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K.W. McDonald, J.D. Sheppard, Jr.; Omalizumab Decreases Steroid Requirements in Patients with Ocular Allergy . Invest. Ophthalmol. Vis. Sci. 2004;45(13):4847.
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Introduction:Produced by chimeric monoclonal antibody technology, a humanized FC fragment with murine IgE receptor binding sites creates immune complexes obviating activation of mast cell receptors by circulating IgE. This therapy has proven effective in the treatment of steroid dependent asthma. Many patients with severe atopic ocular disease also suffer from asthma as well as abnormally elevated serum IgE levels. Methods:6 patients with severe IgE mediated ocular surface disease, 3 each with atopic blepharokeratoconjunctivitis and vernal keratoconjunctivitis, were treated with subcutaneous omalizumab (Xolair®, Genentech/Novartis) using dosages determined by body weight and total serum IgE. Enrollment requirements included elevated serum RAST titers for at least 1 antigen. Patients were followed for 3 months. Patient history was evaluated for papillary conjunctivitis (conj), corneal findings (corn), topical steroid use (gtts), oral steroid use (PO), asthma symptoms (asthm), change in forced expiratory volume (FEV1), eczema symptoms (eczem), and rhinitis symptoms (rhin). Results:A favorable ocular symptom and slit lamp examination response was noted in all 6 patients. 5 of the 6 were able to significantly reduce systemic steroid requirements. All 6 were able to reduce topical ocular steroid requirements while maintaining reduced ocular symptoms. No systemic adverse effects were noted. FEV––1– significantly improved in 4 patients; 4 patients noted an improvement in eczema; and 4 patients noted an improvement in asthma symptoms.
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