Gatta Alessia, Della Valle Loredana, Farinelli Anila, Scarano Gilda, Lumaca Arianna, Cavallucci Enrico, Di Gioacchino Mario, Paganelli Roberto
Department of Medicine and Science of Ageing, and School of Specialization in Allergy and Clinical Immunology, G. d'Annunzio University, Chieti, Italy.
Case Rep Ophthalmol. 2020 Jul 3;11(2):268-275. doi: 10.1159/000508031. eCollection 2020 May-Aug.
Vernal keratoconjunctivitis (VKC) is a persistent, severe allergic eye disease, mainly occurring in children, that can lead to severe ocular complications including visual loss. The underlying etiology and pathophysiology of VKC remain unclear. Common therapies include topical antihistamines and mast cell stabilizers that are effective in mild-to-moderate forms of VKC but are often ineffective in severe forms that require topical or systemic corticosteroids. Dependence on steroids is common with potential adverse effects both local, as increased intraocular pressure, glaucoma, infection and cataract, as well as systemic ones, as reduction in child growth velocity. Alternative therapies are immunosuppressive drugs, like cyclosporine A and tacrolimus, that usually are effective but may also cause adverse effects. A promising therapeutic option is omalizumab, a recombinant anti-IgE humanized monoclonal antibody, currently used as add-on therapy for moderate to severe uncontrolled allergic asthma and chronic spontaneous urticaria. Here, we report the short-time duration of effective relief of symptoms after the prolonged use of omalizumab in a patient affected by refractory VKC. However, in our case any apparent beneficial effect was short lasting, and we propose that the duration of the disease and the concomitant long-term use of steroids leads to iatrogenic damage; thus, the disease becomes refractory to anti-IgE treatment.
春季角结膜炎（VKC）是一种持续性的严重过敏性眼病，主要发生于儿童，可导致包括视力丧失在内的严重眼部并发症。VKC的潜在病因和病理生理学仍不清楚。常用治疗方法包括局部用抗组胺药和肥大细胞稳定剂，它们对轻至中度VKC有效，但对需要局部或全身用糖皮质激素的重度VKC通常无效。依赖类固醇很常见，可能会产生局部不良反应，如眼压升高、青光眼、感染和白内障，以及全身不良反应，如儿童生长速度减慢。替代疗法是免疫抑制药物，如环孢素A和他克莫司，通常有效，但也可能引起不良反应。一种有前景的治疗选择是奥马珠单抗，一种重组抗IgE人源化单克隆抗体，目前用作中重度未控制的过敏性哮喘和慢性自发性荨麻疹的附加治疗。在此，我们报告了一名难治性VKC患者长期使用奥马珠单抗后症状有效缓解的持续时间较短。然而，在我们的病例中，任何明显的有益效果都是短暂的，我们认为疾病的持续时间和长期同时使用类固醇会导致医源性损伤；因此，疾病对抗IgE治疗变得难治。
