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Atopic Keratoconjunctivitis: Diagnosis and Treatment. CURRENT OPHTHALMOLOGY REPORTS 2022. [DOI: 10.1007/s40135-022-00299-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Fukuda K, Kishimoto T, Sumi T, Yamashiro K, Ebihara N. Biologics for allergy: therapeutic potential for ocular allergic diseases and adverse effects on the eye. Allergol Int 2022; 72:234-244. [PMID: 36333219 DOI: 10.1016/j.alit.2022.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/21/2022] [Accepted: 09/30/2022] [Indexed: 11/28/2022] Open
Abstract
Biologics applying antibodies against IgE, IL-5, IL-5 receptor α, IL-4 receptor α, and IL-13 have dramatically improved recent treatment outcomes in allergic diseases including asthma, rhinitis, and atopic dermatitis. However, these drugs have not been approved for ocular allergic diseases such as allergic conjunctivitis, vernal keratoconjunctivitis, and atopic keratoconjunctivitis. Although the putative mechanisms suggest that these drugs should have beneficial effects in patients with ocular allergies and some studies have reported such beneficial effects, various adverse ocular symptoms have also been observed in clinical trials and off-label use studies. Since ocular allergic diseases have distinct pathogeneses, each biologic drug must be examined regarding specific effects on each ocular allergy. For example, IgE-mediated type 1 hypersensitivity plays a critical role in allergic conjunctivitis. By contrast, T cells and eosinophilic and non-IgE-mediated type 2 inflammation play important roles in vernal keratoconjunctivitis. Allergists must fully understand the effects of each drug on the eye. This review outlines both potential therapeutic and adverse effects of various biologics on allergic diseases of the eye.
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Affiliation(s)
- Ken Fukuda
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Kochi, Japan.
| | - Tatsuma Kishimoto
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Kochi, Japan
| | - Tamaki Sumi
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Kochi, Japan
| | - Kenji Yamashiro
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Kochi, Japan
| | - Nobuyuki Ebihara
- Department of Ophthalmology and Visual Science, Juntendo University Urayasu Hospital, Tokyo, Japan
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Therapeutic Targets in Allergic Conjunctivitis. Pharmaceuticals (Basel) 2022; 15:ph15050547. [PMID: 35631374 PMCID: PMC9147625 DOI: 10.3390/ph15050547] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/18/2022] [Accepted: 04/22/2022] [Indexed: 02/02/2023] Open
Abstract
Allergic conjunctivitis (AC) is a common condition resulting from exposure to allergens such as pollen, animal dander, or mold. It is typically mediated by allergen-induced crosslinking of immunoglobulin E attached to receptors on primed conjunctival mast cells, which results in mast cell degranulation and histamine release, as well as the release of lipid mediators, cytokines, and chemokines. The clinical result is conjunctival hyperemia, tearing, intense itching, and chemosis. Refractory and chronic cases can result in ocular surface complications that may be vision threatening. Patients who experience even mild forms of this disease report an impact on their quality of life. Current treatment options range from non-pharmacologic therapies to ocular and systemic options. However, to adequately control AC, the use of multiple agents is often required. As such, a precise understanding of the immune mechanisms responsible for this ocular surface inflammation is needed to support ongoing research for potential therapeutic targets such as chemokine receptors, cytokine receptors, non-receptor tyrosine kinases, and integrins. This review utilized several published articles regarding the current therapeutic options to treat AC, as well as the pathological and immune mechanisms relevant to AC. This review will also focus on cellular and molecular targets in AC, with particular emphasis on potential therapeutic agents that can attenuate the pathology and immune mechanisms driven by cells, receptors, and molecules that participate in the immunopathogenesis and immunopathology of AC.
