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Demographic study of paediatric allergic conjunctivitis within a multiethnic patient population
  1. A J Singh,
  2. R S K Loh,
  3. J A Bradbury
  1. St James’s University Hospital, Becket Street, Leeds LS9 7TF, UK
  1. Correspondence to: Mr Anil J Singh, St James’s University Hospital, Becket Street, Leeds LS9 7TF, UK; mraniljsingh{at}yahoo.co.uk

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From October 1999, all patients referred to the paediatric ophthalmology service in Bradford have been added to a computerised database. This is the only paediatric ophthalmology service within the city of Bradford and receives all GP referrals of this type. Patients with a clinical diagnosis of chronic allergic conjunctivitis were identified from October 1999 to July 2001. We compared the relative prevalence of chronic allergic eye disease between white and Asian patients in the paediatric population of the city of Bradford.

Confirmation of the diagnosis of chronic allergic conjunctivitis was made using case records. All patients were seen at the first visit by a consultant paediatric ophthalmologist (JAB).

A diagnosis of chronic allergic conjunctivitis was made if the patient had characteristic symptoms and signs based on criteria set out by Buckley in 1998.1 This was done to ensure accurate and consistent diagnosis of chronic allergic conjunctivitis so as not to include other forms of ocular allergy—for example, drug allergy or preservative toxicity. Inclusion criteria required a history of at least three of the following: a history of recurring symptoms over a period of at least 1 year; itching as a symptom; personal or family history of non-ocular allergic disease; and exacerbation during the pollen season and/or exposure to household pets. Presence of the following clinical signs was also necessary—conjunctival hyperaemia and subtarsal papillae.

Patients were excluded if they had any signs of staphylococcal blepharoconjunctivitis such as eyelid and eyelash crusting; matting of the eyelids; purulent, sticky discharge; eyelid notching and scarring. Patients with mixed disease were also excluded from this study. The presence of corneal complications that required topical steroid for resolution was used to define severe disease.

Clinical data

Forty three patients were identified from the database; 39 patients fulfilled entry criteria for this study and records were retrieved for 35. There were 24 Asians and 11 white children.

For Asian patients, the mean age was 9.58 (SD 4.02) years. For the white patients, the mean age was 7.82 (SD 3.19) years,. Follow up ranged from 3–14 months, mean 6 months. The prevalence of allergic conjunctivitis in Asians was 59 per 100 000 (24 in 40 524) and in white children, 12 per 100 000 (11 in 93 398); a relative prevalence of 5 to 1 (χ2 test p <0.001).

There was a predominance of males in both ethnic groups, 2.4:1 in Asians and 1.8:1 in white children. This difference in sex was not significant between both groups (Fisher’s test, p=0.71).

The overall age distribution for all males was 8.54 years and for all females was 10.01 years. For Asians, the mean age for males was 9.18 years and for females was 10.57 years. For white children, the mean age for males was 7.00 years and for females was 9.25 years.

Corneal complications

There were 14 with punctate epithelial erosions (10 Asians and four white children). Comparing patients from both groups with severe disease, there was a relative prevalence of Asians by 6.75 to 1 (Fisher’s test, p=0.001).

In two cases, visual loss occurred after the onset of chronic allergic conjunctivitis from epithelial plaque and corneal pannus. Both were Asian.

Comment

Various studies have reported allergic eye disease to be more common among Asian and black patients.2–4 This may be due to genetic and/or environmental factors.4–10

We found allergic eye disease to be more common in Asians than white children. It is possible that ocular allergy is multifactorial but perhaps with a greater genetic predisposition in certain ethnic communities.11 We could not comment on the prevalence of chronic allergic conjunctivitis in the community because of referral bias since we only see patients referred by GPs. The extent to which milder cases are treated in the community is not known but we feel that the more severe cases are the ones referred to our department.

Our findings highlight that allergic eye disease appears to be more common and complicated in Asian patients in the Bradford population. This potential risk of sight threatening disease means that they are more likely to require topical steroid treatment. This has led us to recognise that appropriately aggressive treatment is essential in these patients.

References

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