Association found between atopy and HZO

This retrospective, population-based, case-control study found a significant association between atopy and herpetic eye disease due to herpes simplex virus (HSV) or herpes zoster ophthalmicus (HZO).

An association between atopy and HSV ocular disease has been shown in a prior study, but this is the first time an association between atopy and HZO has been described.

The study’s authors assessed the association between atopy and herpetic eye disease in 114 patients with HSV and 137 patients with HZO identified in a Kaiser Permanente Hawaii database. There were two control groups: an ophthalmology clinic control group selected from the population of Kaiser Permanente Hawaii patients 18 years or older with at least one visit to the Kaiser ophthalmology clinic during the study period; and an age- and sex-matched control group selected from the general Kaiser Permanente Hawaii population with at least one physician visit during the study period.

When compared to age- and sex-matched controls, patients with atopic disease had 1.8-fold (P = 0.01) higher odds of developing HZO ocular disease relative to those without atopic disease. This was especially true for patients with asthma. The association was even more impressive for HSV ocular disease; patients with atopy had a 2.6-fold (P < 0.001) higher risk of HSV compared to age- and sex-matched controls. 

When compared to the ophthalmology control group, the risk of HZO was not statistically significant in patients with atopic disease, although the risk of HSV ocular disease was still statistically significant in patients with atopic dermatitis (odd ratio 3.9; P = 0.001) and asthma (odds ratio 1.8; P = 0.03). Patients with multiple atopic conditions were at higher risk of herpetic ocular disease, with a 2.9-fold (P = 0.04) increase in HZO and 8.9-fold (P < 0.001) increase for herpes simplex relative to the ophthalmology clinic controls after adjusting for age and sex.

A diagnosis of herpes ocular disease should be higher on the differential for any patient with atopic disease, particularly atopic dermatitis. In patients with known herpetic eye disease, atopy may be a risk factor for a prolonged disease course and need for more aggressive therapy. Because of the wide range of ophthalmic manifestations (blepharitis, conjunctivitis, dermatitis, keratitis and uveitis in this study) and increased risk of advanced disease in atopic patients, ophthalmologists should include specific questions about allergies, asthma and skin disease in their review of systems in almost every patient. 

The researchers conclude that the results of this study are novel and should be validated in other populations. These findings also raise questions about whether there are common pathophysiological mechanisms behind both HZV and HZO.