360 Effects of Omalizumab in Children with Atopic Keratocojunctivitis: A New Treatment for Severe Ocular Allergies?—Report of Two Cases

BACKGROUND: Keratoconjunctivitis is a severe form of ocular allergy, difficult to control and with poor prognosis. The purpose of this study was to verify the clinical efficacy of humanized monoclonal antibody omalizumab treatment in children with this condition. METHODS: Report of 2 cases of children with severe vernal keratoconjunctivitis poorly controlled by the conventional therapeutic scheme that were submitted to treatment with Omalizumab. The disease was scored according to the severity by ophthalmologic evaluation (amount of viscous mucus, giant papillae >1 mm, aspect of cornea/keratitis) and graduation of allergic symptons (itching, tearing, photophobia), before and after the last subcutaneous administration of Omalizumab. Evaluation by Parents/ guardians using the same score, regarding to itchy eyes, runny eyes and photophobia, after Omalizumab application, was also requested. RESULTS: Case 1: MPOS (7 years) with vernal keratoconjunctivitis and atopic dermatitis since childhood, both with progressive severity. Recalcitrant ocular itching and photophobia, in addition had other atopic conditions such as mild asthma, rhinitis and egg allergy. Total IgE = 1323 IU/mL. Ocular manifestations poorly controlled with topical use of antihistamines, cromolyn, tacrolimus and cyclosporine. The use of topical corticosteroids was frequent, but resulted in brief improvement. Case 2: HCS (6 years) with vernal keratoconjunctivitis since 3 years age, and mild asthma and moderate persistent rhinitis. Continued use of topical tacrolimus 0.03% showed an initial improvement, but subsequent relapses resulted in frequent use of systemic prednisolone and eye drops antibiotics to control symptoms. Total IgE = 1530 IU/mL. After the second Omalizumab application, good or excellent improvement in ocular symptoms of both children was observed by allergists and parents. Ophthalmologic evaluation showed moderate improvement in the amount of slime and little or no improvement in the structural changes of the eye (cornea and appearance of giant papillae). CONCLUSIONS: There are few reports about the use of Omalizumab in allergic keratoconjunctivitis. Our work points to the need for further research in this area as the Anti-IgE may become a promising therapy for this difficult to control condition.