Case Studies

 Case 4.4 Seasonal allergic conjunctivitis

A 7-year-old boy developed itchy eyes and swollen lids after playing tennis in the garden. Because his mother had hay fever, the boy's symptoms were also presumed to be an allergy to grass pollen. After several episodes of increasing severity, medical help was sought. He was skin tested; a wheal-and-flare reaction appeared 5-15min after prick testing with extracts of grass pollens, cat fur and house dust mite. The speed and nature of the reaction confirmed immediate (type I) hypersensitivity to these antigens, and he was told to try to avoid exposure to high concentrations of grasses in the pollen season. He developed similar reactions the following summer, particularly in June and July; they were sometimes accompanied by sneezing and rhinorrhoea. He was therefore started on prophylactic eye drops containing sodium cromoglycate, which successfully prevented the seasonal allergic conjunctivitis.