflammatory disease of the conjunctiva and cornea that affects children and young adults, especially in sub-Saharan Africa. A limbal form (tropical endemic limbo conjunctivitis) is thought to be more common in the tropics where research on this vision-impairing condition is scanty. We sought to review current literature from sub-Saharan Africa, with a focus on the prevalence of VKC and its clinical presentation. RECENT FINDINGS: There is a variable prevalence of VKC in SSA, up to 32.9% of children, especially in male individuals less than 5 years old, and has been diagnosed in a 4-month-old baby. Associated factors include exposure to dust, personal and family history of atopy, Vitamin D3 deficiency and HIV. The mixed form of VKC is the most frequent form seen and conjunctival pigmentation might be an early diagnostic sign. SUMMARY: Childhood screening programs for VKC should be established to reduce the morbidity, decreased quality of life and school absenteeism that is seen in these patients. VKC-related research should be encouraged in this milieu to bring to light the particularities of VKC in SSA.

Analysis of Multimorbidity of Moderate to Severe Allergic Rhinitis in Children: A Real-World Study.

INTRODUCTION: Allergic rhinitis (AR) in children is associated with various comorbidities, posing challenges for treatment and management. There have been few investigations of these multimorbidities in Chinese children with AR. Here, we investigated the prevalence of multimorbidities in children with moderate to severe AR and analyzed the influencing factors using real-world data. METHODS: In total, 600 children who visited the outpatient clinic of our hospital and were diagnosed with moderate-severe AR were prospectively enrolled. All children underwent allergen detection and electronic nasopharyngoscopy. Parents or guardians completed a questionnaire that included age, sex, mode of delivery, feeding pattern, and familial history of allergy. The multimorbidities investigated included atopic dermatitis (AD), asthma, allergic conjunctivitis (AC), chronic rhinosinusitis (CRS), adenoid hypertrophy (AH), tonsil hypertrophy (TH), recurrent epistaxis, and recurrent respiratory tract infections (RRTIs). RESULTS: The AR multimorbidities reported in children were as follows: recurrent epistaxis (46.5%), AC (46.3%), AD (40.7%), asthma (22.5%), RRIs (21.3%), CRS (20.5%), AH (19.7%), and TH (12.5%). In univariate logistic regression analysis, age (<6 years), birth mode, familial history of allergy, and single dust mite allergy were associated with AR multimorbidity (p < 0.05). Multivariate logistic regression revealed that a familial history of allergy was an independent risk factor for AC (odds ratio [OR] = 1.539, 95% confidence interval [CI]: 1.104-2.145) and AH (OR = 1.506, 95% CI: 1.000-2.267) (p < 0.05). Age (<6 years) was independently associated with the risk of AD (OR = 1.405, 95% CI: 1.003-1.969) and RRTIs (OR = 1.869, 95% CI: 1.250-2.793) (p < 0.05), cesarean section with AR and CRS risk (OR = 1.678, 95% CI: 1.100-2.561), and single dust mite allergy with asthma (OR = 1.590, 95% CI: 1.040-2.432) and CRS (OR = 1.600, 95% CI: 1.018-2.515) risk (p < 0.05). Further, non-dust mite allergy was independently associated with AR and CRS (OR = 2.056, 95% CI: 1.084-3.899). CONCLUSION: AR was found to be accompanied by different comorbidities, including both allergic and non-allergic comorbidities, complicating disease treatment. These findings demonstrated that age (<6 years), familial history of allergy, types of allergens, and cesarean section were risk factors for different multimorbidities associated with AR.

An observational study on the presence of perilimbal conjunctival pigmentation in vernal keratoconjunctivitis.

Purpose: To evaluate presence of perilimbal pigmentation (PLP) in Indian patients with vernal keratoconjunctivitis (VKC). Methods: A cross sectional study was conducted from 2019 to 2020 at a tertiary eye care center in Western Maharashtra, India. In this study, 152 cases of VKC were identified. The presence, type, color, and extent of PLP were recorded. The incidence of presence of PLP was calculated. Its correlations with severity and duration of VKC were analyzed using Wilcoxon-Mann-Whitney U test and Chi square test. Results: Of 152 cases, 79.61% were males. Mean age at presentation was 11.4 ± 5.6 years. The characteristic PLP was present in 81 cases (53.29%; 95% confidence interval [CI]: 45.03%-61.42%; P < 0.001), of which 15 cases (18.5%) had this pigmentation in all the four quadrants. There was a significant difference between the groups with respect to quadrants involvement in terms of the extent of PLP in clock hours (χ2 = 73.85, P < 0.001). However, the extent did not correlate with age (rho = 0.08, P = 0.487), sex (P = 0.115), time since onset in months (rho = 0.03, P = 0.77), duration of VKC and type or color of PLP (P = 0.12). Conclusion: Perilimbal pigmentation seems to be a consistent clinical finding seen in a significant number of VKC cases. It may benefit ophthalmologists in treating VKC cases when the palpebral/limbal signs are elusive.

