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Valeille A, Ouilhon C, Subtil F, Hacard F, Jaulent C, Bérard F, Nicolas JF, Fauquert JL, Nosbaum A. Comprehensive Ophthalmological Evaluation in Atopic Dermatitis. Dermatology 2024; 240:434-442. [PMID: 38354719 DOI: 10.1159/000536233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/07/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Atopic dermatitis (AD), a chronic type 2 inflammatory skin disease, is frequently associated with ocular surface diseases (OSD) which may appear or worsen under anti-type 2-targeted treatments. However, the exact prevalence of OSD and the ophthalmology referral criteria remain ill-defined in AD patients before initiating such biotherapies. We aimed to characterize the prevalence, the nature and the factors related to OSD development in AD that may justify an ophthalmological management. METHODS A total of 98 consecutive AD inpatients without biological treatment were retrospectively included. These were systematically evaluated by an ophthalmologist during their dermatological care. Clinical and laboratory data were analysed to characterize OSD and their risk factors. RESULTS OSD were found in 83/98 AD patients (85%); mainly dry eye syndrome (64%, 63/98), allergic conjunctivitis (42%, 41/98), posterior (33%, 32/98), and anterior blepharitis (27%, 26/98). In AD patients without ocular symptoms, OSDs were also frequently found (63%, 12/19) and were mostly mild. Risk factors for OSD were history of allergic rhinitis, allergic sensitization, head and neck AD, ocular symptoms (foreign body sensation in the eye, burning, itching, photophobia), and total IgE level >3,000 kU/L. CONCLUSION The prevalence of OSD was high, even in asymptomatic patients. The risk factors identified may indicate the need for ophthalmological examination for therapeutic management, especially when biological agents targeting type 2 inflammation are considered.
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Affiliation(s)
- Anaïs Valeille
- Allergy and Clinical Immunology Department, Lyon South University Hospital Center, Hospices Civils de Lyon, Lyon, France
- Immunology and Allergy Clinic, University Claude Bernard Lyon 1, Lyon, France
| | - Coralie Ouilhon
- Ophthalmology Department, Lyon South University Hospital Center, Hospices Civils de Lyon, Lyon, France
| | - Fabien Subtil
- Laboratoire de Biométrie et Biologie Évolutive, CNRS, University of Lyon, University Lyon 1, Villeurbanne, France
- Biostatistics Department, Hospices Civils de Lyon, Lyon, France
| | - Florence Hacard
- Allergy and Clinical Immunology Department, Lyon South University Hospital Center, Hospices Civils de Lyon, Lyon, France
- Immunology and Allergy Clinic, University Claude Bernard Lyon 1, Lyon, France
- Ophthalmology Department, Lyon South University Hospital Center, Hospices Civils de Lyon, Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, CNRS, University of Lyon, University Lyon 1, Villeurbanne, France
- Biostatistics Department, Hospices Civils de Lyon, Lyon, France
- CIRI (International Center for Infectiology Research) INSERM U1111, Lyon Higher Normal School, University Claude Bernard Lyon 1, Lyon, France
| | - Coline Jaulent
- Allergy and Clinical Immunology Department, Lyon South University Hospital Center, Hospices Civils de Lyon, Lyon, France
| | - Fréderic Bérard
- Allergy and Clinical Immunology Department, Lyon South University Hospital Center, Hospices Civils de Lyon, Lyon, France
- Immunology and Allergy Clinic, University Claude Bernard Lyon 1, Lyon, France
- Ophthalmology Department, Lyon South University Hospital Center, Hospices Civils de Lyon, Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, CNRS, University of Lyon, University Lyon 1, Villeurbanne, France
- Biostatistics Department, Hospices Civils de Lyon, Lyon, France
- CIRI (International Center for Infectiology Research) INSERM U1111, Lyon Higher Normal School, University Claude Bernard Lyon 1, Lyon, France
| | - Jean-François Nicolas
- Allergy and Clinical Immunology Department, Lyon South University Hospital Center, Hospices Civils de Lyon, Lyon, France
- Immunology and Allergy Clinic, University Claude Bernard Lyon 1, Lyon, France
- Ophthalmology Department, Lyon South University Hospital Center, Hospices Civils de Lyon, Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, CNRS, University of Lyon, University Lyon 1, Villeurbanne, France
- Biostatistics Department, Hospices Civils de Lyon, Lyon, France
- CIRI (International Center for Infectiology Research) INSERM U1111, Lyon Higher Normal School, University Claude Bernard Lyon 1, Lyon, France
| | - Jean-Luc Fauquert
- Pediatric Allergy Unit, Clermont-Ferrand University Hospital, University Hospital Center Estaing, Clermont-Ferrand, France
| | - Audrey Nosbaum
- Allergy and Clinical Immunology Department, Lyon South University Hospital Center, Hospices Civils de Lyon, Lyon, France
- Immunology and Allergy Clinic, University Claude Bernard Lyon 1, Lyon, France
- Ophthalmology Department, Lyon South University Hospital Center, Hospices Civils de Lyon, Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, CNRS, University of Lyon, University Lyon 1, Villeurbanne, France
- Biostatistics Department, Hospices Civils de Lyon, Lyon, France
- CIRI (International Center for Infectiology Research) INSERM U1111, Lyon Higher Normal School, University Claude Bernard Lyon 1, Lyon, France
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Wu D, Daniel BS, Lai AJX, Wong N, Lim DKA, Murrell DF, Lim BXH, Mehta JS, Lim CHL. Dupilumab-associated ocular manifestations: A review of clinical presentations and management. Surv Ophthalmol 2022; 67:1419-1442. [PMID: 35181280 DOI: 10.1016/j.survophthal.2022.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 02/07/2022] [Accepted: 02/11/2022] [Indexed: 10/19/2022]
Abstract
Dupilumab is a first-in-class biologic approved by the European Medicines Agency (EMA) and the US Food and Drug Administration (US FDA) for the treatment of multiple atopic diseases, including atopic dermatitis, asthma, and chronic rhinosinusitis with nasal polyposis. Since gaining traction as an effective treatment modality, multiple reports have highlighted the many ocular side effects associated with dupilumab usage. These range from mild diseases such as conjunctivitis, dry eyes, and blepharitis, to more severe manifestations such as intraocular inflammation and cicatrising conjunctivitis. The pathogenesis behind these manifestations remains controversial but are likely multi-factorial. We review the current evidence surrounding ocular manifestations of dupilumab-associated disease and proposed treatments to provide an overview of this unique disease entity. With increasing usage of dupilumab, formal recommendations regarding the treatment of dupilumab-associated ocular disease are warranted to provide standardised clinical guidance. Furthermore, it is important for healthcare practitioners to remain abreast with existing literature to adequately counsel and empower patients with the knowledge surrounding contemporary treatments for atopic diseases and their associated side-effects.