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Kırıkkaya E, Değirmenci P. Effects of omalizumab on allergic conjunctivitis. Int Ophthalmol 2021; 42:167-175. [PMID: 34426862 DOI: 10.1007/s10792-021-02010-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 08/13/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the effect of subcutaneous omalizumab therapy on the allergic conjunctivitis symptoms of patients being treated for asthma. METHODS A total of 84 eyes of 42 patients who were receiving subcutaneous omalizumab therapy for asthma and complained of allergic conjunctivitis symptoms underwent complete ophthalmic examination. All of the patients were graded according to signs and symptoms and duration of symptoms, evaluated using an ocular severity index (SI) and quality of life questionnaires. Immunoglobulin E (IgE) levels and both initial and final %FEV1 (forced expiratory volume in the first second) values were also evaluated. p values < 0.05 were accepted as statistically significant. RESULTS The study included 36 women (85.7%) and 6 men (14.3%) with a mean age of 54.5 ± 10.8 years. The mean duration of omalizumab therapy was 46 ± 30.9 months. There were statistically significant changes between initial and final values for ocular SI, quality of life, subjective symptom frequency and severity and %FEV1. Final values of SI, quality of life, and symptom severity and frequency were statistically significantly lower compared to initial values, while final %FEV1 was statistically significantly higher compared to initial value (p < 0.001). CONCLUSION Omalizumab therapy for asthma had a favorable effect on the patients' allergic conjunctivitis symptoms and decreased parameters related to ocular disease severity, improved quality of life and increased %FEV1values. TRIAL REGISTRATION NUMBER 2019/5-5, Trial Registration Date: 28/03/2019, Retrospectively registered.
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Affiliation(s)
- E Kırıkkaya
- Department of Ophthalmology, Health Sciences University İzmir Tepecik Training and Research Hospital, Gaziler Street, Konak, Izmir, Turkey.
| | - P Değirmenci
- Department of Allergy and Immunology, Health Sciences University İzmir Tepecik Training and Research Hospital, Izmir, Turkey
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Chigbu DI, Labib BA. Immunopharmacology in Vernal Keratoconjunctivitis: Current and Future Perspectives. Pharmaceuticals (Basel) 2021; 14:ph14070658. [PMID: 34358085 PMCID: PMC8308551 DOI: 10.3390/ph14070658] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/24/2021] [Accepted: 06/29/2021] [Indexed: 12/27/2022] Open
Abstract
Vernal keratoconjunctivitis (VKC) is a complex and chronic, multifactorial Th2 cell-mediated chronic ocular surface inflammatory condition that typically affects predominantly male children in hot or warm climates. The primary symptom is intense ocular pruritus, often significant enough to affect activities of daily living. Clinical features differ from simple forms of allergic conjunctivitis in that they are more-or-less confined to the superior tarsus and limbus. There is also a risk of corneal involvement, which leads to irreversible vision loss in approximately 6% of patients. Right now, there is no standardized treatment protocol, and many of the currently available options are not effective in severe and recurrent cases. As such, it is imperative to understand this complex allergic immune response in order to identify future therapeutic targets. This review will focus on potential drug targets in VKC, with particular emphasis on immunomodulators and immunobiologic agents.
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Singh RB, Liu L, Yung A, Anchouche S, Mittal SK, Blanco T, Dohlman TH, Yin J, Dana R. Ocular redness - II: Progress in development of therapeutics for the management of conjunctival hyperemia. Ocul Surf 2021; 21:66-77. [PMID: 34000363 DOI: 10.1016/j.jtos.2021.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 11/30/2022]
Abstract
Conjunctival hyperemia is one of the most common causes for visits to primary care physicians, optometrists, ophthalmologists, and emergency rooms. Despite its high incidence, the treatment options for patients with conjunctival hyperemia are restricted to over-the-counter drugs that provide symptomatic relief due to short duration of action, tachyphylaxis and rebound redness. As our understanding of the immunopathological pathways causing conjunctival hyperemia expands, newer therapeutic targets are being discovered. These insights have also contributed to the development of animal models for mimicking the pathogenic changes in microvasculature causing hyperemia. Furthermore, this progress has catalyzed the development of novel therapeutics that provide efficacious, long-term relief from conjunctival hyperemia with minimal adverse effects.
