Allergic conjunctivitis medical therapy: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
 
(22 intermediate revisions by the same user not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Allergic conjunctivitis}}
{{Allergic conjunctivitis}}
{{CMG}}
{{CMG}} {{AE}} {{Sujaya}}


==Overview==
==Overview==
To suppress the inflammation that underlies AC signs and symptoms, interventions that target one or more points in the inflammatory response cascade are necessary (Table 1). The most common treatment approach for management of extant AC is use of a topical pharmacologic medication (e.g., a dual-acting antihistamine–mast cell stabilizer agent) to reduce inflammation combined with nonpharmacologic remedies (e.g., cold compresses or artificial tears) to provide temporary symptomatic relief.23,32 Although this approach is effective for most patients with mild symptoms of SAC or PAC, none of these medications last a full 24 hours. In addition, patients who experience moderate to severe symptoms that significantly interfere with daily activities and quality of life may require more effective and longer-lasting treatment. There have been few recent developments in strategies for treatment of AC. Existing drug classes and immunotherapies have been modified to improve safety and efficacy profiles, but AC remains inconvenient and costly to manage. A key limitation of many topical AC treatments is the need for multiple daily instillations to maintain symptomatic relief.2,16,33
[[Therapeutic]] interventions for [[allergic]] [[conjunctivitis]] target one or more points in the [[inflammatory]] response cascade. The most common treatment approach is use of a [[topical]] [[pharmacologic]] [[medication]] combined with cold compresses or artificial tears.Moderate to severe [[symptoms]] affecting quality of life may warrant more [[effective]] and longer-lasting [[treatment]].A key limitation of many [[topical]] [[treatments]] is the need for multiple daily dosing for maintenance.


