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ALLERGIC CONJUNCTIVITIS IN CHILDHOOD

Janilson Barros de Sá1

Vinicius Carvalho de Sá2

João Guilherme de Sá Santos3

Abstract: Allergic conjunctivitis is an eye condition prevalent among children, characterized by

inammation of the conjunctiva resulting from an allergic reaction to substances such as pollen,

dust, dust mites and animal dander. This disease is a manifestation of the immune system and causes

symptoms such as intense itching, tearing, hyperemia and a sensation of a foreign body in the eyes.

The management of allergic conjunctivitis ranges from simple measures, such as frequent eye washing

and avoidance of allergens, to the use of medications such as antihistamines, mast cell stabilizers and

topical corticosteroids. In childhood, the management of allergic conjunctivitis faces diculties such as

variability in response to treatment and the impossibility of completely avoiding exposure to allergens.

The general objective of this study is to evaluate management strategies for allergic conjunctivitis

in childhood, with an emphasis on the eectiveness of available treatments and the identication of

factors that inuence the response to treatment. Specic objectives include analyzing the eectiveness

of dierent treatments, investigating the inuence of environmental and individual factors on disease

severity and recurrence, and discussing the management of allergic conjunctivitis. This study is relevant

as appropriate management of allergic conjunctivitis can prevent complications and improve children’s

well-being. Identifying factors that inuence response to treatment can contribute to the development of

more personalized and eective therapeutic approaches. Recent literature highlights the need to improve

education of parents and caregivers about allergic conjunctivitis to ensure appropriate management of

the disease. Studies show that understanding the immunological mechanisms underlying the disease

1 Pediatrician, Paraíso College

2 Graduating in Medicine from the Faculty of Medicine of Olinda

3 Graduating in Medicine from the Pernambuco College of Health

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is crucial for developing new therapies. Therefore, this research not only adds to scientic knowledge

about childhood allergic conjunctivitis, but also provides valuable insights for clinical practice and

health policy formulation.

Keywords: allergic conjunctivitis, children, inammation, allergens.

INTRODUCTION

Allergic conjunctivitis is a common eye condition that aects children around the world,

characterized by an inammation of the conjunctiva caused by an allergic reaction to substances such

as pollen, dust, mites and animals (Santos, 2018). This eye disease is a manifestation of the immune

system in response to allergens and can cause symptoms such as intense itching, tearing, hyperemia

and foreign body sensation (OLIVEIRA; SILVA, 2020). The prevalence of allergic conjunctivitis has

increased in recent decades, reecting a global tendency for the growth of allergic diseases, possibly

inuenced by environmental factors and lifestyle changes (Cruz et al., 2017).

In childhood, allergic conjunctivitis is not only an eye health problem, but also a condition

that can signicantly aect children’s quality of life. Uncomfortable symptoms may interfere with

school performance, recreational activities and sleep, leading to a negative impact on the general

development of the child (MORAIS; PEREIRA, 2019). In addition, the presence of other allergic

conditions, such as rhinitis and asthma, may aggravate eye symptoms and complicate disease

management (FERREIRA; CARVALHO, 2016). Therefore, understanding the factors that contribute

to allergic conjunctivitis and the development of eective strategies for their management are essential

to improving the quality of life of aected children.

Treatments for allergic conjunctivitis include from simple measures such as frequent eye

washing and allergens preventing medications such as antihistamines, mast cell stabilizers and

topical corticosteroids (Jones et al., 2015). Recently, advances in understanding the immunological

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mechanisms underlying allergic conjunctivitis have enabled the development of new biological

therapies, which aim to modulate the immune response more specically and eectively (Smith;

Brown, 2021). However, adherence to treatment and correct identication of triggering allergens

remain important challenges in the management of the disease.

Despite the various treatment options available, the management of allergic conjunctivitis in

childhood faces signicant challenges, including variability in response to treatment and diculty in

completely avoiding exposure to allergens. In addition, lack of knowledge about the disease between

parents and caregivers can lead to inappropriate management, resulting in frequent recurrences and

additional complications. Given this scenario, the question is: How can we improve the management

of allergic conjunctivitis in children, considering the diversity of environmental and individual factors

that inuence the disease?

The overall objective of this study is to evaluate the management strategies of allergic

conjunctivitis in childhood, focusing on the eectiveness of available treatments and identifying

factors that inuence response to treatment.