Vernal Keratoconjunctivitis among Patients Presenting to the Outpatient Department of Ophthalmology of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Vernal keratoconjunctivitis is a seasonally recurring, bilateral inflammation of the conjunctiva, that occurs in male children with invariable personal or family history of atopy. It is characterized by interstitial inflammation of the cornea and can have sight-threatening complications if not treated in time. The aim of this study was to find out the prevalence of vernal keratoconjunctivitis among patients presenting to the outpatient department of ophthalmology of a tertiary care centre. Methods: This descriptive cross-sectional study was conducted among patients presenting to the outpatient department of ophthalmology from June 2020 to May 2021. Ethical approval was taken from the Institutional Review Committee (Reference number: IRC-PA-076). The relevant details of the history and clinical examination of the patients were recorded on a specifically designed proforma. A simple random sampling technique was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 2400 patients with conjunctivitis visiting the outpatient department of ophthalmology, vernal keratoconjunctivitis was seen in 80 (3.33%) (2.61- 4.05, 95% Confidence Interval). Conclusions: The prevalence of vernal keratoconjunctivitis in our study was found to be similar to the other studies done in similar settings. Keywords: conjunctivitis; refractive error; vernal keratoconjunctivitis.

Prevalence of dry eye disease in the patients of allergic conjunctivitis: Hospital-based cross-sectional study.

PURPOSE: Allergic conjunctivitis (AC) is commonly associated with dry eye. This study was conducted to assess the prevalence of dry eye in different subsets of AC patients. METHODS: This observational, cross-sectional study, conducted in the Department of Ophthalmology of a tertiary center in north India, included 132 patients of AC. The diagnosis of dry eye disease (DED) was made on the basis of Ocular Surface Disease Index (OSDI), Schirmer's test, and tear film break-up time (TFBUT). RESULTS: The prevalence of dry eye in AC patients was found to range between 31% and 36%. On OSDI scoring, 20.45% of patients had mild, 18.18% moderate, and 31.81% had a severe grade of DED, respectively. The mean OSDI score was noted to be significantly higher in patients with perennial allergic conjunctivitis (PAC) (29.82 ± 12.41), followed by seasonal allergic conjunctivitis (SAC) (25.35 ± 12.88), and least in the patients of vernal keratoconjunctivitis (VKC) (13.60 ± 8.63) (p < 0.0001), respectively. The TFBUT was found to be less than 10 s in 45.45% of PAC, 30.43% of SAC, and 20% of VKC patients, respectively. The difference between the mean TFBUT among the three groups was statistically insignificant (p = 0.683). Schirmer's test value of <10 mm was observed in 45.45% of PAC, 43.47% of SAC, and 10% of VKC patients, respectively. CONCLUSION: This study revealed a high prevalence of DED in patients with AC. Among the different types of AC patients, PAC had the highest percentage of DED followed by SAC and least in VKC, respectively.

Practice patterns and opinions in the treatment of allergic eye disease: A survey among Indian ophthalmologists.