==[[Medical]] [[Therapy]]==
==[[Medical]] [[Therapy]]==
Line 10: Line 10:
* Inhibits binding of free [[histamine]] to its receptors, thus preventing further release of [[inflammatory]] mediators from [[mast]] [[cells]].  
* 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.
*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.
*Most dual-acting agents, like [[ketotifen]] 0.025% [[ophthalmic]] solution<ref name="pmid12742839">{{cite journal| author=Abelson MB, Chapin MJ, Kapik BM, Shams NB| title=Efficacy of ketotifen fumarate 0.025% ophthalmic solution compared with placebo in the conjunctival allergen challenge model. | journal=Arch Ophthalmol | year= 2003 | volume= 121 | issue= 5 | pages= 626-30 | pmid=12742839 | doi=10.1001/archopht.121.5.626 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12742839  }} </ref>,  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 0.25%<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]] Stablizers===
===[[Mast]] [[Cell]] Stablizers===
*Topical mast [[cell]] stabilizers (e.g., cromolyn sodium, lodoxamide tromethamine, nedocromil sodium, pemirolast potassium) inhibit the early phase response by preventing release of [[histamine]], [[cytokines]], and other [[inflammatory]] and [[chemotactic]] mediators<ref name="pmid22067457">{{cite journal| author=Bielory BP, O'Brien TP, Bielory L| title=Management of seasonal allergic conjunctivitis: guide to therapy. | journal=Acta Ophthalmol | year= 2012 | volume= 90 | issue= 5 | pages= 399-407 | pmid=22067457 | doi=10.1111/j.1755-3768.2011.02272.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22067457  }} </ref>.
*Most mast [[cell]] stabilizers need to be given four to six times daily; nedocromil sodium can be given twice daily<ref name="pmid24150468">{{cite journal| author=Azari AA, Barney NP| title=Conjunctivitis: a systematic review of diagnosis and treatment. | journal=JAMA | year= 2013 | volume= 310 | issue= 16 | pages= 1721-9 | pmid=24150468 | doi=10.1001/jama.2013.280318 | pmc=4049531 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24150468  }} </ref>.
*The required loading time for maximal [[efficacy]] of mast [[cell stabilizers]], necessitates their initiation before [[symptoms]] appear<ref name="pmid22067457">{{cite journal| author=Bielory BP, O'Brien TP, Bielory L| title=Management of seasonal allergic conjunctivitis: guide to therapy. | journal=Acta Ophthalmol | year= 2012 | volume= 90 | issue= 5 | pages= 399-407 | pmid=22067457 | doi=10.1111/j.1755-3768.2011.02272.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22067457  }} </ref>.
'''Common [[drug]] regimens''': 2% [[Cromolyn]] [[sodium]]<ref name="pmid3932499">{{cite journal| author=Kray KT, Squire EN, Tipton WR, Selner JC, O'Dea J, Nelson HS| title=Cromolyn sodium in seasonal allergic conjunctivitis. | journal=J Allergy Clin Immunol | year= 1985 | volume= 76 | issue= 4 | pages= 623-7 | pmid=3932499 | doi=10.1016/0091-6749(85)90785-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3932499  }} </ref>, 2% [[nedocromil]] [[sodium]]<ref name="pmid8030804">{{cite journal| author=Melamed J, Schwartz RH, Hirsch SR, Cohen SH| title=Evaluation of nedocromil sodium 2% ophthalmic solution for the treatment of seasonal allergic conjunctivitis. | journal=Ann Allergy | year= 1994 | volume= 73 | issue= 1 | pages= 57-66 | pmid=8030804 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8030804  }} </ref>
===[[Corticosteroids]]===
*They inhibit formation of multiple classes of late-phase response mediators, including [[prostaglandins]], [[leukotrienes]], [[histamine]], and some [[cytokines]]<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>.
*[[Corticosteroids]] are not the first choice for AC except for moderate-to-severe [[inflammation]] unlikely to respond adequately to [[antihistamine]]–mast [[cell]] stabilizer [[medications]].
*Due to the potential for side effects, they are administered for short durations in the early stages or during [[flare-ups]] until controlled with safer [[medications]] such as antihistamines, mast [[cell]] stabilizers, or dual-acting, single-molecule antihistamine–mast [[cell]] stabilizer agents<ref name="pmid23974684">{{cite journal| author=O'Brien TP| title=Allergic conjunctivitis: an update on diagnosis and management. | journal=Curr Opin Allergy Clin Immunol | year= 2013 | volume= 13 | issue= 5 | pages= 543-9 | pmid=23974684 | doi=10.1097/ACI.0b013e328364ec3a | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23974684  }} </ref>.
*Most cases of SAC or PAC do not often require [[corticosteroids]]. For patients who require long-term use of [[corticosteroids]], close observation by an [[ophthalmologist]] is recommended<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>.
===[[Nonsteroidal]] [[Anti-inflammatory]] [[Drugs]]<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>===
* All [[topical]] [[NSAID]]s (e.g., ketorolac, nepafenac, bromfenac) can be used chronically to relieve [[itching]]<ref name="pmid20159228">{{cite journal| author=Kim SJ, Flach AJ, Jampol LM| title=Nonsteroidal anti-inflammatory drugs in ophthalmology. | journal=Surv Ophthalmol | year= 2010 | volume= 55 | issue= 2 | pages= 108-33 | pmid=20159228 | doi=10.1016/j.survophthal.2009.07.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20159228  }} </ref>.
* They require four times daily dosing.
*A [[systematic]] [[review]] revealed that [[topical]] [[NSAID]]s were ineffective on other [[symptoms]], such as [[chemosis]] or [[swelling]]<ref name="pmid17994441">{{cite journal| author=Swamy BN, Chilov M, McClellan K, Petsoglou C| title=Topical non-steroidal anti-inflammatory drugs in allergic conjunctivitis: meta-analysis of randomized trial data. | journal=Ophthalmic Epidemiol | year= 2007 | volume= 14 | issue= 5 | pages= 311-9 | pmid=17994441 | doi=10.1080/09286580701299411 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17994441  }} </ref>.
*They are rarely used today because of their lack of [[efficacy]] as a result of inhibition of release of only one type of [[inflammatory]] mediator (i.e., [[prostaglandins]].
