Allergic conjunctivitis medical therapy: Difference between revisions

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Revision as of 18:04, 29 August 2022

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Treatment of allergic conjunctivitis is by avoiding the allergen (e.g. avoiding grass in bloom during the "hay fever season") and treatment with antihistamines, either topical (in the form of eye drops), or systemic (in the form of tablets). Antihistamines, medication that stabilizes mast cells, and non-steroidal anti-inflammatory drugs (NSAIDs) are safe and usually effective.

Medical Therapy

Dual-Acting Antihistamine–Mast Cell Stabilizing Agents^[1]

Inhibits binding of free histamine to its receptors, thus preventing further release of inflammatory mediators from mast cells.
Olopatadine, alcaftadine, epinastine, bepotastine besilate are the current first-line agents for acute symptomatic relief and control of inflammation and suitable for long-term use.
Most dual-acting agents require twice-daily dosing^[2]. Olopatadine 0.2%^[3] and alcaftadine^[4] are administered once-daily and maintain effectiveness through 16 hours after administration, as demonstrated in conjunctival allergen challenge studies.

References

↑ Carr W, Schaeffer J, Donnenfeld E (2016). "Treating allergic conjunctivitis: A once-daily medication that provides 24-hour symptom relief". Allergy Rhinol (Providence). 7 (2): 107–14. doi:10.2500/ar.2016.7.0158. PMC 5010431. PMID 27466061.
↑ Bielory L, Meltzer EO, Nichols KK, Melton R, Thomas RK, Bartlett JD (2013). "An algorithm for the management of allergic conjunctivitis". Allergy Asthma Proc. 34 (5): 408–20. doi:10.2500/aap.2013.34.3695. PMID 23998237.
↑ Abelson MB, Gomes PJ (2008). "Olopatadine 0.2% ophthalmic solution: the first ophthalmic antiallergy agent with once-daily dosing". Expert Opin Drug Metab Toxicol. 4 (4): 453–61. doi:10.1517/17425255.4.4.453. PMID 18433347.
↑ Greiner JV, Edwards-Swanson K, Ingerman A (2011). "Evaluation of alcaftadine 0.25% ophthalmic solution in acute allergic conjunctivitis at 15 minutes and 16 hours after instillation versus placebo and olopatadine 0.1%". Clin Ophthalmol. 5: 87–93. doi:10.2147/OPTH.S15379. PMC 3037035. PMID 21339800.

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[pmid27466061-1] Carr W, Schaeffer J, Donnenfeld E (2016). "Treating allergic conjunctivitis: A once-daily medication that provides 24-hour symptom relief". Allergy Rhinol (Providence). 7 (2): 107–14. doi:10.2500/ar.2016.7.0158. PMC 5010431. PMID 27466061.

[pmid23998237-2] Bielory L, Meltzer EO, Nichols KK, Melton R, Thomas RK, Bartlett JD (2013). "An algorithm for the management of allergic conjunctivitis". Allergy Asthma Proc. 34 (5): 408–20. doi:10.2500/aap.2013.34.3695. PMID 23998237.

[pmid18433347-3] Abelson MB, Gomes PJ (2008). "Olopatadine 0.2% ophthalmic solution: the first ophthalmic antiallergy agent with once-daily dosing". Expert Opin Drug Metab Toxicol. 4 (4): 453–61. doi:10.1517/17425255.4.4.453. PMID 18433347.

[pmid21339800-4] Greiner JV, Edwards-Swanson K, Ingerman A (2011). "Evaluation of alcaftadine 0.25% ophthalmic solution in acute allergic conjunctivitis at 15 minutes and 16 hours after instillation versus placebo and olopatadine 0.1%". Clin Ophthalmol. 5: 87–93. doi:10.2147/OPTH.S15379. PMC 3037035. PMID 21339800.

