Clinical expression of AKC involves conjunctiva, eyelids and cornea, with a wide spectrum of symptoms such as intense itching, tearing and redness. In the most severe forms, corneal damage can lead to visual loss.1
AKC is a complex chronic inflammatory disease of the ocular surface. Frequent association with other allergic manifestations, high serum and tear IgE levels, and presence of positive FCR1-mast cells in the conjunctiva suggest that the disease is mediated by immediate hypersensitivity. Both conjunctival epithelial cells and inflammatory cells infiltrating conjunctival tissues (eosinophils, T lymphocytes, mast cells, basophils) are responsible for the secretion of both Th1 and Th2 cytokines that induce progressive remodelling of the conjunctival connective tissue, leading to mucus metaplasia, conjunctival thickening, neovascularisation and scarring, responsible for the corneal complications of the disease.2
Topical antihistamines combined with mast cell stabilisers are the cornerstone of the ocular allergy treatment, but more aggressive treatments such as topical or systemic immunosuppressive drugs (steroids, tacrolimus, ciclosporin A) may be required in the most severe forms. However, such treatments may have serious side effects. Omalizumab, a monoclonal anti-IgE antibody, is successfully used for the treatment of persistent atopic asthma,3
with few side effects. Omalizumab has also shown beneficial effects in other IgE-mediated diseases, such as atopic dermatitis, urticaria, eosinophil-associated gastrointestinal diseases and seasonal rhinoconjunctivitis.4
The costs of the treatment do not support the use of omalizumab for ordinary allergic rhinoconjunctivitis, but its use has been proposed for the treatment of severe ocular allergy,5
despite no clinical data at this time being available, except for an unpublished series of six patients.6
This observation suggests that omalizumab may be a good option for the treatment of severe AKC, especially to avoid side effects of immunosuppressive treatments. Specific trials should be designed for allergic eye diseases.
- AKC, in the most severe forms, can lead to visual and social handicap.
- AKC is a complex chronic inflammatory disease of the ocular surface, associated with local IgE production and features for immediate hypersensitivity.
- Omalizumab may be a good option for the treatment of severe AKC.