Immunological features in children with vernal keratoconjunctivitis

Background: Vernal Keratoconjunctivitis (VKC) is a rare (<1:10 000 in Europe) chronic, bilateral, seasonally exacerbed inflammation of the ocular surface involving tarsal and/or bulbar conjunctiva. VKC especially affects male children and young boys and it tends to regress in puberty. The diagnosis is based on the common conjuncitval symptoms (itching, photophobia and tearing) and on the characteristic signs (giant papillae, conjunctival hyperaemia and Horner-Trantas dots on the limbal conjunctiva). Moreover, photophobia is a constant feature of the VKC. Aim: To define a clinical, anamnestic and immunological profile of patients with VKC evaluating also the presence of biomarker autoantibodies. Methods: The study was performed at the Immunology and Allergology service of the Pediatric Department, Policlinico Umberto I Hospital, Rome. We enrolled 28 children (18:M) aged 4–14 years with diagnosis of VKC made by an ophthalmologist. To each patient, we asked the family history of allergic and immunological diseases. Among the immunological disorders, we evaluated mainly the presence of Hashimoto′ s thyroiditis, type I diabetes, psoriasis, rheumatoid arthritis and Systemic Lupus Erythematosus (SLE). All patients with a diagnosis of VKC underwent to a serological evaluation with the dosage of ANA autoantibodies. Results: 17 patients (60.7%) patients reported a family history of allergic diseases. About the immunological disorders, one patient presented type 1 diabetes and 14 patients (53%) reported a positive family history for autoimmune diseases: 6 (21%) for Hashimoto′s thyroiditis, 4 (14%) for type I diabetes, 3 (10%) for psoriasis and one for Systemic Lupus Erythematosus. 10 (35.7%) patients were ANA positive and they tended to present an higher severity of VKC. The association between ANA positivity and the family history of immune disorders was not demonstrated. Conclusions: These findings encourage us to consider the VKC as a multifactorial disease that can not be explained only by an allergic mechanism. Moreover, among the patients with VKC, it is important to recognise those subgroups with certain anamnestic, clinical and serum characteristics in order to find out an appropriate therapeutic management and a careful follow-up.