Specic objectives:

1. Analyze the eectiveness of dierent treatments available for allergic conjunctivitis in

children.

2. Investigate the inuence of environmental and individual factors on the severity and

recurrence of allergic conjunctivitis.

3. Discuss allergic conjunctivitis and disease management.

This study is of great relevance, as allergic conjunctivitis is a common condition that can

signicantly aect children’s quality of life. As highlighted by Silva and Rodrigues (2019), proper

management of allergic conjunctivitis can prevent complications and improve the well-being of aected

children. In addition, identication of factors that inuence response to treatment can contribute to

the development of more personalized and eective therapeutic approaches.

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Recent literature reinforces the importance of studies in this area. According to Oliveira et al.

(2020), there is an urgent need to improve parents and caregivers’ education on allergic conjunctivitis

to ensure proper disease management. Studies such as Smith and Brown (2021) also point out that

understanding the immunological mechanisms underlying the disease is crucial for the development

of new therapies. Therefore, this research not only contributes to scientic knowledge about allergic

conjunctivitis in childhood, but also provides valuable insights for clinical practice and the formulation

of health policies.

Methodology

This study adopted the narrative review methodology of literature, a qualitative method that

seeks to compile, analyze and critically interpret the existing scientic production on a particular

theme. In the case of allergic conjunctivitis in childhood, narrative review allowed the comprehensive

and detailed view of the dierent aspects of this condition, including their prevalence, symptoms,

risk factors, impact on children’s quality of life and management strategies. The narrative review is

especially useful for topics that cover a body of extensive and diverse literature, where the integration

of dierent theoretical and empirical perspectives is necessary for a holistic understanding of the

problem.

Research sources for this review included online databases widely recognized by the scientic

community. Among these bases are Scielo (Scientic Electronic Library Online), which oers access

to a vast collection of scientic journals in Latin America and the Caribbean, providing an essential

regional perspective on allergic conjunctivitis; Lilacs (Latin American and Caribbean in Health

Sciences), which is one of the most important databases in Latin America, oering a broad coverage

of relevant articles published in scientic journals in the region; and Pubmed (National Library of

Medicine), one of the largest and most comprehensive biomedical databases in the world, which

includes millions of international scientic literature citations, covering clinical, epidemiological

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and basic research aspects of allergic conjunctivitis. The inclusion of these databases ensured a

comprehensive and diverse coverage of the available literature, allowing the incorporation of global

and regional perspectives on the subject.

The selection process of studies followed strict criteria to ensure the relevance and quality

of information included in the review. Initially, searches were performed using keywords such as

“allergic conjunctivitis”, “childhood”, “prevalence”, “treatment” and “quality of life” in Portuguese

and English. The articles were selected based on the relevance to the theme, date of publication

(prioritizing the last ten years) and type of study (including systematic revisions, clinical trials,

observational studies and expert opinion articles). After the initial identication of the articles,

a screening of the summaries was performed to verify the adequacy to the scope of the review,

followed by the full reading of the selected texts for the extraction and detailed analysis of the data.

The adopted methodology allowed a robust and critical synthesis of existing literature on childhood

allergic conjunctivitis, oering valuable insights for clinical practice and future research.

Development

Childhood allergies represent a signicant set of immunological conditions that aect a

growing number of children worldwide. Characterized by exaggerated immunological responses to

normally harmless substances, such as pollen, dust, food and animal hair, allergies can manifest in

various ways, including rhinitis, asthma, atopic dermatitis and allergic conjunctivitis. The prevalence

of these conditions has increased in recent decades, partly due to environmental factors and changes

in life habits. Allergies not only cause physical discomfort, but also negatively impact children’s

quality of life, aecting their school performance, recreational activities and emotional well-being.

Understanding underlying immunological mechanisms and developing eective management

strategies are essential for mitigating the adverse eects of these conditions on childhood.