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Affiliation(s)
- Rohan Bir Singh
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Lingjia Liu
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Ann Yung
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Sonia Anchouche
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sharad K Mittal
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Tomas Blanco
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Thomas H Dohlman
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Jia Yin
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Reza Dana
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
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Rodrigues J, Kuruvilla ME, Vanijcharoenkarn K, Patel N, Hom MM, Wallace DV. The spectrum of allergic ocular diseases. Ann Allergy Asthma Immunol 2020; 126:240-254. [PMID: 33276116 DOI: 10.1016/j.anai.2020.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The purpose of this article is to review the pathophysiologic mechanisms, differential diagnosis, evaluation, and treatment of the various manifestations of ocular allergy, with an especial focus on immunoglobulin E (IgE)-mediated disease. DATA SOURCES A PubMed search was performed to include articles, using the search terms ocular allergy and allergic conjunctivitis. STUDY SELECTIONS Recent and relevant human studies in the English language pertaining to our topic of study were selected. Animal studies pertaining to pathophysiology of ocular allergy were also reviewed. We focused on clinical trials, practice guidelines, reviews, and systematic reviews. In addition, case reports were reviewed if they described rare clinical presentations, disease mechanisms, or novel therapies. RESULTS Ocular allergy encompasses both IgE- and non-IgE-mediated disease, and the clinical severity may range from mild to sight-threatening inflammation. A comprehensive treatment regimen including education, lifestyle measures, topical therapies, and even systemic interventions may be necessary for the effective management of ocular allergies, tailored according to symptom severity. CONCLUSION Ocular allergy is frequently encountered by allergists and eye-care specialists, and despite progressively increasing incidence, it often remains underdiagnosed and, hence, untreated.
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Affiliation(s)
- Jonathan Rodrigues
- Allergy & Immunology, Sanford Health, Bismarck, North Dakota; Department of Internal Medicine and Department of Pediatrics, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota.
| | - Merin E Kuruvilla
- Division of Pulmonary, Allergy, Critical Care, and Sleep, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Kristine Vanijcharoenkarn
- Division of Pulmonary, Allergy, Critical Care, and Sleep, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Nikki Patel
- Allergy & Immunology, Sanford Health, Sioux Falls, South Dakota
| | | | - Dana V Wallace
- Allergy and Immunology, Nova Southeastern University, Davie, Florida
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Kim SE, Nowak V, Quartilho A, Larkin F, Hingorani M, Tuft S, Dahlmann-Noor A. Systemic interventions for severe atopic and vernal keratoconjunctivitis in children and young people up to the age of 16 years. Cochrane Database Syst Rev 2020; 10:CD013298. [PMID: 33084033 PMCID: PMC8078190 DOI: 10.1002/14651858.cd013298.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Atopic keratoconjunctivitis (AKC) and vernal keratoconjunctivitis (VKC) are severe and potentially sight-threatening allergic eye diseases characterised by chronic inflammation of the ocular surface. Both topical and systemic treatments are used. This Cochrane Review focuses on systemic treatments. OBJECTIVES To assess the effects of systemic treatments (including corticosteroids, NSAIDS, immunomodulators, and monoclonal antibodies), alone or in combination, compared to placebo or other systemic or topical treatment, for severe AKC and VKC in children and young people up to the age of 16 years. SEARCH METHODS We searched CENTRAL, Ovid MEDLINE, Ovid Embase, the ISRCTN registry, ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). There were no restrictions to language or year of publication. We last searched the electronic databases on 17 February 2020. SELECTION CRITERIA We searched for randomised controlled trials (RCTs) that involved systemic treatments in children aged up to 16 years with a clinical diagnosis of AKC or VKC. We planned to include studies that evaluated a single systemic medication versus placebo, and studies that compared two or multiple active treatments. DATA COLLECTION AND ANALYSIS We used standard methods expected by Cochrane. MAIN RESULTS No trial met the inclusion criteria of this Cochrane Review. No RCTs have been carried out on this topic. AUTHORS' CONCLUSIONS There is currently no evidence from randomised controlled trials regarding the safety and efficacy of systemic treatments for VKC and AKC. Trials are required to test efficacy and safety of current and future treatments. Outcome measures need to be developed which can capture both objective clinical and patient-reported aspects of the condition and treatments.