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Affiliation(s)
- Duoduo Wu
- Yong Loo Lin School of Medicine, National University of Singapore
| | - Benjamin S Daniel
- St George Hospital, Kogarah, Sydney, NSW, Australia; St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Andre J X Lai
- Yong Loo Lin School of Medicine, National University of Singapore
| | - Nathan Wong
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Dawn K A Lim
- Yong Loo Lin School of Medicine, National University of Singapore; Department of Ophthalmology, National University Health System, Singapore
| | - Dedee F Murrell
- St George Hospital, Kogarah, Sydney, NSW, Australia; School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Blanche X H Lim
- Yong Loo Lin School of Medicine, National University of Singapore; Department of Ophthalmology, National University Health System, Singapore
| | - Jodhbir S Mehta
- Duke-NUS Graduate Medical School, Singapore; Singapore Eye Research Institute, Singapore; Singapore National Eye Centre, Singapore
| | - Chris H L Lim
- Yong Loo Lin School of Medicine, National University of Singapore; Department of Ophthalmology, National University Health System, Singapore; Singapore Eye Research Institute, Singapore; School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia.
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Neagu N, Dianzani C, Avallone G, Dell'Aquila C, Morariu SH, Zalaudek I, Conforti C. Dupilumab ocular side effects in patients with atopic dermatitis: a systematic review. J Eur Acad Dermatol Venereol 2022; 36:820-835. [PMID: 35122335 DOI: 10.1111/jdv.17981] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 01/05/2022] [Indexed: 11/29/2022]
Abstract
Atopic dermatitis (AD) is a chronic, inflammatory skin disorder that most frequently occurs in children, but it can also affect adults. Even though most AD cases can be managed with topical treatments, moderate-to-severe forms require systemic therapies. Dupilumab is the first human monoclonal antibody approved for the treatment of AD. Its action is through IL-4 receptor alpha subunit inhibition, thus blocking IL-4 and IL-13 signaling pathways. It has been shown to be an effective, well tolerated therapy for AD, as well as for asthma, chronic rhinosinusitis with nasal polyposis (CRSwNP) and eosinophilic esophagitis (EoE). However, an increasing incidence of Dupilumab-induced ocular surface disease (DIOSD) has been reported in patients treated with Dupilumab, as compared to placebo. The aim of this study was to summarize scientific data regarding DIOSD in AD patients treated with Dupilumab. A search of PubMed and clinicaltrials.gov databases was performed. There was no limit to study design. All AD cases were moderate-to-severe. DIOSD was either dermatologist-, allergist-, or ophtalmologist-assessed. Evidence shows that DIOSD occurs most frequently in patients with atopic dermatitis and not in other skin conditions, neither in patients with asthma, CRSwNP, nor EoE who are on Dupilumab treatment. Further studies are warranted in order to establish a causal relationship between Dupilumab and ocular surface disease. Nevertheless, ophtalmological evaluations prior to Dupilumab initiation can benefit AD patients with previous ocular pathology or current ocular symptomatology. Also, patch testing for ocular allergic contact dermatitis might be advantageous in patients with a history of allergic conjunctivitis. Furthermore, TARC, IgE and circulating eosinophils levels might be important biomarkers for a baseline assessment of future candidates to Dupilumab treatment. However, TARC measurements should be resumed for research purposes only.
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Affiliation(s)
- N Neagu
- State Clinic of Dermatology, Mureș County Hospital, Tîrgu Mureș, Romania
| | - C Dianzani
- Plastic and Reconstructive Surgery Unit, Medico University of Rome, Campus Bio, Rome, Italy
| | - G Avallone
- Medical Sciences Department, Section of Dermatology, University of Turin, Turin, Italy
| | - C Dell'Aquila
- Department of Medical, Surgical Sciences and Health, Eye Clinic, University of Trieste, Trieste, Italy
| | - S-H Morariu
- State Clinic of Dermatology, Mureș County Hospital, Tîrgu Mureș, Romania
| | - I Zalaudek
- Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
| | - C Conforti
- Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
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