Purpose: Management of allergic eye disease is seldom straightforward and often challenging. We conducted an online survey to elicit opinions on the preferred practice pattern in the treatment of allergic eye disease. Methods: An online survey questionnaire was sent to all practicing ophthalmologists using social media platforms. The respondents were asked about their clinical experience and preferred treatment in various scenarios such as mild-moderate vernal keratoconjunctivitis (VKC), chronic VKC, refractory VKC, steroid responders, giant papillae, and shield ulcer. Respondents were asked about the newer molecule (alcaftadine) and reservations regarding systemic immuno-suppressants and ordering allergy tests in their practice. Results: Ninety - one participants responded to the survey. About 57.1% of ophthalmologists reported coming across more than 10 cases per week in their practice. The most common age group was 5-10 years (61.1%), but adult onset VKC was also reported at 41.6% (1-2 per month), 37.1% (3-5 per month), and 13.5% (more than 10 per month). The disease is perennially present (36.7%), and a mixed form has been reported by 47.8% of ophthalmologists. Dual-acting agents were preferred by 40% in mild-moderate clinical variants. Topical steroids in slow tapering dosage were preferred by 86.7% in their prescription. Tacrolimus 0.03% was preferred by 65.9% and given for at least 3 months of continuous usage by 47.6% of ophthalmologists. High-dose topical steroids were preferred for giant papillae (67.8%) and Shields ulcers (68.3%) in our survey. Supratarsal steroid injection was preferred by 50% in treating refractory VKC in our survey. Conclusion: Allergic eye disease is a common yet annoying disease. The signs and symptoms can vary from subtle, innocuous forms to devastating variants affecting vision and day-to-day work. This survey aims to elicit responses from clinicians spreading across different geographical areas and compares responses based on experience in practice.

Size-specific particulate matter and outpatient visits for allergic conjunctivitis in children: a time-stratified case-crossover study in Guangzhou, China.

This time-stratified case-crossover study aims to quantify the risk of allergic conjunctivitis (AC) associated with short-term exposure to PMs (i.e., PM1, PM2.5, PMc, and PM10) among children in Guangzhou, China. We collected data on children's daily AC outpatient visits from the Guangzhou Women and Children Medical Center during February 20, 2016 to December 31, 2018, and also extracted air pollution and meteorological data in the same time frame. We used conditional logistic regression model to estimate the associations between PMs and AC outpatient visits, and conducted subgroup analyses stratified by sex, age, and season. During the study period, we recorded 39,330 children's outpatient visits for AC, including 27,638 boys and 11,692 girls. The associations between PMs and AC were general linear with no clear threshold, which were largest at the current days but remained positive for lag 1 to 3 days. For every 10 µg/m3 increase in daily PM1, PM2.5, PMc, and PM10 concentrations, the estimated risks of AC outpatient visits at the current days increased by 2.5% (OR = 1.025, 95% CI: 1.011-1.039), 1.8% (OR = 1.018, 95% CI: 1.009-1.027), 2.1% (OR = 1.021, 95% CI: 1.004-1.039), and 1.3% (OR = 1.013, 95% CI: 1.007-1.020), respectively. In addition, our stratified analyses revealed that girls and children aged 1 to 6 years were more sensitive to PM exposure, and the PM-associated risks for AC were more apparent in autumn and winter. Our study suggests that short-term exposure to PMs may induce AC in children.

Indication-prescription study for the management of conjunctivitis in a Colombian population.

PURPOSE: Conjunctivitis is one of the most common ocular pathologies. Its treatment depends on its etiology, but an excessive use of antibiotics and corticosteroids, which in many cases are contraindicated, has been described. The objective was to describe the prescription patterns of medications used to treat conjunctivitis in a Colombian population. METHODS: This was a cross-sectional study on the pharmacological treatment of patients diagnosed with conjunctivitis between April 1, 2020, and March 31, 2021; based on a drug-dispensing database of approximately 8.5 million people affiliated with the Colombian Health System. Some sociodemographic and pharmacological variables and comorbidities were considered. A descriptive analysis was performed. RESULTS: A total of 8708 patients were identified; they had a median age of 44.7 years, and 59.3% were women. The most common causes of conjunctivitis were unspecified (53.1%) and allergic (37.4%). The most commonly used drug was olopatadine (26.1%), followed by dexamethasone with neomycin and polymyxin B (25.0%). A total of 97.0% of the patients received ophthalmic prescriptions, while 12.8% received systemic medications. Glucocorticoids (40.3%), antibiotics (37.7%) and antihistamines (31.7%) were the most commonly used groups of ophthalmic drugs. Glucocorticoids and ophthalmic antibiotics were the medications most frequently prescribed by general practitioners for the treatment of viral or bacterial conjunctivitis. CONCLUSIONS: Many patients with conjunctivitis are not being managed according to the recommendations of clinical practice guidelines, which highlights that the widespread use of antibiotics with ophthalmic glucocorticoids could be considered potentially inappropriate prescriptions in many cases.