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Affiliation(s)
| | | | - Ana Quartilho
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Frank Larkin
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Stephen Tuft
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Annegret Dahlmann-Noor
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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The allergic eye: recommendations about pharmacotherapy and recent therapeutic agents. Curr Opin Allergy Clin Immunol 2020; 20:414-420. [PMID: 32558665 DOI: 10.1097/aci.0000000000000669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Ocular allergies affect an estimated 40% of the population, 98% of which are because of allergic conjunctivitis. With the current advent of both repurposed drugs for ocular allergies, as well as novel drugs and methods of administration, there is a need for an updated review of current available medications. A clear characterization of each treatment will ultimately allow treating physicians to restore patients' quality of life and decrease burden of disease. RECENT FINDINGS Currently, there are a number of reformulated antihistamines, with cetrizine being the most recent ophthalmic solution available. Nevertheless, there is ongoing research in the field of immunotherapy, steroids, flavonoids, cannabis, and drug-delivery systems. SUMMARY Although dual-activity agents remain the keystone for treatment, newer drugs and drug-delivery systems offer other novel directions for delivering appropriate relief with minimal adverse effects.
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Dupuis P, Prokopich CL, Hynes A, Kim H. A contemporary look at allergic conjunctivitis. Allergy Asthma Clin Immunol 2020; 16:5. [PMID: 31993069 PMCID: PMC6975089 DOI: 10.1186/s13223-020-0403-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/09/2020] [Indexed: 01/16/2023] Open
Abstract
Allergic eye disease is common, yet often overlooked in North America. In the U.S., up to 40% of the population is deemed to be affected and this number is growing. Symptoms and signs of ocular allergy can lead to decreased productivity and negatively impact quality of life (QoL). Various treatment options exist to achieve symptom control. For allergic conjunctivitis, ophthalmic agents include antihistamines, mast cell stabilizers, dual-activity agents, nonsteroidal anti-inflammatory drugs (NSAIDs), steroids and some off-label treatments. Immunotherapy is recommended as a therapeutic option. This review provides a summary of the forms of ocular allergies, with a focus on symptoms and signs, impact on QoL, physical examination, diagnosis and therapeutic options of allergic conjunctivitis. Through multidisciplinary collaborations, a simplified algorithm for the treatment of allergic conjunctivitis is proposed for Canadian clinical practice.
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Affiliation(s)
- Pascale Dupuis
- 1Division of Clinical Immunology and Allergy, Department of Medicine, St. Joseph's Hospital, Western University, Room B3-102, 268 Grosvenor Street, London, ON N6A 4V2 Canada
| | - C Lisa Prokopich
- 2School of Optometry & Vision Science, University of Waterloo, 200 Columbia St W., Waterloo, ON N2L 3G1 Canada
| | | | - Harold Kim
- 1Division of Clinical Immunology and Allergy, Department of Medicine, St. Joseph's Hospital, Western University, Room B3-102, 268 Grosvenor Street, London, ON N6A 4V2 Canada.,4Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University Health Sciences Centre, 1280 Main St. W., Hamilton, ON L8S 4K1 Canada
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Management of advanced ocular surface disease in patients with severe atopic keratoconjunctivitis. Ocul Surf 2019; 17:303-309. [DOI: 10.1016/j.jtos.2018.12.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 11/08/2018] [Accepted: 12/03/2018] [Indexed: 12/15/2022]
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Abstract
PURPOSE OF REVIEW The purpose of this article is to review treatment advances in ocular allergy that include the treatment of the various signs and symptoms of the allergic inflammatory response of the ocular surface. RECENT FINDINGS Recent studies have demonstrated improved pharmacological effect of topical agents with artificial tears and cold compresses; brimonidine, a new ophthalmic decongestant which has demonstrated decreased rebound conjunctivitis; and potential use of contact lens and other novel delivery instruments to increase medication retention time. Currently, there have been limited advances in novel ophthalmic treatments. Non-pharmacological interventions have demonstrated in a randomized control study that artificial tears and the use cold compresses alone or in combination with ophthalmic antihistamines can enhance the effectiveness of a traditional pharmacological therapy. The primary advances have been the start of head-to-head studies comparing various agents actively being used in the treatment of ocular allergy. In addition, there has been increasing interest in the development of novel delivery systems to increase residence time of pharmacological agents in the ocular surface such as nanoparticles, microfilms; examining novel pathways of controlling the allergic inflammatory response of the ocular surface such as modulation of cytokines, transcription factors, and immunophilins.
