Treating the Ocular Component of Allergic Rhinoconjunctivitis and Related Eye Disorders

Leonard Bielory, MD; C. H. Katelaris, MD; Susan Lightman, FRCP, FRCOphth, PhD; Robert M. Naclerio, MD

Summary

Ocular allergies, which are often underdiagnosed, have a significant impact on the life of the patient. These symptoms are expensive in terms of treatment and also in terms of indirect costs. It is vital to reach a better understanding of allergic mechanisms and inflammation, which may lead to improved treatment. Moreover, the emergence of new medications for the treatment of nasal and ocular symptoms may improve compliance in patients suffering from allergic conditions, such as AR, in which the ocular component is present. Currently, the most effective treatments for AR are INS; it would be advantageous, therefore, to develop a drug of this class that is consistently shown to improve eye symptoms (as well as nasal symptoms) to provide greater symptom relief, increase patient compliance, and reduce costs associated with the current requirement for multiple medications.

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^{Aberg N. Asthma and allergic rhinitis in Swedish conscripts. Clin Exp Allergy. 1989;19:59-63. Abstract

Barbee RA, Kaltenborn W, Lebowitz MD, et al. Longitudinal changes in allergen skin test reactivity in a community population sample. J Allergy Clin Immunol. 1987;79:16-24. Abstract

Maziak W, Behrens T, Brasky TM, et al. Are asthma and allergies in children and adolescents increasing. Results from ISAAC phase I and phase III surveys in Munster, Germany. Allergy. 2003;58:572-579. Abstract

Verlato G, Corsico A, Villani S, et al. Is the prevalence of adult asthma and allergic rhinitis still increasing. Results of an Italian study. J Allergy Clin Immunol. 2003;111:1232-1238. Abstract

Bielory L. Update on ocular allergy treatment. Expert Opin Pharmacother. 2002;3:541-553. Abstract

Austin JB, Kaur B, Anderson HR, et al. Hay fever, eczema, and wheeze: a nationwide UK study (ISAAC, international study of asthma and allergies in childhood). Arch Dis Child. 1999;81:225-230. Abstract

Nathan RA, Meltzer EO, Selner JC, et al. Prevalence of allergic rhinitis in the United States. J Allergy Clin Immunol. 1997;99:S808-S814.

Bousquet J, van Cauwenberge P, Khaltaev N. Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol. 2001;108:S147-S334. Abstract

ECRHS. Variations in the prevalence of respiratory symptoms, self-reported asthma attacks, and use of asthma medication in the European Community Respiratory Health Survey (ECRHS). Eur Respir J. 1996;9:687-695. Abstract

HealthSTAR Communications. Allergies in America: executive summary. Available at: www.myallergiesinamerica.com Accessed January 17, 2007.

Singh K, Bielory L, Hackensack NJ, et al. Epidemiology of ocular allergy symptoms in United States adults (1988-1994). Presented at the American College of Allergy, Asthma & Immunology Annual Meeting, Philadelphia, Pennsylvania, November 9-15, 2006; Abstract 34.

Singh K, Bielory L, Hackensack NJ, et al. Epidemiology of ocular allergy symptoms in regional parts of the United States in the adult population (1988-1994). Presented at the American College of Allergy, Asthma & Immunology Annual Meeting, Philadelphia, Pennsylvania, November 9-15, 2006; Abstract 35.

Viinanen A, Munhbayarlah S, Zevgee T, et al. Prevalence of asthma, allergic rhinoconjunctivitis and allergic sensitization in Mongolia. Allergy. 2005;60:1370-1377. Abstract

Hussain A, Awan H, Khan MD. Prevalence of non-vision-impairing conditions in a village in Chakwal district, Punjab, Pakistan. Ophthal Epidemiol. 2004;11:413-426.

Kosrirukvongs P, Visitsunthorn N, Vichyanond P, et al. Allergic Conjunctivitis. Asian Pac J Allergy Immunol. 2001;19:237-244. Abstract

Scadding GK, Richards DH, Price MJ. Patient and physician perspectives on the impact and management of perennial and seasonal allergic rhinitis. Clin Otolaryngol Allied Sci. 2000;25:551-557. Abstract

Bousquet J, Knani J, Hejjaoui A, et al. Heterogeneity of atopy. I. Clinical and immunologic characteristics of patients allergic to cypress pollen. Allergy. 1993;48:183-188. Abstract

Wuthrich B, Brignoli R, Canevascini M, et al. Epidemiological survey in hay fever patients: symptom prevalence and severity and influence on patient management. Schweiz Med Wochenschr. 1998;128:139-143. Abstract

Pitt AD, Smith AF, Lindsell L, et al. Economic and quality-of-life impact of seasonal allergic conjunctivitis in Oxfordshire. Ophthal Epidemiol. 2004;11:17-33.

Smith AF, Pitt AD, Rodruiguez AE, et al. The economic and quality of life impact of seasonal allergic conjunctivitis in a Spanish setting. Ophthal Epidemiol. 2005;12:233-242.