'''Common [[drug]] regimens''': [[Ketorolac]] 0.4%-0.5% [[ophthalmic]] solution<ref name="pmid18433352">{{cite journal| author=Schechter BA| title=Ketorolac tromethamine 0.4% as a treatment for allergic conjuctivitis. | journal=Expert Opin Drug Metab Toxicol | year= 2008 | volume= 4 | issue= 4 | pages= 507-11 | pmid=18433352 | doi=10.1517/17425255.4.4.507  | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18433352  }} </ref>
===[[Leukotriene]] [[receptor]] [[antagonists]]<ref name="pmid24229824">{{cite journal| author=Gane J, Buckley R| title=Leukotriene receptor antagonists in allergic eye disease: a systematic review and meta-analysis. | journal=J Allergy Clin Immunol Pract | year= 2013 | volume= 1 | issue= 1 | pages= 65-74 | pmid=24229824 | doi=10.1016/j.jaip.2012.07.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24229824  }} </ref>===
* [[Montelukast]], available for [[oral]] dosing, prevent binding of [[leukotrienes]] to their [[conjunctival]] [[receptors]] to decrease [[inflammation]] and relieve multiple [[ocular]] [[allergic]] [[symptoms]].
* [[Leukotriene]] [[receptor]] [[antagonists]] have a slower onset of action and are less effective than [[topical]] [[antihistamines]. Therefore, they are not the first-line therapy or [[monotherapy]]  for [[allergic]] [[conjunctivitis]].
===[[Antihistamine]]–[[Vasoconstrictor]] Combinations<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>===
*[[Topical]] [[vasoconstrictors]] effectively reduces [[ocular]] [[hyperemia]] by stimulating [[vascular]] [[α-adrenergic]] [[receptors]].
*[[Vasoconstrictors]] come in common, nonprescription combination formulations consisting of an [[antihistamine]] (e.g., naphazoline-antazoline, naphazoline-pheniramine). They start acting rapidly,and improve [[redness]] and [[itchiness]].
*Long-term use reduces [[effectiveness]] over time and gives rise to a potential [[rebound]] effect characterized by persistent red [[eye]] on discontinuation<ref name="pmid22067457">{{cite journal| author=Bielory BP, O'Brien TP, Bielory L| title=Management of seasonal allergic conjunctivitis: guide to therapy. | journal=Acta Ophthalmol | year= 2012 | volume= 90 | issue= 5 | pages= 399-407 | pmid=22067457 | doi=10.1111/j.1755-3768.2011.02272.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22067457  }} </ref>.
* Like [[topical]] [[antihistamines]], combination [[antihistamine]]-[[vasoconstrictor]] formulations have a relatively short duration of action and are administered four times daily<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>.
===[[Topical]] [[antihistamines]]<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>===
*[[Topical]] [[antihistamines]] are widely available over the counter [[medications]].
*They competitively block [[histamine]] receptors on [[nerve]] endings and [[blood]] vessels of the [[mucosal]] surface, thereby reducing [[itching]] and [[conjunctival]] [[hyperemia]]<ref name="pmid24229824">{{cite journal| author=Gane J, Buckley R| title=Leukotriene receptor antagonists in allergic eye disease: a systematic review and meta-analysis. | journal=J Allergy Clin Immunol Pract | year= 2013 | volume= 1 | issue= 1 | pages= 65-74 | pmid=24229824 | doi=10.1016/j.jaip.2012.07.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24229824  }} </ref>.
*First-generation [[antihistamines]] gave rise to various [[systemic]] adverse effects (e.g., [[sedation]], [[dizziness]], [[cognitive]] impairment, blurred [[vision]]) due to the [[anticholinergic]] actions and nonspecific binding to the H2 [[receptors]]. Newer [[oral]], [[intranasal]], and [[topical]] [[ocular]] [[antihistamines]] demonstrate improved H1 [[receptor selectivity]], however burning and [[dryness]] of the eyes remain a concern.
*[[Topical]] [[antihistamines]] (e.g., levocabastine, emedastine difumarate) provide rapid, [[symptomatic]] relief, but require dosing four times daily due to shorter duration of action<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>.
===[[Allergen]] specific [[immunotherapy]]===
*[[Allergen]] [[immunotherapy]] is indicated for patients with inadequate response to or unacceptable adverse effects from [[pharmacologic]] agents<ref name="pmid17765078">{{cite journal| author=Joint Task Force on Practice Parameters. American Academy of Allergy, Asthma and Immunology. American College of Allergy, Asthma and Immunology. Joint Council of Allergy, Asthma and Immunology| title=Allergen immunotherapy: a practice parameter second update. | journal=J Allergy Clin Immunol | year= 2007 | volume= 120 | issue= 3 Suppl | pages= S25-85 | pmid=17765078 | doi=10.1016/j.jaci.2007.06.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17765078  }} </ref>.
*[[Immunotherapy]] improves [[symptoms]] of [[itchiness]], watery [[eyes]], and red [[eyes]] by desensitizing individuals to the triggers and preventing the activation of [[inflammatory]] signaling pathways<ref name="pmid21848759">{{cite journal| author=Calderon MA, Penagos M, Sheikh A, Canonica GW, Durham SR| title=Sublingual immunotherapy for allergic conjunctivitis: Cochrane systematic review and meta-analysis. | journal=Clin Exp Allergy | year= 2011 | volume= 41 | issue= 9 | pages= 1263-72 | pmid=21848759 | doi=10.1111/j.1365-2222.2011.03835.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21848759  }} </ref>.
*Despite its effectiveness, this treatment approach,a majority of patients do not pursue [[desensitizing]] [[immunotherapy]] options recommended by their health care providers.Rather, they use prescription or nonprescription medications to manage their [[symptoms]]<ref name="pmid24679733">{{cite journal| author=Blaiss MS, Dykewicz MS, Skoner DP, Smith N, Leatherman B, Craig TJ | display-authors=etal| title=Diagnosis and treatment of nasal and ocular allergies: the Allergies, Immunotherapy, and RhinoconjunctivitiS (AIRS) surveys. | journal=Ann Allergy Asthma Immunol | year= 2014 | volume= 112 | issue= 4 | pages= 322-8.e1 | pmid=24679733 | doi=10.1016/j.anai.2014.02.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24679733  }} </ref>.


