Long-term Outcomes of the Management of Chronic Refractory Ocular Allergy Using Allergen Immunotherapy

Allergic eye disease (AED) can be mild, moderate, or severe and have varying chronicity. Although milder disease is easier to treat, persistent refractory cases can be a challenge. Allergen-specific immunotherapy (AIT) has been explored in treating refractory cases, especially in those with systemic associations. The purpose of this study was to assess the indications and outcomes of AIT in refractory AED.

The clinical details of patients with AED were retrospectively obtained. Cases that had exacerbations despite maximum topical therapy were termed refractory. Refractory cases were referred to the allergy specialist for evaluation and management. Based on the results of allergen testing and clinical history, allergen immunotherapy was administered as per standard guidelines. The outcomes of treatment for reduction in steroid usage and episodes of allergy were studied.

A total of 805 patients with AED were included. Of these, 121 with refractory AED were referred to the allergy specialist. After allergen testing (skin prick test), 52 patients were started on AIT. Ninety percent patients experienced a reduction in allergy symptoms. There was a significant reduction in topical and oral steroid requirement after AIT ( P < 0.01). Only 15 patients required potent topical steroid post-AIT compared with 32 before ( P < 0.05). Long-term follow-up of these patients (mean duration 25.5 months) showed good allergy control with minimal side effects.

AIT can be an useful addition to our armamentarium in cases of refractory AED and a safe option in the long term.