Bernstein DI, Levy AL, Hampel FC, et al. Treatment with intranasal fluticasone propionate significantly improves ocular symptoms in patients with seasonal allergic rhinitis. Clin Exp Allergy. 2004;34:952-957. Abstract

DeWester J, Philpot EE, Westlund RE, et al. The efficacy of intranasal fluticasone propionate in the relief of ocular symptoms associated with seasonal allergic rhinitis. Allergy Asthma Proc. 2003;24:331-337. Abstract

Meltzer EO, Bachert C, Bloom M, et al. Efficacy of intranasal mometasone furoate for the treatment of ocular symptoms in patients with seasonal allergic rhinitis. Allergy Clin Immunol Int. 2005;17: Abstract 709.

Craig JP, Tomlinson A. Effect of age on tear osmolality. Optom Vis Sci. 1995;72:713-717. Abstract

Furukawa RE, Polse KA. Changes in tear flow accompanying aging. Am J Optom Physiol Opt. 1978;55:69-74. Abstract

Law AW, Reed SD, Sundy JS, et al. Direct costs of allergic rhinitis in the United States: estimates from the 1996 Medical Expenditure Panel Survey. J Allergy Clin Immunol. 2003;111:296-300. Abstract

Donshik PC, Porazinski AD. Giant papillary conjunctivitis in frequent-replacement contact lens wearers: a retrospective study. Trans Am Ophthalmol Soc. 1999;97:205-216. Abstract

Belfort R, Marbeck P, Hsu CC, et al. Epidemiological study of 134 subjects with allergic conjunctivitis. Acta Ophthalmol Scand Suppl. 2000;38-40.

Bielory L. Allergic diseases of the eye. Med Clin North Am. 2006;90:129-148. Abstract

Chambless SL, Trocme S. Developments in ocular allergy. Curr Opin Allergy Clin Immunol. 2004;4:431-434. Abstract

Butrus S, Portela R. Ocular allergy: diagnosis and treatment. Ophthalmol Clin North Am. 2005;18:485-492. Abstract

Tanaka M, Dogru M, Takano Y, et al. The relation of conjunctival and corneal findings in severe ocular allergies. Cornea. 2004;23:464-467. Abstract

Onguchi T, Dogru M, Okada N, et al. The impact of the onset time of atopic keratoconjunctivitis on the tear function and ocular surface findings. Am J Ophthalmol. 2006;141:569-571. Abstract

Takano Y, Fukagawa K, Dogru M, et al. Inflammatory cells in brush cytology samples correlate with the severity of corneal lesions in atopic keratoconjunctivitis. Br J Ophthalmol. 2004;88:1504-1505. Abstract

McGill JI, Holgate ST, Church MK, et al. Allergic eye disease mechanisms. Br J Ophthalmol. 1998;82:1203-1214. Abstract

Bacon AS, Ahluwalia P, Irani AM, et al. Tear and conjunctival changes during the allergen-induced early- and late-phase responses. J Allergy Clin Immunol. 2000;106:948-954. Abstract

Anderson DF, MacLeod JD, Baddeley SM, et al. Seasonal allergic conjunctivitis is accompanied by increased mast cell numbers in the absence of leucocyte infiltration. Clin Exp Allergy. 1997;27:1060-1066. Abstract

Leonardi A, Curnow SJ, Zhan H, et al. Multiple cytokines in human tear specimens in seasonal and chronic allergic eye disease and in conjunctival fibroblast cultures. Clin Exp Allergy. 2006;36:777-784. Abstract

Calder VL, Jolly G, Hingorani M, et al. Cytokine production and mRNA expression by conjunctival T-cell lines in chronic allergic eye disease. Clin Exp Allergy. 1999;29:1214-1222. Abstract

Nivenius E, Montan PG, Chryssanthou E, et al. No apparent association between periocular and ocular microcolonization and the degree of inflammation in patients with atopic keratoconjunctivitis. Clin Exp Allergy. 2004;34:725-730. Abstract

Matsuura N, Uchio E, Nakazawa M, et al. Predominance of infiltrating IL-4-producing T cells in conjunctiva of patients with allergic conjunctival disease. Curr Eye Res. 2004;29:235-243. Abstract

Leonardi A, Jose PJ, Zhan H, et al. Tear and mucus eotaxin-1 and eotaxin-2 in allergic keratoconjunctivitis. Ophthalmology. 2003;110:487-492. Abstract

Trocme SD, Hallberg CK, Gill KS, et al. Effects of eosinophil granule proteins on human corneal epithelial cell viability and morphology. Invest Ophthalmol Vis Sci. 1997;38:593-599. Abstract

Hingorani M, Calder V, Jolly G, et al. Eosinophil surface antigen expression and cytokine production vary in different ocular allergic diseases. J Allergy Clin Immunol. 1998;102:821-830. Abstract

Sarac O, Erdener U, Irkec M, et al. Tear eotaxin levels in giant papillary conjunctivitis associated with ocular prosthesis. Ocul Immunol Inflamm. 2003;11:223-230. Abstract

Trocme SD, Leiferman KM, George T, et al. Neutrophil and eosinophil participation in atopic and vernal keratoconjunctivitis. Curr Eye Res. 2003;26:319-325. Abstract

Stokes TC, Feinberg G. Rapid onset of action of levocabastine eye-drops in histamine-induced conjunctivitis. Clin Exp Allergy. 1993;23:791-794. Abstract

Donshik PC, Pearlman D, Pinnas J, et al. Efficacy and safety of ketorolac tromethamine 0.5% and levocabastine 0.05%: a multicenter comparison in patients with seasonal allergic conjunctivitis. Adv Ther. 2000;17:94-102. Abstract

Novartis Ophthalmics. Livostin Prescribing Information; 2002.

