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Serge Doan, Flore Amat, Eric E Gabison, isabelle cochereau, Jocelyne Just; Experience with the monoclonal anti IgE antibody Omalizumab in severe refractory vernal keratoconjunctivitis in children. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4885.
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© ARVO (1962-2015); The Authors (2016-present)
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. Omalizumab is a monoclonal anti IgE antibody, administered systematically and authorized for severe asthma. We report our clinical experience with omalizumab in severe VKC children.
We retrospectively reviewed the files of 4 boys treated with omalizumab because of severe VKC, defined as persistent corneal inflammation despite continuous topical 2% cyclosporine and steroid eye drops.
Four boys, aged 7 to 13 years old, were treated. All children had asthma and 1 had severe lid eczema. Two patients had required supratarsal 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 4 responded to the treatment, with a decrease in frequency and in duration of the inflammatory flares, and also a decreased need for topical steroid. 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 3 patients. The fourth child did not respond to o and needed oral steroids for his VKC and his asthma. Noticeably, this 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 16 months (range, 6 to 26 months).
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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