Allergic conjunctivitis is one of the most common allergic manifestations in children,

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characterized by the inammation of the conjunctiva caused by an immune response to environmental

allergens. This condition causes symptoms such as intense itching, tearing, redness and foreign body

sensation, which can be extremely uncomfortable and aect children’s quality of life. Early identication

and proper management of allergic conjunctivitis are fundamental to prevent complications and

improve the well-being of aected children. In addition to pharmacological treatments, which include

antihistamines, mastocyte and corticosteroid stabilizers, parents and caregivers education about the

disease and their preventive measures play a crucial role in symptom control and reduced allergens

exposure. Thus in this chapter there is allergies in childhood and allergic conjunctivitis in childhood

Childhood allergies

Childhood allergies are a group of immunological conditions that aect a signicant portion

of the pediatric population globally. Characterized by adverse reactions of the immune system to

substances that are generally harmless, such as pollen, mites, foods and animals, these conditions can

manifest in many ways, including asthma, allergic rhinitis, atopic dermatitis and allergic conjunctivitis.

The prevalence of these conditions has increased substantially in recent decades, becoming an

important concern for public health (SILVA et al., 2015). This chapter aims to address various aspects

of allergies in childhood, including epidemiology, diagnosis, pathophysiology and symptoms, with

special focus on therapeutic and management approaches.

The prevalence of allergies in childhood varies widely depending on the geographical region,

socioeconomic factors and lifestyles. Recent studies indicate that about 20% to 30% of children

in developed countries have some kind of allergic condition (SANTOS et al., 2018). In Brazil, for

example, allergic rhinitis aects approximately 25% of children, while asthma prevalence is about

10% (Almeida et al., 2016). These numbers are worrying because childhood allergies are associated

with a series of comorbidities that can signicantly impact the quality of life of aected children and

their families.

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Several risk factors are associated with the development of childhood allergies. Among the

most important are genetic predisposition, early exposure to allergens, environmental pollution and

changes in eating habits (NUNES; LIMA, 2017). Children with family history of allergies have an

increased risk of developing allergic conditions. In addition, urbanization and exposure to pollutants,

such as cigarette smoke and industrial pollutants, have been implicated in the growing prevalence of

allergic diseases in urban areas (MARTINS; OLIVEIRA, 2019).

The pathophysiology of allergies involves a complex immune response that is triggered by

exposure to allergens. This response is mediated by immune system cells, such as Type 2 Type 2

(TH2) lymphocytes, which promote the production of immunoglobulin and (IgE) by B cells. IgE

binds to mastocytes and basophils, resulting in the release of inammatory mediators , like histamine,

leukotrienes and prostaglandins, which cause allergic symptoms (Rodrigues et al., 2020). This

inammatory process can aect various parts of the body, including respiratory tract, skin and eyes.

Symptoms of childhood allergies may vary widely depending on the type of allergen and

exposure pathway. Common symptoms include sneezing, runny nose, eye itching, urticaria, eczema

and, in severe cases, anaphylaxis (Carvalho; Pereira, 2018). The diagnosis is usually based on clinical

history and symptoms presented by the child. Laboratory tests, such as specic IgE dosage and

hypersensitivity cutaneous tests, can be used to conrm the presence of sensitization to specic

allergens (FERNANDES et al., 2017).

Respiratory allergies, including allergic rhinitis and asthma, are some of the most common

manifestations of childhood allergies. Allergic rhinitis is characterized by symptoms such as splashes,

runny nose, nasal congestion, and eye itching, while asthma surrounds chronic airway inammation,

resulting in symptoms such as cough, wheezing and breathing diculty (SOUZA et al., 2016). The

coexistence of these conditions is common and can complicate the clinical management of aected

children.

Atopic dermatitis, or eczema, is another frequent manifestation of childhood allergy,

characterized by chronic skin inammation that causes intense itching, rash and dry skin (GOMES;

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MARTINS, 2017). This condition can have a signicant impact on children’s quality of life, interfering

with sleep, school performance and daily activities. Atopic dermatitis is often associated with other

allergic conditions, such as asthma and allergic rhinitis, in a phenomenon known as atopic march.

Allergic conjunctivitis is an inammation of the ocular conjunctiva caused by an allergic

reaction to allergens such as pollen, mites and hair. Symptoms include itching, tearing, redness

and foreign body sensation (PEREIRA; SILVA, 2018). This condition may occur in isolation or in

association with other allergies, such as allergic rhinitis. The diagnosis is based on clinical history and

symptoms, and can be conrmed by specic allergic tests.

