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Neue und zukünftige Therapieansätze in der Behandlung der allergischen Konjunktivitis

New and future treatment approaches for allergic conjunctivitis

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Zusammenfassung

Hintergrund

Schwere und rezidivierende okuläre Allergien können herkömmliche Ophthalmika v. a. bei chronischen Verlaufsformen an ihre Grenzen bringen. Erste neuwertige Immunmodulatoren und Biologika sind bereits im klinischen Einsatz und könnten Abhilfe schaffen.

Ziel der Arbeit (Fragestellung)

Anhand der immunpathophysiologischen Mechanismen der okulären Allergie sollen mögliche Angriffspunkte für innovative Therapieansätze aufgezeigt werden. Ebenso soll ein Überblick über vielversprechende neue und zukünftige Immunmodulatoren und Biologika sowie deren Wirkweise gegeben werden.

Material und Methoden

Es erfolgten ein Aufarbeiten aktueller Übersichtsarbeiten zur okulären Allergie und Therapie allergischer Systemerkrankungen sowie das Analysieren von Fallberichten zur Therapie von okulären Allergien mithilfe von Immunmodulatoren und Biologika und die Darstellung deren klinischer Relevanz und Einsatzmöglichkeiten.

Ergebnisse

Bei chronischen Verlaufsformen der okulären Allergie sind komplexe, durch Immunglobulin E (IgE), Mastzellen, CD4-positive Typ-2-T-Helferzellen und eosinophile Granulozyten vermittelte Entzündungsreaktionen der Augenoberfläche maßgebend. Ciclosporin A 0,1 %-Augentropfen sind in Europa seit 2018 bei Kindern mit schwerer Keratoconjunctivitis vernalis (VKC) ab dem vierten Lebensjahr zugelassen. Zudem präsentieren Fallberichte vielversprechende Daten zum systemischen Off-label-Einsatz von Biologika wie Dupilumab oder Omalizumab bei therapierefraktärer VKC oder atopischer Keratokonjunktivitis (AKC).

Schlussfolgerungen

Ein tiefes Verständnis der Immunpathophysiologie okulärer Allergien ist notwendig, um weitere Therapieziele für zukünftige Immunmodulatoren und Biologika zu detektieren. Therapeutisch bleibt die immunmodulierende Therapie derzeit auf Ciclosporin A-Augentropfen beschränkt. Andere immunmodulatorische Präparate wie Tacrolimus und Biologika können meist nur „off-label“ zum Einsatz kommen. Weitere Studien zum kontrollierten klinischen Einsatz dieser Substanzen in der Therapie der VKC oder AKC sind unterwegs.

Abstract

Background

In severe and recurrent ocular allergies conventional ophthalmic drugs can reach their limits, especially in chronic forms. The first novel immunomodulators and biologicals are already in clinical use and could provide relief.

Objective

Based on the immunopathophysiological mechanisms of ocular allergies, possible targets for innovative treatment approaches are presented. An overview of promising new and future immunomodulators and biologicals and their modes of action is also given.

Material and Methods

Current reviews on ocular allergies and the treatment of systemic allergic diseases were screened. Case reports on the treatment of ocular allergy using immunomodulators and biologicals were analyzed. The clinical relevance and possible applications are presented.

Results

In chronic forms of ocular allergies, complex ocular surface inflammatory responses mediated via immunoglobulin E (IgE), mast cells, CD4-positive type 2 T‑helper cells and eosinophilic granulocytes are predominant. Cyclosporine A 0.1% eyedrops have been approved in Europe since 2018 for children aged 4 years and older with severe vernal keratoconjunctivitis (VKC). In addition, case reports present promising data on the systemic off-label use of biologicals, such as dupilumab or omalizumab, in refractory VKC or atopic keratoconjunctivitis (AKC).

Conclusion

A profound understanding of the immunopathophysiology of ocular allergies is necessary to detect further targets for future immunomodulators and biologicals. Currently, immunomodulatory therapy remains limited to cyclosporine A eyedrops. Other immunomodulatory agents, such as tacrolimus and biologicals can only be used off-label. Further studies on the controlled clinical use of these substances in the treatment of VKC or AKC are underway.

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Authors and Affiliations

  1. Augenklinik und Poliklinik, LMU Klinikum, LMU München, Mathildenstr. 8, 80336, München, Deutschland

    Stefan Kassumeh, Barbara S. Brunner, Siegfried G. Priglinger & Elisabeth M. Messmer

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  1. Stefan Kassumeh
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  2. Barbara S. Brunner
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  3. Siegfried G. Priglinger
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  4. Elisabeth M. Messmer
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Corresponding author

Correspondence to Stefan Kassumeh.

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Interessenkonflikt

S. Kassumeh: Santen GmbH; GSK Deutschland. S.G. Priglinger: Alcon/Novartis, Pharm-Allergan GmbH, Carl Zeiss, BVI, Bayer AG, Bausch & Lomb, Örtli AG. E.M. Messmer: Speaker: Alcon/Novartis, Bausch & Lomb, Dompé, Novartis, Santen GmbH, Théa Pharma GmbH, TRB-Chemedica AG, VISUfarma; Consultant: Alcon/Novartis, Alfa Intes, DMG, Dompé, Kala, Novartis, Santen GmbH, Shire, Sun, Sifi, Théa Pharma GmbH, TRB-Chemedica AG, VISUfarma. B.S. Brunner gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Kassumeh, S., Brunner, B.S., Priglinger, S.G. et al. Neue und zukünftige Therapieansätze in der Behandlung der allergischen Konjunktivitis. Ophthalmologie 121, 180–186 (2024). https://doi.org/10.1007/s00347-024-01996-9

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