==References==
==References==

Latest revision as of 18:38, 10 September 2022

Allergic conjunctivitis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Allergic Conjunctivitis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Allergic conjunctivitis medical therapy On the Web

recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Allergic conjunctivitis medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

National Guidelines Clearinghouse

NICE Guidance

FDA on Allergic conjunctivitis medical therapy

CDC on Allergic conjunctivitis medical therapy

Allergic conjunctivitis medical therapy in the news

Blogs on Allergic conjunctivitis medical therapy

Directions to Hospitals Treating Allergic conjunctivitis

Risk calculators and risk factors for Allergic conjunctivitis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sujaya Chattopadhyay, M.D.[2]

Overview

Therapeutic interventions for allergic conjunctivitis target one or more points in the inflammatory response cascade. The most common treatment approach is use of a topical pharmacologic medication combined with cold compresses or artificial tears.Moderate to severe symptoms affecting quality of life may warrant more effective and longer-lasting treatment.A key limitation of many topical treatments is the need for multiple daily dosing for maintenance.

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, like ketotifen 0.025% ophthalmic solution[2], require twice-daily dosing[3]. Olopatadine 0.2%[4] and alcaftadine 0.25%[5] are administered once-daily and maintain effectiveness through 16 hours after administration, as demonstrated in conjunctival allergen challenge studies.

Mast Cell Stablizers

  • Topical mast cell stabilizers (e.g., cromolyn sodium, lodoxamide tromethamine, nedocromil sodium, pemirolast potassium) inhibit the early phase response by preventing release of histamine, cytokines, and other inflammatory and chemotactic mediators[6].
  • Most mast cell stabilizers need to be given four to six times daily; nedocromil sodium can be given twice daily[7].
  • The required loading time for maximal efficacy of mast cell stabilizers, necessitates their initiation before symptoms appear[6].