The dierential diagnosis of childhood allergies is crucial to dierentiate these conditions

from other diseases that may have similar symptoms. For example, viral and bacterial respiratory

infections may cause symptoms similar to those of allergic rhinitis, while skin diseases such as psoriasis

and seborrheic dermatitis, may mimic atopic dermatitis (COSTA; ALMEIDA, 2019). Laboratory tests

and detailed clinical history are essential to establish a precise diagnosis and guide proper treatment.

The management of childhood allergies involves a combination of pharmacological

prevention and treatment measures. Prevention includes the identication and avoidance of known

allergens, which can be challenging in urban environments where exposure to pollutants is inevitable

(ALMEIDA et al., 2016). Pharmacological treatment includes the use of antihistamines, corticosteroids,

bronchodilators and specic immunotherapy, depending on the type and severity of allergy (SANTOS

et al., 2018).

Antihistamines are often used as the rst line of treatment for mild to moderate allergies.

They block histamine receptors, reducing the symptoms of itching, sneezing and runny nose. Second-

generation antihistamines, such as loratadine and cetirizine, are preferred due to their safety prole

and lower sedative side eects (MARTINS; OLIVEIRA, 2019). Corticosteroids are eective in

treating serious inammation associated with allergies. They can be administered topically, inhaled

or systemically, depending on the location and severity of symptoms. Although highly eective, their

prolonged use should be monitored due to the risk of adverse eects, such as adrenal suppression and

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osteoporosis (GOMES; MARTINS, 2017).

Specic immunotherapy, also known as desensitization, is a treatment that aims to modify the

immune response to the allergen, providing long -term relief from allergic symptoms. This treatment

involves the administration of increasing doses of the allergen in question, either subcutaneous or

sublingual over a period of time (RODRIGUES et al., 2020). Immunotherapy has shown to be eective

for respiratory allergies and insect bites, with benets that can last years after the end of treatment.

Several barriers can make it dicult for eective treatment of childhood allergies, including

limited access to specialized care, lack of knowledge about disease and economic diculties.

Interventions directed to overcome these barriers, such as public health policies and support programs,

can signicantly improve the clinical results and quality of life of allergic children (COSTA;

ALMEIDA, 2019).

Continuous research on the pathophysiology of allergies and the development of new therapies

promise signicant advances in the management of these conditions. New biological treatments,

which aim at specic components of immune response, are under development and can oer more

eective and safe options for children with severe allergies (PEREIRA; SILVA, 2018). In addition, the

implementation of public health policies focused on prevention and early management of childhood

allergies is essential to reduce the impact of these conditions on society.

Childhood allergies represent a signicant challenge for children, parents and health

professionals. The comprehensive understanding of risk factors, pathophysiology and symptoms

is crucial for precise diagnosis and eective management. The multidisciplinary approach, which

includes education, prevention and personalized treatment, is critical to improving the quality of life

of allergic children. Continuous advances in research and clinical practice oer hope for a future

where childhood allergies can be more eectively controlled, allowing all children to live a healthy

life and without limitations imposed by these chronic conditions.

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Allergic conjunctivitis in childhood

Childhood allergies represent a group of immunological conditions that occur in response to

environmental, food or contact allergens, and have become a growing concern in global public health

(SILVA; RODRIGUES, 2019). Among the various allergic manifestations, allergic conjunctivitis

stands out for its high prevalence and impact on the quality of life of children. This condition is

characterized by an inammation of the conjunctiva, the membrane that covers the surface of the eye

and the inside of the eyelids, and is triggered by an exaggerated immune response to substances such

as pollen, dust, mites and animal hair (Ferreira; Carvalho, 2016).

The prevalence of allergic conjunctivitis in childhood has increased signicantly in recent

decades, following the overall tendency of increased allergic diseases (Cruz et al., 2017). Epidemiological

studies indicate that up to 40% of school -age children may have symptoms of allergic conjunctivitis

at some point in their lives (Smith; Brown, 2021). This elevation in prevalence can be attributed to

several factors, including urbanization, environmental pollution, lifestyle changes and changes in

allergens from early childhood (OLIVEIRA; SILVA, 2020).

The immune response in allergic conjunctivitis involves a complex interaction between

immunological cells and inammatory mediators. Exposure to allergens leads to activation of Type

2 Type 2 (th2) cells, which in turn promote IgE production by B cells. The connection of IgE to

mastocites results in the release of histamine and other inammatory mediators, causing them Classic

symptoms of allergic conjunctivitis such as itching, tearing, hyperemia and conjunctival edema

(MORAIS; PEREIRA, 2019).

