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P.B. Williams, D.J. Simon, J.D. Sheppard, Jr, F.A. Lattanzio, Jr; Omalizumab Improves Symptoms of Severe Ocular Allergy . Invest. Ophthalmol. Vis. Sci. 2005;46(13):942.
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Purpose: The recently FDA approved asthma drug, omalizumab (XolairTM), shows promise in relieving allergy symptoms. Omalizumab is a humanized FC fragment with murine IgE receptor binding sites. It forms IgE immune complexes, which interrupt the immune response cascade that causes allergic symptoms. This project examines the relationship between IgE levels, RAST titers, and systemic clinical response in patients with severe ocular allergic conjunctivitis. Methods: Inclusion criteria included elevated IgE and serum RAST titers for at least one antigen and symptoms consistent with allergic conjunctivitis. Patients were evaluated for ocular allergic symptoms, topical and oral steroid use, FEV1, and systemic allergic symptoms (asthma, eczema, rhinitis, itchy or watery eyes, hives, sneezing, and coughing). The patients periodically graded their allergic symptoms for each symptom on a scale of 0–10 (10 being most severe) and a cumulative score was calculated such that the most severe allergy symptoms would receive a score of 80. Omalizumab was administered subcutaneously 1–2 times per month with dose based on weight and total serum IgE. Each visit included an interval history and slit lamp exam (SLE), with additional attention to systemic allergic symptoms. Results: Omalizumab requires from 1–3 months to show effect. Patients with the highest serum levels of IgE had the highest cumulative allergy score (CAS) at baseline prior to treatment (range 25 – 51). Those same patients with the highest levels of IgE showed the most dramatic decrease in CAS (range 4 – 25) with a particularly striking improvement in ocular and upper respiratory symptoms and SLE findings. There was also a trend toward decreased dependence on ophthalmic topical steroids. Conclusions: Preliminary data indicates that in patients with marked serum IgE elevation, omalizumab shows a proportionate clinical response when compared to patients with lower serum IgE levels. Drugs with this novel mechanism show promise for severe ocular surface allergic disease, atopic keratoconjunctivitis, and concomitant systemic allergic morbidity.
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