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 ==Overview==
 Treatment of allergic conjunctivitis is by avoiding the allergen (e.g. avoiding grass in bloom during the "hay fever season") and treatment with [[antihistamine]]s, either topical (in the form of [[eye drop]]s), or systemic (in the form of tablets). Antihistamines, medication that stabilizes mast cells, and [[non-steroidal anti-inflammatory drugs]] (NSAIDs) are safe and usually effective.
-==Medical Therapy==
+==[[Medical]] [[Therapy]]==
-Antihistamines, medication that stabilizes mast cells, and [[non-steroidal anti-inflammatory drugs]] (NSAIDs) are safe and usually effective. [[Corticosteroid]]s are reserved for more severe cases of ocular allergy disease, and their use should be monitored by an eye care physician due to possible side-effects. When an [[allergen]] is identified, the patient should avoid the allergen as much as possible.
+===Dual-Acting [[Antihistamine]]–[[Mast]] [[Cell]] Stabilizing Agents<ref name="pmid27466061">{{cite journal| author=Carr W, Schaeffer J, Donnenfeld E| title=Treating allergic conjunctivitis: A once-daily medication that provides 24-hour symptom relief. | journal=Allergy Rhinol (Providence) | year= 2016 | volume= 7 | issue= 2 | pages= 107-14 | pmid=27466061 | doi=10.2500/ar.2016.7.0158 | pmc=5010431 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27466061  }} </ref>===
+* Inhibits binding of free [[histamine]] to its receptors, thus preventing further release of [[inflammatory]] mediators from [[mast]] [[cells]].
-If the allergen is encountered and the symptoms are mild, a [[cold compress]] can be used to provide relief. It is a quick and easy solution without using any medications. The cold temperature of the water will help to bring down swelling, as it would in a bruise or burn. In addition, there are many antihistamine medications available for purchase.
+*Olopatadine, alcaftadine, epinastine, bepotastine besilate are the current first-line agents for acute [[symptomatic]] relief and control of [[inflammation]] and suitable for long-term use.
+*Most dual-acting agents require twice-daily dosing<ref name="pmid23998237">{{cite journal| author=Bielory L, Meltzer EO, Nichols KK, Melton R, Thomas RK, Bartlett JD| title=An algorithm for the management of allergic conjunctivitis. | journal=Allergy Asthma Proc | year= 2013 | volume= 34 | issue= 5 | pages= 408-20 | pmid=23998237 | doi=10.2500/aap.2013.34.3695 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23998237  }} </ref>. Olopatadine 0.2%<ref name="pmid18433347">{{cite journal| author=Abelson MB, Gomes PJ| title=Olopatadine 0.2% ophthalmic solution: the first ophthalmic antiallergy agent with once-daily dosing. | journal=Expert Opin Drug Metab Toxicol | year= 2008 | volume= 4 | issue= 4 | pages= 453-61 | pmid=18433347 | doi=10.1517/17425255.4.4.453  | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18433347  }} </ref> and alcaftadine<ref name="pmid21339800">{{cite journal| author=Greiner JV, Edwards-Swanson K, Ingerman A| title=Evaluation of alcaftadine 0.25% ophthalmic solution in acute allergic conjunctivitis at 15 minutes and 16 hours after instillation versus placebo and olopatadine 0.1%. | journal=Clin Ophthalmol | year= 2011 | volume= 5 | issue=  | pages= 87-93 | pmid=21339800 | doi=10.2147/OPTH.S15379 | pmc=3037035 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21339800  }} </ref>  are administered once-daily and maintain effectiveness through 16 hours after administration, as demonstrated in [[conjunctival]] [[allergen]] challenge studies.
-[[Mast cell stabilizer]]s can help curing patients with allergic conjunctivitis when [[cold compress]] are no longer effective. They tend to have delayed results, but they have fewer side-effects than the other treatments and last much longer than those of [[antihistamines]]. Some patients are given an [[antihistamine]] at the same time so that there is some relief of symptoms before the mast cell stabilizers becomes effective. Doctors commonly prescribe [[lodoxamide]] and [[nedocromil]] as mast cell stabilizers, which come as [[eye drop]]s.
-A mast cell stabilizer is a class of non-steroid controller medicine that reduces the release of inflammation-causing chemicals from mast cells. They block a calcium channel essential for mast cell degranulation, stabilizing the cell, thus preventing the release of [[histamine]]. Decongestants may also be prescribed. Another common mast cell stabilizer that is used for treating allergic conjunctivitis is [[sodium cromoglicate]].
-[[Antihistamine]] medications are frequently prescribed because they provide immediate relief from the itch and burning symptoms.
-Dual-action medications are also prescribed frequently. Olopatadine (Patanol)<ref>{{cite journal |author=Rosenwasser LJ, O'Brien T, Weyne J |title=Mast cell stabilization and anti-histamine effects of olopatadine ophthalmic solution: a review of pre-clinical and clinical research |journal=Curr Med Res Opin |volume=21 |issue=9 |pages=1377–87 |year=2005 |month=September|pmid=16197656 |doi=10.1185/030079905X56547 |url=http://informahealthcare.com/doi/abs/10.1185/030079905X56547}}</ref> and [[Ketotifen Fumarate]] (Alaway or Zaditor)<ref>{{cite journal |author=Avunduk AM, Tekelioglu Y, Turk A, Akyol N |title=Comparison of the effects of ketotifen fumarate 0.025% and olopatadine HCl 0.1% ophthalmic solutions in seasonal allergic conjunctivities: a 30-day, randomized, double-masked, artificial tear substitute-controlled trial |journal=Clin Ther |volume=27 |issue=9|pages=1392–402 |year=2005 |month=September |pmid=16291412 |doi=10.1016/j.clinthera.2005.09.013|url=http://linkinghub.elsevier.com/retrieve/pii/S0149-2918(05)00178-5}}</ref> both provide protection by acting as an antihistamine and a mast cell stabilizer together. Patanol is a prescription medication, whereas [[Ketotifen Fumarate]] is not.
-It is mandatory that the patients not use anything besides clean, warm water until visiting their doctors. Many of the eye drops can cause burning and stinging, and usually nearly all medications have [[side-effects]]. Therefore, patients are strongly recommended to first talk to their doctors before using any type of medication.
-Individuals prone to developing allergenic conjunctivitis may prevent getting the condition by having proper eye [[hygiene]], especially if wearing contact lenses. People allergic to pollen or mold are also advised to stay indoors when allergen levels are high. Allergic persons are recommended to keep the doors and windows closed and use air conditioners during the summer months to prevent developing allergic conjunctivitis.
 ==References==