Symptoms of allergic conjunctivitis may vary from light to severe and include intense

itching, excessive tearing, ocular redness and foreign body sensation (FERREIRA; CARVALHO,

2016). The diagnosis is usually clinical, based on medical history and symptoms presented by the

child. However, allergic tests, such as specic IgE dosage and hypersensitivity skin tests, may be

useful for identifying the triggering allergens and conrming the diagnosis (SANTOS, 2018).

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Allergic conjunctivitis can signicantly aect children’s quality of life, interfering with daily

activities such as school performance, sports and games, as well as causing physical and emotional

discomfort (Smith; Brown, 2021). The co-occurrence of other allergic conditions, such as rhinitis and

asthma, may aggravate symptoms and complicate disease management (FERREIRA; CARVALHO,

2016).

Treatment of allergic conjunctivitis includes non -pharmacological and pharmacological

measures. Non -pharmacological measures involve reducing exposure to allergens, such as maintaining

dust and mites free environments and the use of air lters. Pharmacological options include topical

and oral antihistamines, mastócitic stabilizers, topical corticosteroids and immunomodulators (Jones

et al., 2015). The choice of treatment should be individualized, considering the severity of symptoms

and response to the previous treatment (OLIVEIRA; SILVA, 2020).

Antihistamines are often the rst line of treatment for allergic conjunctivitis, rapidly acting

on the reduction of ocular itching and redness. These medications block histamine receptors, reducing

the inammatory response (MORAIS; PEREIRA, 2019). Topical antihistamines such as olopatadine

and ketotiphene have been widely used due to their eectiveness and safety prole (Smith; Brown,

2021).

Mastocy stabilizers, such as sodium chromoglycate and laodoxamide, prevent mastocyte

degranulation and the release of inammatory mediators. These medications are eective in preventing

the symptoms of allergic conjunctivitis, but their eect may take a few weeks to manifest, being more

suitable for prophylactic use (Jones et al., 2015).

Topical corticosteroids, such as dexamethasone and lotprednol, are used in cases of severe

or refractory allergic conjunctivitis to conventional treatments. Although eective in reducing

inammation, its use should be cautious due to potential adverse eects, such as increased intraocular

pressure and risk of eye infections (Smith; Brown, 2021).

Immunomodulators, such as cyclosporine and tacrololimus, have emerged as therapeutic

options for allergic conjunctivitis, especially in severe or chronic cases. These drugs modulate the

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immune response, reducing inammation and associated symptoms (OLIVEIRA; SILVA, 2020).

Recent studies have shown the eectiveness of these agents in disease control, with an acceptable

safety prole (MORAIS; PEREIRA, 2019).

The education of parents and caregivers is a crucial component in the management of

allergic conjunctivitis in childhood. Information about the nature of the disease, triggering factors

and preventive measures can help improve symptom control and treatment adherence (SANTOS,

2018). Educational programs and informative materials have shown to be eective in reducing the

exacerbations of the disease and improving the quality of life of children (FERREIRA; CARVALHO,

2016).

Several barriers can make it dicult to treat allergic conjunctivitis, including lack of

knowledge about the disease, diculties in access to specialized care and inadequate adherence to

the therapeutic regime. Studies suggest that interventions aimed at overcoming these barriers, such

as awareness campaigns and support programs, can signicantly improve clinical results (Cruz et al.,

2017).

Continuous research on the pathophysiology of allergic conjunctivitis and the development

of new biological therapies promise signicant advances in disease management. Directed therapies,

which specically modulate components of immune response, are under development and can oer

more eective and safe options for children with allergic conjunctivitis (Smith; Brown, 2021).

Allergic conjunctivitis in childhood is a prevalent condition that requires a multifaceted

approach to its eective management. Understanding immunological mechanisms, early identication

of allergens, and proper use of available therapies is fundamental to symptom control and improving

the quality of life of aected children. In addition, the education of parents and caregivers and

overcoming barriers to treatment are essential components of a comprehensive strategy of disease

management.

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Environmental factors and treatments available for allergic conjunctivitis

Ocular allergy is one of the most common conditions in daily ophthalmological practice.

