Vernal keratoconjunctivitis in Down syndrome: a case report

To the best of our knowledge, at the time of writing, this is the first description of VKC in a patient with DS. In fact, in literature we have found no any other case of VKC as well as few studies on allergic disease in DS children, that probably indicates their poor likelihood of developing these diseases. Allergic sensitization is rare in DS individuals compared to the general population: they show low levels of specific IgE (7.6%) and fewer positive skin prick tests (18%) compared to non-DS children (40.2% and 54%, respectively) [6, 7]. Thus, finding an inflammatory-allergic disease such as VKC in DS is unusual but nevertheless possible as demonstrated by our case. Furthermore in patients affected by VKC itching induces eye rubbing with corneal epithelium microtrauma and damage. This, in susceptible individuals, can lead to cytokines release, myofibroblastst differentiation, biomechanical forces change and corneal tissue thinning with development of keratoconus [8, 9], a frequent complication of both VKC [10] and DS [1]. Therefore, our case suggests important implications for diagnostic workup and treatment. Before starting a specific treatment, in presence of suggestive symptoms, health professionals should consider other causes of specific symptoms associated with eye disease in DS, such as inflammatory-allergic ones. In this way, tailored therapies could be applied and corneal transplantation, required in 0.2% of DS with keratoconus, could be avoided [1, 11].

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