Can omalizumab be used effectively to treat severe conjunctivitis in children with asthma? A case example and review of the literature

Table 1 Studies assessing the use of omalizumab in conjunctivitis as a comorbidity

Ref.	Study group	Study type (level of evidence)	Intervention	Outcome	Results
Doan et al[13], 2017	4 patients with severe VKC, asthma, rhinitis and AD	Non-controlled, open-label, retrospective case series (Level 4)	2 weekly treatment with Omalizumab for range of 16-42 mo	Ocular VAS scale. Bonini grading. ACT score	3/4 had improvement in VAS score and Bonini grading. 3/4 had total control
Sánchez and Cardona[18], 2012	1 patient. 16 years old with severe refractory VKC, asthma, AD and rhinitis	Case report (Level 4)	2 weekly treatment with Omalizumab for 18 mo	Ocular VAS scale. Objective physician evaluation including cessation of immunosuppressive therapies	Ocular VAS improvement. Reduction of red eyes, photophobia and papillae. Cessation of ciclosporin and corticosteroids
de Klerk et al[19], 2013	1 patient. 12 years old with severe refractory VKC, asthma and rhinitis	Case report (Level 4)	Monthly treatment with Omalizumab for 18 mo	Juniper’s rhinoconjunctivitis QOL score. Reduction in immunosuppressive ocular therapy	Improvement in Juniper’s rhinoconjunctivitis score. Cessation of ciclosporin and olapatadine
Occasi et al[20], 2015	1 patient. 15 years old boy with asthma, severe VKC and AD	Case report (Level 4)	2 weekly treatment with Omalizumab for 3 mo	Achieving asthma control. Resolution of AD and VKC symptoms	Asthma control achieved at 3 mo. Resolution of VKC symptoms at 3 mo
Rossberg et al[11], 2020	2 patients with severe VKC, asthma and AD	Case report (Level 4)	2 weekly treatment with Omalizumab for 11 mo and 6 mo	Bonini grading	Improvement in Bonini grading

QOL: Quality of life; VKC: Vernal keratoconjunctivitis; VAS: Visual analogue scale; ACT: Advanced communication training.

Table 2 Current Indications for prescribing omalizumab

Ref.	Age	Previous treatment
NICE[4]	> 6 yr	Optimised standard treatment with documented compliance
		Continuous or 4 or more courses of oral steroids in the previous year
NICE[5]	> 12 yr	Poor response to standard treatment with H1-antihistamines and leukotriene receptor antagonists
		Objective severity score (weekly urticaria activity score) > 28