Inammation of the allergic etiology conjunctiva rarely occurs in isolation and usually occurs together

with the involvement of ocular annexial structures, such as corneal and eyelids, which is why it is

often referred to as “allergic eye disease”.

Allergic conjunctivitis is a common eye condition that is signicantly inuenced by

environmental factors. The incidence of allergic conjunctivitis has increased, which is partially

attributed to the increase in environmental pollution levels. Pollients such as pollen, dust and other air

allergens are the main triggers of allergic conjunctivitis, causing symptoms such as itching, redness

and tearing. Seasonal allergic conjunctivitis, the most prevalent type, is particularly inuenced

by seasonal variations at pollen levels, while perennial allergic conjunctivitis can be triggered by

exposure throughout the year to allergens, such as either either animal hair (Castillo et al. 2015).

In the pathogenesis of this process, mastocytes are involved, which with their disagreement

produce the massive release of histamine and other inammatory substances, although eosinophils,

lymphocytes and neutrophils also acquire great importance. Most ocular allergic processes are

produced by a type I or IgE dependent mechanism, whose response is mediated by mastocytes. The

late phase or type IV allergic response is one that occurs between 6 and 12 hours after contact with

the allergen and depends on the activity of neutrophils and eosinophils. The nal action of these

cells enabled in the target organ consists of vasodilation, increased vascular permeability, leukocyte

chemotaxis, tissue destruction and later, repair of the ocular surface (FERREIRA; CARVALHO,

2016).

From the semiological point of view, the fundamental symptom is itching, although redness,

mosmosis or mucous secretion may also appear. Among therapeutic measures, it acquires great

importance to the reduction of symptoms that aict the patient, for which there is an important

therapeutic arsenal ranging from the classic vasoconstricients, antihistamines or corticosteroids to

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recently introduced medicines, such as new stabilizers of the mast. Cell membrane or other therapeutic

methods not yet fully developed or implemented, such as cyclosporine or plasmapheresis in certain

cases (SILVA; RODRIGUES, 2019).

It is noteworthy the importance of topical pathway over systemic in the treatment of eye

allergic diseases. However, the hygienic support measures that also reduce symptoms and reduce

the risk of superinfections and complications should not be forgotten. These eye allergic diseases are

classied below and their symptoms, diagnosis and treatment are explained (OLIVEIRA; SILVA,

2020).

The mechanism by which eye allergic disease occurs is still unknown. It was classically

described as a type I immediate hypersensitivity reaction or IgE dependent. Today it is known that

there are many other immunological mechanisms involved, because although mastocyte degranulation,

eosinophilic inltration and family history of atopy are found in many ocular allergic diseases, in

other cases there is no such antecedents, high IgE values or absence of Response to antihistamines

and membrane stabilizers. In addition, contact dermativitis represents a classic example of type IV or

delayed reaction (Dudeja et al., 2019, Dara et al., 2022).

The late phase allergic response (which occurs between 6 and 12 hours after contact with the

allergen) depends on the activity of neutrophils and eosinophils. The latter release basic proteins and

peroxidases, among other cytotoxins responsible for tissue damage in allergic conditions. They also

feed on the process as they promote the disagreement of mastocytes, releasing more inammatory

agents. The nal action of all these target organized cells consists of vasodilation, increased vascular

permeability, leukocyte chemotaxis, tissue destruction and subsequent repair of ocular surface tissues

(CHIGBU; COYNE, 2015, Cruz et al., 2017).

Most eye allergic processes are produced by a type i3 hypersensitivity mechanism. When

the antigen to which the patient is sensitized comes into contact with two IgE molecules on the mastic

surface, his disagrail is activated through a calcium -dependent mechanism. This involves the release

of preformed mediators and the activation of the synthesis of new and more powerful mediators.

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Mastocites are primordial cells in allergic response4 and their activation occurs when antigen comes

into contact with two IgE molecules on its surface by triggering degranulation and release of pre-

formed factors from which the most relevant is histamine although there are other factors that are

also also factors that are also activated and actively participate in the inammatory reaction must be

forgotten. Heparin, proteolytic enzymes and metabolites of the arachidonic acid are highlighted. Both

degradation roads are involved in this process, cyclooxygenase and lipoxigenase, so prostaglandins,

leukotrienes and thromboxanos will be produced. Chemotactic substances, as a mediator of preformed

mast cells that attract new mastocytes and eosinophils and platelet activation factor (Smith; Brown,

2021, Jones et al., 2015, Cruz et al., 2017).

