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Act quickly when treating atopic keratoconjunctivitis to avoid adverse outcomes

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Abstract

Atopic keratoconjunctivitis (AKC) is the most severe form of allergic conjunctivitis and, if inadequately treated, can cause vision loss. Treatment aims to minimize symptoms, recurrence and consequent eye rubbing, which cause long-term eye damage. First-line treatment generally involves the use of topical ophthalmic formulations of mast-cell stabilizers and/or antihistamines, corticosteroids, calcineurin inhibitors and immunomodulators (used in that order). Systemic formulations of these drugs can be used to treat refractory cases of AKC or when deemed appropriate for the individual.

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References

  1. Hogan MJ. Atopic keratoconjunctivitis. Am J Ophthalmol. 1953;36(71):937–47.

    Article  CAS  Google Scholar 

  2. Chen JJ, Applebaum DS, Sun GS, et al. Atopic keratoconjunctivitis: a review. J Am Acad Dermatol. 2014;70(3):569–75.

    Article  Google Scholar 

  3. Bonini S, Gramiccioni C, Bonini M, et al. Practical approach to diagnosis and treatment of ocular allergy: a 1-year systematic review. Curr Opin Allergy Clin Immunol. 2007;7(5):446–9.

    Article  Google Scholar 

  4. Ridolo E, Kihlgren P, Pellicelli I, et al. Atopic keratoconjunctivitis: pharmacotherapy for the elderly. Drugs Aging. 2019;36(7):581–8.

    Article  Google Scholar 

  5. Nivenius E, Van der Ploeg I, Gafvelin G, et al. Conjunctival provocation with airborne allergen in patients with atopic keratoconjunctivitis. Clin Exp Allergy. 2012;42(1):58–65.

    Article  CAS  Google Scholar 

  6. Bonini S. Atopic keratoconjunctivitis. Allergy. 2004;59(Suppl 78):71–3.

    Article  Google Scholar 

  7. Ding W, Zou GL, Zhang W, et al. Interleukin-33: its emerging role in allergic diseases. Molecules. 2018. https://doi.org/10.3390/molecules23071665.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Lin J, Zhao GQ, Wang Q, et al. Regulation of interleukin 33/ST2 signaling of human corneal epithelium in allergic diseases. Int J Ophthalmol. 2013;6:23–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Leonardi A, Jose PJ, Zhan H, et al. Tear and mucus eotaxin-1 and eotaxin-2 in allergic keratoconjunctivitis. Ophthalmology. 2003;110(3):487–92.

    Article  Google Scholar 

  10. Oshinskie L, Haine C. Atopic dermatitis and its ophthalmic complications. J Am Optom Assoc. 1982;53(11):889–94.

    CAS  PubMed  Google Scholar 

  11. Rich LF, Hanifin JM. Ocular complications of atopic dermatitis and other eczemas. Int Ophthalmol Clin. 1985;25(1):61–76.

    Article  CAS  Google Scholar 

  12. Zhan H, Smith L, Calder V, et al. Clinical and immunological features of atopic keratoconjunctivitis. Int Ophthalmol Clin. 2003;43(1):59–71.

    Article  Google Scholar 

  13. Bielory L. Allergic and immunologic disorders of the eye. Part II: ocular allergy. J Allergy Clin Immunol. 2000;06(6):1019–32.

    Article  Google Scholar 

  14. Tuft SJ, Ramakrishnan M, Seal DV, et al. Role of Staphylococcus aureus in chronic allergic conjunctivitis. Ophthalmology. 1992;99(2):180–4.

    Article  CAS  Google Scholar 

  15. Guglielmetti S, Dart JK, Calder V. Atopic keratoconjunctivitis and atopic dermatitis. Curr Opin Allergy Clin Immunol. 2010;10(5):478–85.

    Article  CAS  Google Scholar 

  16. Spergel JM. Immunology and treatment of atopic dermatitis. Am J Clin Dermatol. 2008;9(4):233–44.

    Article  Google Scholar 

  17. Wakamatsu TH, Okada N, Kojima T, et al. Evaluation of conjunctival inflammatory status by confocal scanning laser microscopy and conjunctival brush cytology in patients with atopic keratoconjunctivitis (AKC). Mol Vis. 2009;15:1611–9.

    PubMed  PubMed Central  Google Scholar 

  18. Wise SK, Lin SY, Toskala E, et al. International consensus statement on allergy and rhinology: allergic rhinitis. Int Forum Allergy Rhinol. 2018;8(2):108–352.

    PubMed  Google Scholar 

  19. Jabbehdari S, Starnes TW, Kurji KH, et al. Management of advanced ocular surface disease in patients with severe atopic keratoconjunctivitis. Ocul Surf. 2019;17(2):303–9.

