Where eye meets body part 2: uniting allergy pathways in ocular and atopic disease - T cells take the lead.

Purpose of review: This review compares the T-cell-mediated pathways of atopic dermatitis and atopic keratoconjunctivitis (AKC), as well as allergic asthma and vernal conjunctivitis (VKC).These chronic, T cell-mediated conditions frequently coexist and are unified by Th2-driven inflammation, epithelial barrier dysfunction, and tissue remodeling. By comparing their epidemiology, pathogenesis, genetic contributors, and therapeutic approaches, this review examines how skin, airway, and ocular allergic pathways intersect and diverge.

Recent findings: Barrier dysfunction and Th2-driven inflammation contribute to disease persistence across atopic dermatitis, AKC, allergic asthma, and VKC, with structural remodeling evident in chronic stages. In atopic dermatitis and allergic asthma, genetic studies implicate type 2 immune pathways, while in VKC, unfolded protein response genes are implicated; epigenetic changes, including DNA methylation and histone regulation, are emerging as shared contributors. Topical calcineurin inhibitors improve symptoms in both atopic dermatitis and AKC, though biologics like dupilumab may induce conjunctivitis in atopic dermatitis patients. Inhaled corticosteroids and anti-type 2 biologics remain mainstays for allergic asthma, while mast cell stabilizers and topical corticosteroids are used in VKC. New therapies, including JAK inhibitors and novel anti-inflammatory agents, offer additional options across these interconnected allergic diseases.

Summary: By highlighting immunologic convergence and divergence across these allergic conditions, this review underscores the importance of cross-specialty awareness and tailored treatments. Integrating ocular findings into broader allergy care may improve outcomes for patients with multicompartment involvement.