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Affiliation(s)
- Leonard Bielory
- Department of Medicine and Ophthalmology, Hackensack Meridian School of Medicine at Seton Hall University, Nutley, NJ, USA.
- Department of Medicine, Thomas Jefferson University Sidney Kimmel School of Medicine, Philadelphia, PA, USA.
- Rutgers University Center of Environmental Prediction, New Brunswick, NJ, USA.
- , Springfield, USA.
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Simpson RS, Lee JK. Omalizumab as single-dose therapy for vernal keratoconjunctivitis. Ann Allergy Asthma Immunol 2018; 122:119-120. [PMID: 30243989 DOI: 10.1016/j.anai.2018.09.458] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/16/2018] [Accepted: 09/17/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Rachel S Simpson
- Division of Life Sciences, Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada; Evidence Based Medical Educator Inc, Toronto, Ontario, Canada.
| | - Jason K Lee
- Evidence Based Medical Educator Inc, Toronto, Ontario, Canada; Canadian Society of Allergy and Clinical Immunology, Orleans, Ontario, Canada
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Jongkhajornpong P, Laisuan W. Successful Subcutaneous Allergen-Specific Immunotherapy in Refractory Atopic Keratoconjunctivitis: A Case Report. Case Rep Ophthalmol 2018; 8:562-567. [PMID: 29422859 PMCID: PMC5803704 DOI: 10.1159/000485174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 11/13/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose We report a case of refractory atopic keratoconjunctivitis (AKC) which was successfully treated with subcutaneous immunotherapy (SCIT). Case Report A 22-year-old woman presented with severe allergic conjunctivitis for one and a half year. She failed to respond to conventional topical anti-allergic medications, topical corticosteroid, as well as topical cyclosporine A. Therefore, oral corticosteroids had to be prescribed to control the exacerbation for 1 year. Due to refractory AKC and to avoid long-term corticosteroid use, we referred her to an allergy clinic for considering the role of SCIT. Allergology investigations showed positive skin prick test and strongly elevated serum-specific IgE to Dermatophagoides farinae (Der f) and Dermatophagoides pteronyssinus (Der p). She received a conventional protocol of SCIT using Der f and Der p allergen extracts. Results The patient's ocular signs and symptoms were dramatically improved 2 months after the initiation of SCIT, and oral corticosteroids could be discontinued within 3 months of the treatment. She was maintained with mast cell stabilizers and preservative-free tears without any episodes of exacerbation. Conclusions SCIT may contribute to successful outcomes in controlling symptoms and preventing exacerbation in AKC patient. It should be considered as an alternative or even a primary treatment for patients with refractory AKC. However, the optimal SCIT protocol must be discussed with an allergist on an individual basis for the best outcome.
