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Asthma medication may relieve severe eye allergies
Omalizumab, a recently approved asthma drug, effectively treated severe ocular allergies in a small study.
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In a small study, researchers have successfully treated severe ocular allergies, including atopic keratoconjunctivitis, with a drug usually used to treat asthma.
Patricia B. Williams, PhD, FCP, and colleagues have enrolled a total of nine patients in a clinical study of Xolair (omalizumab, Genentech/Novartis) to assess the drug’s efficacy in severe ocular allergies. Six-month follow-up information is available for six of the patients.
The drug was shown to reduce itching, rhinitis, lid swelling and other signs and symptoms of ocular allergy, according to Dr. Williams.
The sample size is small because there is not a large patient population who fit these criteria for severe ocular allergy, Dr. Williams said in an interview with Ocular Surgery News.
Patients with atopic keratoconjunctivitis and the most severe degrees of ocular allergic disease are those who would benefit the most from the drug, Dr. Williams explained. It is not advised in women who are pregnant or nursing or in patients under the age of 12 years, she said.
“Most of these patients have asthma or other manifestations of allergic disease. These are patients we would have to manage with steroids. Steroid therapy complications are extremely common in this group of patients, while the alternatives to treatment are few,” she said. “Topical steroids potentially increase IOP and cause cataracts, and for systemic steroids there is a whole list including fluid retention, hypertension and increased risk of infection. This appears to be a less toxic approach.”
Dr. Williams plans to enroll more patients in the study and follow them for a longer time, she said.
The therapy
Omalizumab was administered to the patients subcutaneously, once or twice a month, Dr. Williams said, with dosing dependent on the severity of the disease, the patient’s weight and serum immunoglobulin-E (IgE). At each follow-up visit the patient was assessed subjectively for a number of symptoms, both ocular and non-ocular.
“Relief is seen in a couple of months,” Dr. Williams said. “It is a gradual improvement,” she said.
In the results to date, omalizumab reduced ocular allergic signs and symptoms and reduced the need for topical steroids, she said. No systemic adverse effects were noted.
“One patient developed a cutaneous reaction and wanted to stop the treatments, which she did. But the patient came back later wanting to get back on the protocol because the allergic symptoms were worse than having a rash,” Dr. Williams said.
While initiating subcutaneous therapy with omalizumab, patients should continue to use steroid therapy, she said. The goal is to taper the steroids as the therapeutic effect of the omalizumab increases.
“Omalizumab stops the allergic reaction before it becomes a reaction, but it will not stop the symptoms that are already there,” Dr. Williams explained. Patients will have continuing symptoms, and that is the reason for the continued steroid use until omalizumab takes its gradual effect, she said.
How the drug works
Dr. Williams emphasized that omalizumab is not a steroid; it is a new and possibly less toxic approach to treating severe eye allergy. The drug is currently approved by the Food and Drug Administration for the treatment of allergic asthma.
The compound is a monoclonal antibody with IgE receptor binding sites on it, Dr. Williams said.
It works at the very beginning of the allergic cascade of effects, she said.
The drug “binds up the IgE before it can bind to the mast cells in the body,” Dr. Williams explained. “When the IgE binds to the IgE receptors on mast cells, the mast cells degranulate and release all sorts of noxious things, histamines, leukotrienes and other compounds that trigger an allergic response. So if this drug binds up the allergen-induced IgE, it cannot activate the mast cells to release all these compounds that cause the allergic reaction.”
It is hoped that inhibiting IgE can alter the course of the disease in the long term, she said.
For Your Information:
- Patricia B. Williams, PhD, FCP, can be reached at Thomas R. Lee Center for Ocular Pharmacology, Dept. of Physiological Sciences, Eastern Virginia Medical School, Lewis Hall, 3023, P.O. Box 1980, Norfolk, VA 23501-1980; 757-446-5632; e-mail: pbwillia@umich.edu; williaP@evms.edu.
- Genentech Inc. and Novartis International AG are joint manufacturers of Xolair. Genentech can be reached at 1 DNA Way, South San Francisco, CA 94080-4990; 650-225-1000; fax: 650-225-6000; Web site: www.gene.com. Novartis can be reached at CH-4002 Basel, Switzerland; 41-61-324-11-11; fax: 41-61-324-80-01; Web site: www.novartis.com.
References:
- Williams PB. Omalizumab for severe ocular allergy. Presented at: Annual Meeting of the American College of Clinical Pharmacology.
- Kim Norton is an OSN Staff Writer who covers all aspects of ophthalmology.