Immunotherapy Matches Cyclosporin A in Resolving Allergic Conjunctivitis Signs

Both allergen immunotherapy and cyclosporin A treatment provide sign relief in perennial allergic conjunctivitis, according to research published in International Ophthalmology. Immunotherapy use is on the rise due to significant side effects of long-term topical or systemic agents use, which can include the development of cataracts and glaucoma.

Researchers conducted a retrospective study to assess the clinical efficacies of topical cyclosporin A and subcutaneous allergen immunotherapy in perennial allergic conjunctivitis. 

The team assigned adult patients with perennial allergic conjunctivitis and confirmed sensitization to house dust mites to receive either topical cyclosporine A treatment or subcutaneous allergen immunotherapy. They assessed efficacy by grading 4 allergic signs (papillary reaction, limbal involvement, corneal involvement, and conjunctival hyperemia) and followed the participants for 6 months, recording sign scores at 1, 3, and 6 months.

A total of 20 patients who were followed up at a single center were included in the study. Each treatment group had 10 patients. The cyclosporine group included 70% women and 30% men and had a mean age of 29.5±3.92 years. The immunotherapy group was 60% women and 40% men and had a mean age of 28.1±3.99 years.

With a repeated measures analysis, the investigators found both the cyclosporine and immunotherapy groups experienced significant improvements in scores for papillary reaction (P =.011 and P =.003), limbal involvement (P =.031 and P =.001), and conjunctival hyperemia (P =.001 and P <.001, respectively) over the course of the 6-month follow up. In the same analysis, they found only the cyclosporine group experienced a significant improvement in corneal involvement scores (P =.015). 

Cyclosporin A, unlike topical and systemic poly pharmacotherapy, does not carry a high risk of side effects following long-term use. However, patients may experience stinging or burning due to preservatives in the solution. Patients may also experience increased risk for molluscum contagiosum, papilloma virus, and herpes virus infections, according to the study. Immunotherapy, on the other hand, may be particularly useful in patients with perennial allergic conjunctivitis due to its rapid and sustained effect following hyposensitization.

“We suggest that allergen immunotherapy can be initiated early in treatment resistant cases to prevent development of asthma, and to improve patient compliance and quality of life,” the researchers recommend. “However, immunotherapy should be done under close supervision since it rarely causes life-threatening allergic reactions.”

Limitations of the study included the retrospective design, small sample size, relatively short follow-up duration, absence of symptom evaluation, no routine use of a validated instrument at the study institution, and lack of posttreatment IgE level measurements due to the COVID-19 pandemic.