Atopic keratoconjunctivitis (AKC) is a complex chronic inflammatory disease of the ocular surface which may lead to visual loss in the most severe forms1.
We present a 12 year-old boy referred to the Allergy outpatients clinic severely afflicted for the last 4 years with persistent AKC, moderate persistent rhinitis and mild persistent asthma. Regretably, despite several therapeutic regimes -including systemic and topical antihistamines, and topical steroids, ciclosporine and tacrolimus- and 2 eye surgeries, the AKC lacked optimal control with a marked impact on the patient´s quality of life (QoL). Diagnostic work-up showed a positive skin prick test (SPT) to house dust mites (Dermatophagoides spp.), a total serum IgE of 313 UI/L and specific serum IgE (kU/l) to D. pteronyssinus: 49.0; D. farinae: 36.7. Lung function test (LFT) were normal and a fractional exhaled nitric oxide (FeNO): 25 ppb. A 4-week subcutaneous dose of omalizumab 300 mg was initiated. Clinical and serological follow-up was observed during the whole protocol.
The AKC showed a rapid clinical improvement only 8 weeks after omalizumab was started, with an expected increase in total serum IgE, and no changes in the LFT or FeNO. No adverse events were observed and by week 12 the patient could be controlled with topical tacrolimus leading to normalization in his QoL.
Omalizumab may be a promising therapeutic agent in severe AKC, especially in those poor or non-responders to conventional drugs. Specific studies are required to evaluate the long-term efficacy and safety of omalizumab in severe ocular allergy.