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Affiliation(s)
- Passara Jongkhajornpong
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wannada Laisuan
- Division of Allergy, Immunology, and Rheumatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Paik J, Batta P. Management of Ocular Surface Allergic Diseases. OCULAR SURFACE DISEASE 2018:93-108. [DOI: 10.1007/978-3-319-15823-5_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
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Doan S, Amat F, Gabison E, Saf S, Cochereau I, Just J. Omalizumab in Severe Refractory Vernal Keratoconjunctivitis in Children: Case Series and Review of the Literature. Ophthalmol Ther 2016; 6:195-206. [PMID: 27909980 PMCID: PMC5449293 DOI: 10.1007/s40123-016-0074-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Indexed: 12/27/2022] Open
Abstract
Introduction Vernal keratoconjunctivis (VKC) is a severe form of pediatric ocular allergy, characterized by acute and chronic corneoconjunctival inflammation that may lead to visual sequelae. Although topical immunosuppressive drugs such as cyclosporine are usually effective, some severe forms may be refractory and require prolonged steroid therapy. Very few papers report the use of omalizumab in VKC in the literature. In the present study, we describe our clinical experience with omalizumab in severe VKC children. Methods We retrospectively reviewed the files of four boys treated with omalizumab because of severe VKC, defined as persistent corneal inflammation despite continuous topical 2% cyclosporine and steroid eye drops. We also performed a literature review. Results Four boys, aged 7–13 years old, were treated. All children had asthma and one had severe lid eczema. Two patients had required intrapalpebral depot-steroid injections. Omalizumab was administered every 2 weeks by subcutaneous injections, at doses varying from 450 to 600 mg per injection. Three patients out of four responded to the treatment, with a decrease in global symptoms (median symptom rating decreasing from 89 to 29 on a 100-mm visual analog scale), frequency and in duration of the inflammatory flares, and also a decreased need for topical steroid. Their median clinical grade decreased from 4 to 3 (Bonini grading). However, the response was incomplete and they still had inflammatory corneoconjunctival flares despite continuous topical cyclosporine. On the other hand, asthma and lid eczema were completely controlled in these three patients. The fourth child did not respond to omalizumab and needed oral steroids for his VKC and his asthma. Noticeably, this latter patient did not have detectable sensitization to any allergen, contrary to the other cases. The treatment was stopped in this refractory case, but is still ongoing in all other cases, with a median duration of 33 months (range 16–42 months). In the literature (four cases), omalizumab may have a more complete efficacy in some cases, but the results are still variable. Conclusion Omalizumab is an interesting treatment in severe refractory forms of VKC, but its efficacy is incomplete in these very severe cases.
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Affiliation(s)
- Serge Doan
- Ophthalmology Department of Fondation A de Rothschild and Hôpital Bichat, Paris, France. .,Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
| | - Flore Amat
- APHP-Hôpital Armand Trousseau, Centre de l'asthme et des allergies, Paris, France.,Université Pierre et Marie Curie, Paris, France.,Equipe EPAR, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR_S1136, INSERM, Paris, France
| | - Eric Gabison
- Ophthalmology Department of Fondation A de Rothschild and Hôpital Bichat, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Sarah Saf
- APHP-Hôpital Armand Trousseau, Centre de l'asthme et des allergies, Paris, France.,Université Pierre et Marie Curie, Paris, France.,Equipe EPAR, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR_S1136, INSERM, Paris, France
| | - Isabelle Cochereau
- Ophthalmology Department of Fondation A de Rothschild and Hôpital Bichat, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Jocelyne Just
- APHP-Hôpital Armand Trousseau, Centre de l'asthme et des allergies, Paris, France.,Université Pierre et Marie Curie, Paris, France.,Equipe EPAR, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR_S1136, INSERM, Paris, France
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Pradère P, Garcia G, Humbert M, Aubier M, Taillé C. [Omalizumab: What have we learned after ten years of prescription?]. Rev Mal Respir 2015; 33:117-27. [PMID: 26346415 DOI: 10.1016/j.rmr.2015.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/26/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Omalizumab, an anti-immunoglobulin E monoclonal antibody, has now been used for ten years as an add-on therapy for severe adult atopic asthma, poorly controlled by high-doses inhaled steroids and long-acting beta-agonists. BACKGROUND This innovative therapy has been the first biotherapy used on a large scale in severe asthma. It has shown clinical benefits, especially in the prevention of severe exacerbation, with a satisfactory safety profile. Despite its cost, it is an interesting alternative to continuous oral steroids, which cause more long-term side effects. PERSPECTIVES After ten-years of prescription of omalizumab, we review here the mechanism of action, the benefits, the main side effects, the cost-effectiveness and also the alternative indications of this interesting molecule. We also consider the practicalities of using omalizumab, particularly the importance a rigorous assessment of its efficacy after 16 weeks of treatment, and possible future therapeutic indications. CONCLUSION Omalizumab has proven its efficacy in large randomized studies but also in real life practice in severe allergic asthma.