Acute allergic conjunctivitis is a sudden onset that aects the eyelids and the conjunctiva

in the form of Blefaroconjunctivitis. This is an immediate reaction of type I after direct contact

with the allergen. It is typically characterized by sudden and very intense itching, accompanied by

the immediate appearance of diuse conjunctival hyperemia, rapidly developing eyelid edema and

eczematosa reaction. In very serious cases, general symptoms such as hypotension, glottis edema and

sometimes cardiac arrhythmias are associated. These last two are especially serious for the risk of

death they cause (Dudeja et al., 2019, Chigbu; Coyne, 2015).

Seasonal allergic conjunctivitis is the most common allergic eye disease and is usually

found in a widespread context of allergies; The most common is rhinoconjunctivitis. We can classify

them in seasonal, when there are recurring episodes of conjunctivitis coincident with pollination, or

chronic, in which signs and symptoms persist permanently. In the latter case, it is also possible to the

presence of acute episodes. It commonly aects young children and adults, often with personal or

family history of atopy. The pathogenic mechanism of this disease is based on the degranulation of

mast cells and basophils that occurs due to a type I hypersensitivity reaction when allergen reaches

the nasal or conjunctival mucosa (MORAIS; PEREIRA, 2019).

The seasonal form occurs recurrently in relation to allergen exposure. The main symptoms

are itching, eyelid edema and conjunctival (milky and swollen aspect of the conjunctive aspect due to

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the presence of edema). It is usually accompanied by nasal symptoms such as rhinorrhea or sneezing.

The most frequent etiopathogenic agents are usually pollen and mites and therefore begin in the

form of crisis in early spring. The chronic form is characterized by the presence of basic symptoms

throughout the year, although it is less pronounced than in seasonal form, and may have exacerbations.

In these patients, the most common allergens are domestic mites (dermatophagoides pteronysimus),

mold, penalties and animal hair. They are more often in winter and a third of these patients, in addition

to eye symptoms, suers from chronic rhinitis (SANTOS, 2018, Ferreira; Carvalho, 2016).

Allergic conjunctivitis, as its etiology indicates, is not contagious, although inappropriate

treatment or excessive eye manipulation favor the superinfection of the process. It is of great importance

to insist with the patient so that it does not rub their eyes despite the itching symptoms they have. In

addition to stimulating histamine secretion and subsequent aggravation of the disease, abrasions and

small injuries may occur in the annexes and even in the eyeball itself. The propagation of pathogens

by hands and the excessive growth of conjunctival bacterial ora are also favored (JONES et al., 2015).

It is advisable to maintain minimal measures of eyelid skin hygiene to control the excessive

growth of conjunctival ora. In most cases, not only the conjunctiva is aected, but also the eyelid in

the form of blepharitis. The skin has eczematous abrasions and reactions as well as dysfunction in the

sebaceous glands. Therefore, it is important to keep it clean from secretions. Hygiene should be careful

using non -abrasive soaps for the skin, and with maneuvers that do not worse your condition. For this,

we will use cleaning products that do not irritate or change skin pH. Currently there are specic

prepared formulas for the gel or lotion eye area. Its dosage is variable: in the lighter forms once a day.

In the most severe cases it is recommended to use two to three times a day, which should always be

done carefully, avoiding any intense mechanical manipulation to avoid the release of histamine and

taking care of the present lesions (SANTOS, 2018, Dudeja et al ., 2019, Dara et al., 2022).

To relieve itching, the instillation of articial tears as needed is advisable; This aims to

achieve two goals: on the one hand, reduce the mechanical manipulation of the eye and, on the other,

clean the surface of the eyeball of allergen, secretions, chemotatic agents released in the tear lm and

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regulate the bacterial ora. so that there is no excessive growth. Traditional or monodose forms can be

used and preservative -free formulas are now preferred, as they have non -negligible irritating power

that worsens symptoms. Moreover, because they do not contain preservatives in their formulation,

they cause less discomfort when instilled and avoid the possibility of allergic reactions derived from

them (Cruz et al., 2017).

