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Vernal keratoconjunctivitis--a rare but serious comorbidity of allergic rhinitis and eustachian tube dysfunction.
Int J Pediatr Otorhinolaryngol. 2010 Jan; 74(1):60-3.IJ

Abstract

OBJECTIVE

To determine the prevalence of symptoms and signs of allergic rhinitis (AR) in children with vernal keratoconjunctivitis (VKC) and evaluate eustachian tube (ET) function using tympanometry.

METHODS

The patients underwent an otolaryngological examination and symptoms of rhinorrhoea, nasal obstruction, nasal itching and sneezing were evaluated for the diagnosis of AR. Tympanometry was performed by a middle ear analyzer (Impedance audiometer AZ 26, Interacoustics A/S, Assens, Denmark). Blood samples were collected for determination of peripheral blood eosinophil count (PBEC) and serum total immunoglobulin E (IgE). Allergen sensitivity was also determined by skin prick test.

RESULTS

The study included 26 males (96.3%) and 1 female (3.7%) with a mean age of 12.1+/-4.4 years. Eight out of 27 subjects (29.6%) had blood eosinophilia and 11 out of 27 subjects had elevated serum IgE (40.7%). A positive skin prick test was identified for at least one allergen in 40% of patients (10/25 subjects). Symptoms and signs of AR were found in 10 subjects (37%). Median serum IgE level in subjects with AR (262.5 kU/L) was higher than without AR (40.2 kU/L) (p=0.08), whereas there were no differences in PBEC or eosinophilia percentage (p>0.05). Mean middle ear pressures in the right and left ears were -66.4 daPa (range between -268 and 4 daPa) and -57.3 daPa (range between -308 and 0daPa), respectively. The tympanometry results were abnormal in 5 subjects (18.5%) (3 type C and 2 type B tympanogram). Three out of 10 VKC patients with AR (30%) and 2 out of 17 VKC patients without AR (11.8%) had abnormal tympanograms (p=0.33).

CONCLUSION

AR is commonly associated with VKC and subjects with AR are almost three times more likely to have ET dysfunction than those without. Therefore, opthalmologists should refer VKC patients to otolaryngologists to delineate associated AR and ET dysfunction. Conversely, patients with OME and/or AR who have persistent allergic eye symptoms may well benefit from opthalmologic evaluation for seasonal allergic conjunctivitis and VKC.

Authors+Show Affiliations

Department of Otolaryngology Head and Neck Surgery, Selçuk University, Meram Medical Faculty, Konya, Turkey. bozkurtmetekaan@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19900723

Citation

Bozkurt, M K., et al. "Vernal Keratoconjunctivitis--a Rare but Serious Comorbidity of Allergic Rhinitis and Eustachian Tube Dysfunction." International Journal of Pediatric Otorhinolaryngology, vol. 74, no. 1, 2010, pp. 60-3.
Bozkurt MK, Bozkurt B, Artac H, et al. Vernal keratoconjunctivitis--a rare but serious comorbidity of allergic rhinitis and eustachian tube dysfunction. Int J Pediatr Otorhinolaryngol. 2010;74(1):60-3.
Bozkurt, M. K., Bozkurt, B., Artac, H., Arslan, N., & Reisli, I. (2010). Vernal keratoconjunctivitis--a rare but serious comorbidity of allergic rhinitis and eustachian tube dysfunction. International Journal of Pediatric Otorhinolaryngology, 74(1), 60-3. https://doi.org/10.1016/j.ijporl.2009.10.011
Bozkurt MK, et al. Vernal Keratoconjunctivitis--a Rare but Serious Comorbidity of Allergic Rhinitis and Eustachian Tube Dysfunction. Int J Pediatr Otorhinolaryngol. 2010;74(1):60-3. PubMed PMID: 19900723.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vernal keratoconjunctivitis--a rare but serious comorbidity of allergic rhinitis and eustachian tube dysfunction. AU - Bozkurt,M K, AU - Bozkurt,B, AU - Artac,H, AU - Arslan,N, AU - Reisli,I, Y1 - 2009/11/08/ PY - 2009/08/03/received PY - 2009/10/07/revised PY - 2009/10/10/accepted PY - 2009/11/11/entrez PY - 2009/11/11/pubmed PY - 2010/4/27/medline SP - 60 EP - 3 JF - International journal of pediatric otorhinolaryngology JO - Int J Pediatr Otorhinolaryngol VL - 74 IS - 1 N2 - OBJECTIVE: To determine the prevalence of symptoms and signs of allergic rhinitis (AR) in children with vernal keratoconjunctivitis (VKC) and evaluate eustachian tube (ET) function using tympanometry. METHODS: The patients underwent an otolaryngological examination and symptoms of rhinorrhoea, nasal obstruction, nasal itching and sneezing were evaluated for the diagnosis of AR. Tympanometry was performed by a middle ear analyzer (Impedance audiometer AZ 26, Interacoustics A/S, Assens, Denmark). Blood samples were collected for determination of peripheral blood eosinophil count (PBEC) and serum total immunoglobulin E (IgE). Allergen sensitivity was also determined by skin prick test. RESULTS: The study included 26 males (96.3%) and 1 female (3.7%) with a mean age of 12.1+/-4.4 years. Eight out of 27 subjects (29.6%) had blood eosinophilia and 11 out of 27 subjects had elevated serum IgE (40.7%). A positive skin prick test was identified for at least one allergen in 40% of patients (10/25 subjects). Symptoms and signs of AR were found in 10 subjects (37%). Median serum IgE level in subjects with AR (262.5 kU/L) was higher than without AR (40.2 kU/L) (p=0.08), whereas there were no differences in PBEC or eosinophilia percentage (p>0.05). Mean middle ear pressures in the right and left ears were -66.4 daPa (range between -268 and 4 daPa) and -57.3 daPa (range between -308 and 0daPa), respectively. The tympanometry results were abnormal in 5 subjects (18.5%) (3 type C and 2 type B tympanogram). Three out of 10 VKC patients with AR (30%) and 2 out of 17 VKC patients without AR (11.8%) had abnormal tympanograms (p=0.33). CONCLUSION: AR is commonly associated with VKC and subjects with AR are almost three times more likely to have ET dysfunction than those without. Therefore, opthalmologists should refer VKC patients to otolaryngologists to delineate associated AR and ET dysfunction. Conversely, patients with OME and/or AR who have persistent allergic eye symptoms may well benefit from opthalmologic evaluation for seasonal allergic conjunctivitis and VKC. SN - 1872-8464 UR - https://www.unboundmedicine.com/medline/citation/19900723/Vernal_keratoconjunctivitis__a_rare_but_serious_comorbidity_of_allergic_rhinitis_and_eustachian_tube_dysfunction_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0165-5876(09)00541-2 DB - PRIME DP - Unbound Medicine ER -