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Affiliation(s)
- P Pradère
- Service de pneumologie, centre de compétence pour les maladies pulmonaires rares, université Paris Diderot, hôpital Bichat, AP-HP, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
| | - G Garcia
- Service de pneumologie, université Paris-Sud, hôpital de Bicêtre, AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - M Humbert
- Service de pneumologie, université Paris-Sud, hôpital de Bicêtre, AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - M Aubier
- Service de pneumologie, centre de compétence pour les maladies pulmonaires rares, université Paris Diderot, hôpital Bichat, AP-HP, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
| | - C Taillé
- Service de pneumologie, centre de compétence pour les maladies pulmonaires rares, université Paris Diderot, hôpital Bichat, AP-HP, 46, rue Henri-Huchard, 75877 Paris cedex 18, France.
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Occasi F, Zicari AM, Petrarca L, Nebbioso M, Salvatori G, Duse M. Vernal Keratoconjunctivitis and immune-mediated diseases: One unique way to symptom control? Pediatr Allergy Immunol 2015; 26:289-291. [PMID: 25692810 DOI: 10.1111/pai.12350] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Francesca Occasi
- Department of Pediatrics, Policlinico Umberto I -'Sapienza' University of Rome, Rome, Italy
| | - Anna Maria Zicari
- Department of Pediatrics, Policlinico Umberto I -'Sapienza' University of Rome, Rome, Italy
| | - Laura Petrarca
- Department of Pediatrics, Policlinico Umberto I -'Sapienza' University of Rome, Rome, Italy
| | - Marcella Nebbioso
- Department of Sense Organs, Policlinico Umberto I -'Sapienza' University of Rome, Rome, Italy
| | - Guglielmo Salvatori
- Department of Medical and Surgical Neonatology, 'Bambino Gesù' Children's Hospital, Rome, Italy
| | - Marzia Duse
- Department of Pediatrics, Policlinico Umberto I -'Sapienza' University of Rome, Rome, Italy
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Incorvaia C, Mauro M, Russello M, Formigoni C, Riario-Sforza GG, Ridolo E. Omalizumab, an anti-immunoglobulin E antibody: state of the art. Drug Des Devel Ther 2014; 8:197-207. [PMID: 24532966 PMCID: PMC3923619 DOI: 10.2147/dddt.s49409] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A large number of trials show that the anti-immunoglobulin (Ig) E antibody omalizumab is very effective in patients with severe allergic asthma. This is acknowledged in consensus documents. The drug also has a good safety profile and a pharmacoeconomic advantage due to a reduction in the number of hospitalizations for asthma attacks. In recent years, some studies have shown that omalizumab is effective also in nonallergic asthma. Effects on the complex signaling mechanisms leading to activation of effector cells and to mediator release may account for this outcome. Indeed, omalizumab has been reported to be effective in a number of IgE-mediated and non-IgE-mediated disorders. Concerning the former, clinical efficacy has been observed in rhinitis, allergic bronchopulmonary aspergillosis, latex allergy, atopic dermatitis, allergic urticaria, and anaphylaxis. In addition, omalizumab has been demonstrated to be able to prevent systemic reactions to allergen immunotherapy, thus enabling completion of treatment in patients who otherwise would have to stop it. Concerning non-IgE-mediated disorders, omalizumab has been reported to be effective in nasal polyposis, autoimmune urticaria, chronic idiopathic urticaria, physical urticaria, idiopathic angioedema, and mastocytosis. Current indications for treatment with omalizumab are confined to severe allergic asthma. Consequently, any other prescription can only be off-label. However, it is reasonable to expect that the use of omalizumab will be approved for particularly important indications, such as anaphylaxis, in the near future.
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Affiliation(s)
- Cristoforo Incorvaia
- Allergy/Pulmonary Rehabilitation, Istituti Clinici di Perfezionamento Hospital, Milan, Italy
| | | | | | | | | | - Erminia Ridolo
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
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