    Article  Google Scholar 

  20. Galor A, Jabs DA, Leder HA. Comparison of antimetabolite drugs as corticosteroid-sparing therapy for noninfectious ocular inflammation. Ophthalmology. 2008;115(10):1826–32.

    Article  Google Scholar 

  21. Bielory L, Schoenberg D. Emerging therapeutics for ocular surface disease. Curr Allergy Asthma Rep. 2019;19(3):16.

    Article  Google Scholar 

  22. Shaker M, Salcone E. An update on ocular allergy. Curr Opin Allergy Clin Immunol. 2016;16(5):505–10.

    Article  CAS  Google Scholar 

  23. Lyseng-Williamson KA. Oral bepotastine: in allergic disorders. Drugs. 2010;70(12):1579–91.

    Article  CAS  Google Scholar 

  24. Coondoo A, Phiske M, Verma S, et al. Side-effects of topical steroids: a long overdue revisit. Indian Dermatol Online J. 2014;5(4):416–25.

    Article  Google Scholar 

  25. Attas-Fox L, Barkana Y, Iskhakov V, et al. Topical tacrolimus 0.03% ointment for intractable allergic conjunctivitis: an open-label pilot study. Curr Eye Res. 2008;33(7):545–9.

    Article  CAS  Google Scholar 

  26. Hingorani M, Moodaley L, Calder VL, et al. A randomized, placebo-controlled trial of topical cyclosporin A in steroid-dependent atopic keratoconjunctivitis. Ophthalmology. 1998;105(9):1715–20.

    Article  CAS  Google Scholar 

  27. Tesse R, Spadavecchia L, Fanelli P, et al. Treatment of severe vernal keratoconjunctivitis with 1% topical cyclosporine in an Italian cohort of 197 children. Pediatr Allergy Immunol. 2010;21(2 Pt 1):330–5.

    Article  Google Scholar 

  28. Daniell M, Constantinou M, Vu HT, et al. Randomised controlled trial of topical ciclosporin A in steroid dependent allergic conjunctivitis. Br J Ophthalmol. 2006;90(4):461–4.

    Article  CAS  Google Scholar 

  29. Miyazaki D, Tominaga T, Kakimaru-Hasegawa A, et al. Therapeutic effects of tacrolimus ointment for refractory ocular surface inflammatory diseases. Ophthalmology. 2008;115(6):988–92.e5.

    Article  Google Scholar 

  30. Ridolo E, Montagni M, Bonzano L, et al. Bilastine: new insight into antihistamine treatment. Clin Mol Allergy. 2015;13(1):1.

    Article  CAS  Google Scholar 

  31. Bousquet J, Ansotegui I, Canonica GW, et al. Establishing the place in therapy of bilastine in the treatment of allergic rhinitis according to ARIA: evidence review. Curr Med Res Opin. 2012;28(1):131–9.

    Article  CAS  Google Scholar 

  32. Sologuren A, Vinas R, Cordon E, et al. Open-label safety assessment of bilastine in elderly patients with allergic rhinoconjunctivitis and/or urticaria. Allergy Asthma Proc. 2018;39(4):299–304.

    Article  CAS  Google Scholar 

  33. Simons FE. Comparative pharmacology of H1 antihistamines: clinical relevance. Am J Med. 2002;113(Suppl 9A):38s–46s.

    Article  CAS  Google Scholar 

  34. Stumpf T, Luqmani N, Sumich P, et al. Systemic tacrolimus in the treatment of severe atopic keratoconjunctivitis. Cornea. 2006;25(10):1147–9.

    Article  Google Scholar 

  35. Hoang-Xuan T, Prisant O, Hannouche D, et al. Systemic cyclosporine A in severe atopic keratoconjunctivitis. Ophthalmology. 1997;104(8):1300–5.

    Article  CAS  Google Scholar 

  36. Daniel E, Thorne JE, Newcomb CW, et al. Mycophenolate mofetil for ocular inflammation. Am J Ophthalmol. 2010;149(3):423–32.

    Article  CAS  Google Scholar 

  37. Hornbeak DM, Thorne JE. Immunosuppressive therapy for eye diseases: effectiveness, safety, side effects and their prevention. Taiwan J Ophthalmol. 2015;5(4):156–63.

    Article  Google Scholar 

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    The article was adapted from Drugs and Aging 2019; 36(7) 581–88 [4] by employees of Adis International Ltd./Springer Nature, who are responsible for the article content and declare no conflicts of interest.

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    The preparation of this review was not supported by any external funding.

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    Adis Medical Writers. Act quickly when treating atopic keratoconjunctivitis to avoid adverse outcomes. Drugs Ther Perspect 36, 17–22 (2020). https://doi.org/10.1007/s40267-019-00694-w

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