Vernal keratoconjunctivitis: Current immunological and clinical evidence and the potential role of omalizumab

Serge Doan; Nikolaos G Papadopoulos; Jason K Lee; Salvatore Leonardi; Sara Manti; Susanne Lau; Carmen Rondon; Vibha Sharma; Uwe Pleyer; Xavier Jaumont; Slawomir B Lazarewicz

doi:10.1016/j.waojou.2023.100788

Vernal keratoconjunctivitis: Current immunological and clinical evidence and the potential role of omalizumab

World Allergy Organ J. 2023 Jun 15;16(6):100788. doi: 10.1016/j.waojou.2023.100788. eCollection 2023 Jun.

Authors

Serge Doan¹, Nikolaos G Papadopoulos^{2

3}, Jason K Lee⁴, Salvatore Leonardi⁵, Sara Manti^{5

6}, Susanne Lau⁷, Carmen Rondon^{8

9}, Vibha Sharma¹⁰, Uwe Pleyer¹¹, Xavier Jaumont¹², Slawomir B Lazarewicz¹²

Affiliations

¹ Ophthalmology Department of Fondation A de Rothschild and Hôpital Bichat, 25-29 Rue Manin, 75019, Paris, France.
² Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece.
³ Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.
⁴ Evidence Based Medical Educator Inc., Toronto Allergy and Asthma Clinic, Toronto, Ontario, Canada.
⁵ Pediatric Respiratory Unit, AOUP "G. Rodolico-San Marco", University of Catania, Catania, Italy.
⁶ Pediatric Unit, Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy.
⁷ Department of Pediatrics, Division of Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
⁸ Allergy Research Group, Instituto de Investigación Biomedica de Malaga (IBIMA)-Plataforma BIONAND.RICORS "Inflammatory Diseases", ARADyAL, Malaga, Spain.
⁹ Allergy Unit, Hospital Regional Universitario de Malaga, Malaga, Spain.
¹⁰ Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK.
¹¹ Department of Ophthalmology, CVK, Charité Universitätsmedizin, Berlin, Germany.
¹² Novartis Pharma AG, Basel, Switzerland.

Abstract

Vernal keratoconjunctivitis (VKC) is a severe ocular allergic disease characterized by chronic inflammation of the cornea and conjunctiva that may lead to loss of visual acuity and blindness. The disease occurs primarily in children and is more common in geographical regions characterized by warm temperatures and high humidity. The clinical manifestations of VKC, when inadequately treated, may lead to severe complications and corneal damage. The prevalence of allergen sensitization, specific serum immunoglobulin E (IgE), and specific tear IgE was reported in approximately 55%-60% of patients with VKC, confirming the involvement of IgE-mediated and non-IgE-mediated mechanisms in the pathophysiology of the condition. This article explores current knowledge on the immunological pathways of VKC and the role of the monoclonal anti-IgE antibody, omalizumab, in its management. The review evaluated the effects of omalizumab beyond the direct IgE-mediated reactions and discusses its potential as a therapeutic target for VKC. Multiple retrospective analyses, case series, and case reports have reported the effectiveness of omalizumab in the management of VKC. A summary of the clinical data from these studies revealed that in children with VKC omalizumab treatment was well tolerated with improvement or resolution of ocular symptoms, reduction in steroid use, and enhancement of quality of life. Omalizumab may serve as a promising treatment option for VKC due to its ability to target both IgE-mediated and non-IgE-mediated pathophysiological pathways. Larger, controlled clinical trials are needed to support these findings.

Keywords: Allergy; Biologics; IgE; Omalizumab; Vernal keratoconjunctivitis.

Publication types

Review