Omalizumab: for severe ocular allergy

Abstract

Identify the efficacy of Omalizumab in severe atopic and vernal ketatoconjunctivitis (AKC e VKC). Four pediatric patients with severe refractory allergic keratoconjunctivits were selected and received Omalizumab 300mg once a month for at least 6 months. Ocular symptoms need for medication and use of topical steroids were analyzed before and after the treatment. −Patient 1: Severe AKC, IgE of > 2000 UI/mL and skin prick test for Dermatophagoides pteronyssinus(Dp) 7x7mm wheal. Improve of pruritus and conjunctival hyperemia after the first dose of Omalizumab; however, after the 2nd dose there was worsening of the pruritus and increased ocular secretion. After the 6thdose the drug was discontinued for treatment failure.−Patient 2: Had increase intraocular pressure due to chronic use of topical steroids; IgE of 488UI/mL and no sensitization to any aeroallergns. The VKC symptoms of pruritus, lacrimation, photophobia and conjuctival hyperemia improved after the first dose, and he remained asymptomatic thereafter up to one year.−Patient 3: Showed significant improvement of symptoms and resolution of corneal ulcers. After 3-month ocular symptoms of AKC returned. The treatment was discontinued after 6 months. Serum IgE of 996 UI/mL and 8x8mm wheal in skin prick test for Dp.−Patient 4: Showed no improvement of AKC after 6 doses of Omalizumab 300mg, and after 6 months, the treatment was discontinued. Serum IgE 171 UI/mL and skin prick test positive for Dp (8x8mm) and Blomia(4x4mm). Omalizumab should be tried as a therapy for severe and refractory conjunctivitis. Of the 4 patients evaluated, one VKC presented complete response to the treatment, two had partial remission of symptoms, and one AKC did not remit with omalizumab. The best patient profile and treatment regimen are yet to be determined. Controlled studies are needed in the future.