The use of cold compresses also produces great relief. The cold, besides having a slight

anesthetic eect, is a stabilizer of the mastic membrane, which reduces the release of histamine.

Traditionally, home-losethouses are used with chamomile compresses, which are not always useful;

In addition to not being sterile forms, where residues may remain, in some cases cross allergies may

occur so that when used symptoms. Ocular baths themselves are widely used to relieve symptoms

or attacks of intense itching. They have the disadvantage of contaminating the container used for

this purpose, so after use should be carefully cleaned with soap and alcohol water and let it dry. This

step is usually ignored, which increases the risk of superinfections. For this reason, it is preferable to

perform irrigations with sterile and preservative saline solutions (Jones et al., 2015).

Topical antihistamines and mastic stabilizers are commonly used to treat allergic

conjunctivitis. These drugs act by inhibiting the action of histamine, a key mediator in allergic

reactions, and stabilizing mastocytes to prevent the release of histamine. Commonly used topical

antihistamines include olopatadine, ketotiphene and oil, while mastic stabilizers include sodium

nedochromil and sodium chromoglycate. Studies have shown that these treatments are eective in

reducing symptoms such as itching, redness and short -term tearing (Castillo et al., 2015, Dudeja et

al., 2019, Dara et al., 2022).

Combined therapies that include antihistamines and mastic stabilizers were considered

particularly eective. For example, olopatadine, which has antihistamine and masto-stabilizer

properties, has shown signicant relief from the symptoms of allergic conjunctivitis. Other combined

treatments include Bepotastin and Alcraftadine, which also have double action and were considered

eective in clinical trials (Dudeja et al., 2019, Chigbu; COYNE, 2015).

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Several studies have compared the eectiveness of dierent topical treatments. For example,

a study comparing olopatadine (0.1%), bepotastin (1.5%) and alkraftadine (0.25%) found that all three

medications were equally eective in resolving mild to moderate allergic conjunctivitis symptoms

with Most patients reporting complete relief after one week of use. Another study in Western Rajhast

also concluded that there was no signicant dierence in the ecacy of olopatadine, bepotastin and

alkaftadine in the treatment of allergic conjunctivitis (Dudeja et al., 2019, Dara et al., 2022).

Environmental, particularly allergen and pollutant factors transported by the air play a

signicant role in the incidence and severity of allergic conjunctivitis. Topical antihistamines and

mast cell stabilizers isolated or in combination are eective treatments to control the symptoms of

allergic conjunctivitis. Comparative studies suggest that more recent drugs with combined actions

of mastocyte and antihistamines stabilization, such as solopatadine, bepotastin and alkoftadine, are

equally eective in symptomatic relief.

Conclusion

Research on the management of allergic conjunctivitis in children highlights the complexity

and the importance of addressing this condition in a multifaceted manner. The results indicate that

while there are several treatment options, from simple preventive measures to advanced biological

therapies, variability in response to treatment and diculty in completely avoiding exposure

to allergens continue to be signicant challenges. The identication of specic allergens and the

education of parents and caregivers are crucial for eective disease management. In addition, research

reinforces that allergic conjunctivitis is not only a matter of eye health, but also a problem that can

negatively impact children’s quality of life, interfering with their school performance, daily activities

and overall well-being. Therefore, eective management strategies should consider not only medical

aspects, but also the social and educational factors that inuence the disease.

Treatment of allergic conjunctivitis involves a range of treatment options, from traditional

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topical antihistamines and mastocyte stabilizers to advanced nanotechnology-based drug

administration systems. Double -acting and corticosteroid agents provide additional therapeutic

benets, while immunotherapy oers a long -term solution for pediatric patients. In progress research

continues to explore new therapeutic targets to improve the management of this common eye condition.

Advances in understanding the immunological mechanisms of allergic conjunctivitis open

new possibilities for the development of more specic and eective therapies. However, to maximize

the benets of these advances, it is essential to ensure adherence to treatment and implementation of

educational programs directed to parents and caregivers. Improvement in the management of allergic

conjunctivitis in children requires an integrated approach that combines eective treatments, adequate

education and prevention strategies. This integrated approach has the potential to signicantly improve

the quality of life of aected children, reduce the frequency and severity of recurrences and contribute

to the development of more personalized and eective clinical practices.

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