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Immune modulation in ocular allergy: Update and future directions
Author(s) -
LEONARDI A
Publication year - 2011
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2011.3443.x
Subject(s) - medicine , topical steroid , immune system , allergy , eosinophil , allergic conjunctivitis , immune modulation , steroid , immunology , pharmacology , vernal keratoconjunctivitis , dermatology , asthma , hormone
Purpose In the presence of active severe allergic reaction, steroids are preferred over anti‐allegic drugs since the former is more effective in inhibiting rapidly the inflammatory component of corneal damage, i.e., eosinophil‐ and neutrophil‐ liberated epithelial toxic mediators. However, one often finds steroid‐resistant forms of VKC and AKC that necessitate an alternative therapy. Methods In poor responders, or when only prolonged steroids are effective, topical cyclosporine 0.5% to 2% ameliorates the signs and symptoms of severe VKC and AKC without significant side effects. New formulations of topical cyclosporine at 0.05% may be further available for the treatment of severe VKC and AKC. Results Topical cyclosporine A (CsA) 1% or 2% emulsion in castor or olive oil has been considered for years the primary alternative to steroids for treatment of severe VKC and AKC. CsA 1% was reported to be the minimum effective concentration in the treatment of vernal shield ulcer, with recurrence observed at lower concentrations.Lower concentrations of CsA have been suggested as a steroid sparing agent with moderate to good effectiveness. Conclusion Newer alternatives to the use of topical mast cell stabilizing drugs, topical steroids and topical cyclosporine are other immunosuppressive drugs and biological agents that are able to specifically target different elements of the immune response.