Common drug regimens: 2% Cromolyn sodium[8], 2% nedocromil sodium[9]

Corticosteroids

Nonsteroidal Anti-inflammatory Drugs[1]

Common drug regimens: Ketorolac 0.4%-0.5% ophthalmic solution[13]

Leukotriene receptor antagonists[14]

Antihistamine–Vasoconstrictor Combinations[1]

Topical antihistamines[1]

Allergen specific immunotherapy

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 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.
  2. ↑ Abelson MB, Chapin MJ, Kapik BM, Shams NB (2003). "Efficacy of ketotifen fumarate 0.025% ophthalmic solution compared with placebo in the conjunctival allergen challenge model". Arch Ophthalmol. 121 (5): 626–30. doi:10.1001/archopht.121.5.626. PMID 12742839.
  3. ↑ 3.0 3.1 3.2 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 6.0 6.1 6.2 Bielory BP, O'Brien TP, Bielory L (2012). "Management of seasonal allergic conjunctivitis: guide to therapy". Acta Ophthalmol. 90 (5): 399–407. doi:10.1111/j.1755-3768.2011.02272.x. PMID 22067457.
  7. ↑ Azari AA, Barney NP (2013). "Conjunctivitis: a systematic review of diagnosis and treatment". JAMA. 310 (16): 1721–9. doi:10.1001/jama.2013.280318. PMC 4049531. PMID 24150468.
  8. ↑ Kray KT, Squire EN, Tipton WR, Selner JC, O'Dea J, Nelson HS (1985). "Cromolyn sodium in seasonal allergic conjunctivitis". J Allergy Clin Immunol. 76 (4): 623–7. doi:10.1016/0091-6749(85)90785-7. PMID 3932499.
  9. ↑ Melamed J, Schwartz RH, Hirsch SR, Cohen SH (1994). "Evaluation of nedocromil sodium 2% ophthalmic solution for the treatment of seasonal allergic conjunctivitis". Ann Allergy. 73 (1): 57–66. PMID 8030804.
  10. ↑ O'Brien TP (2013). "Allergic conjunctivitis: an update on diagnosis and management". Curr Opin Allergy Clin Immunol. 13 (5): 543–9. doi:10.1097/ACI.0b013e328364ec3a. PMID 23974684.
  11. ↑ Kim SJ, Flach AJ, Jampol LM (2010). "Nonsteroidal anti-inflammatory drugs in ophthalmology". Surv Ophthalmol. 55 (2): 108–33. doi:10.1016/j.survophthal.2009.07.005. PMID 20159228.
  12. ↑ Swamy BN, Chilov M, McClellan K, Petsoglou C (2007). "Topical non-steroidal anti-inflammatory drugs in allergic conjunctivitis: meta-analysis of randomized trial data". Ophthalmic Epidemiol. 14 (5): 311–9. doi:10.1080/09286580701299411. PMID 17994441.
  13. ↑ Schechter BA (2008). "Ketorolac tromethamine 0.4% as a treatment for allergic conjuctivitis". Expert Opin Drug Metab Toxicol. 4 (4): 507–11. doi:10.1517/17425255.4.4.507. PMID 18433352.
  14. ↑ 14.0 14.1 Gane J, Buckley R (2013). "Leukotriene receptor antagonists in allergic eye disease: a systematic review and meta-analysis". J Allergy Clin Immunol Pract. 1 (1): 65–74. doi:10.1016/j.jaip.2012.07.001. PMID 24229824.
  15. ↑ Joint Task Force on Practice Parameters. American Academy of Allergy, Asthma and Immunology. American College of Allergy, Asthma and Immunology. Joint Council of Allergy, Asthma and Immunology (2007). "Allergen immunotherapy: a practice parameter second update". J Allergy Clin Immunol. 120 (3 Suppl): S25–85. doi:10.1016/j.jaci.2007.06.019. PMID 17765078.
  16. ↑ Calderon MA, Penagos M, Sheikh A, Canonica GW, Durham SR (2011). "Sublingual immunotherapy for allergic conjunctivitis: Cochrane systematic review and meta-analysis". Clin Exp Allergy. 41 (9): 1263–72. doi:10.1111/j.1365-2222.2011.03835.x. PMID 21848759.
  17. ↑ Blaiss MS, Dykewicz MS, Skoner DP, Smith N, Leatherman B, Craig TJ; et al. (2014). "Diagnosis and treatment of nasal and ocular allergies: the Allergies, Immunotherapy, and RhinoconjunctivitiS (AIRS) surveys". Ann Allergy Asthma Immunol. 112 (4): 322–8.e1. doi:10.1016/j.anai.2014.02.006. PMID 24679733.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Allergic_conjunctivitis_medical_therapy&oldid=1729769"