Hayes VY, Schnider CM, Veys J. An evaluation of 1-day disposable contact lens wear in a population of allergy sufferers. Cont Lens Anterior Eye. 2003;26:85-93. Abstract

Abelson MB, Paradis A, George MA, et al. Effects of Vasocon-A in the llergen challenge model of acute allergic conjunctivitis. Arch Ophthalmol. 1990;108:520-524. Abstract

Spector SL, Raizman MB. Conjunctivitis medicamentosa. J Allergy Clin Immunol. 1994;94:134-136. Abstract

Azevedo M, Castel-Branco MG, Oliveira JF, et al. Double-blind comparison of levocabastine eye drops with sodium cromoglycate and placebo in the treatment of seasonal allergic conjunctivitis. Clin Exp Allergy. 1991;21:689-694. Abstract

Sorkin EM, Ward A. Ocular sodium cromoglycate. An overview of its therapeutic efficacy in allergic eye disease. Drugs. 1986;31:131-148. Abstract

Friday GA, Biglan AW, Hiles DA, et al. Treatment of ragweed allergic conjunctivitis with cromolyn sodium 4% ophthalmic solution. Am J Ophthalmol. 1983;95:169-174. Abstract

Johnson HG, White GJ. Development of new antiallergic drugs (cromolyn sodium, lodoxamide tromethamine). What is the role of cholinergic stimulation in the biphasic dose response. Monogr Allergy. 1979;14:299-306. Abstract

Santos CI, Huang AJ, Abelson MB, et al. Efficacy of lodoxamide 0.1% ophthalmic solution in resolving corneal epitheliopathy associated with vernal keratoconjunctivitis. Am J Ophthalmol. 1994;117:488-497. Abstract

el Hennawi M. A double blind placebo controlled group comparative study of ophthalmic sodium cromoglycate and nedocromil sodium in the treatment of vernal keratoconjunctivitis. Br J Ophthalmol. 1994;78:365-369. Abstract

Verin PH, Dicker ID, Mortemousque B. Nedocromil sodium eye drops are more effective than sodium cromoglycate eye drops for the long-term management of vernal keratoconjunctivitis. Clin Exp Allergy. 1999;29:529-536. Abstract

Discepola M, Deschenes J, Abelson M. Comparison of the topical ocular antiallergic efficacy of emedastine 0.05% ophthalmic solution to ketorolac 0.5% ophthalmic solution in a clinical model of allergic conjunctivitis. Acta Ophthalmol Scand Suppl. 1999;43-46.

Narvaez J, Kroll P, Guzek JP. Effect of topical diclofenac and ketorolac on patient discomfort and corneal sensitivity. J Refract Surg. 2002;18:145-148. Abstract

Shulman DG, Amdahl L, Washington C, et al. A combined analysis of two studies assessing the ocular comfort of antiallergy ophthalmic agents. Clin Ther. 2003;25:1096-1106. Abstract

Dell SJ, Shulman DG, Lowry GM, et al. A controlled evaluation of the efficacy and safety of loteprednol etabonate in the prophylactic treatment of seasonal allergic conjunctivitis. Loteprednol Allergic Conjunctivitis Study Group. Am J Ophthalmol. 1997;123:791-797. Abstract

Dell SJ, Lowry GM, Northcutt JA, et al. A randomized, double-masked, placebo-controlled parallel study of 0.2% loteprednol etabonate in patients with seasonal allergic conjunctivitis. J Allergy Clin Immunol. 1998;102:251-255. Abstract

Fan DS, Yu CB, Chiu TY, et al. Ocular-hypertensive and anti-inflammatory response to rimexolone therapy in children. Arch Ophthalmol. 2003;121:1716-1721. Abstract

Pflugfelder SC, Maskin SL, Anderson B, et al. A randomized, double-masked, placebo-controlled, multicenter comparison of loteprednol etabonate ophthalmic suspension, 0.5%, and placebo for treatment of keratoconjunctivitis sicca in patients with delayed tear clearance. Am J Ophthalmol. 2004;138:444-457. Abstract

Burns E, Mulley GP. Practical problems with eye-drops among elderly ophthalmology outpatients. Age Ageing. 1992;21:168-170. Abstract

Leonardi A, Zafirakis P. Efficacy and comfort of olopatadine versus ketotifen ophthalmic solutions: a double-masked, environmental study of patient preference. Curr Med Res Opin. 2004;20:1167-1173. Abstract

Bielory L, Mongia A. Current opinion of immunotherapy for ocular allergy. Curr Opin Allergy Clin Immunol. 2002;2:447-452. Abstract

Noon L, Cantab BC. Prophylactic innoculation against hay fever. Lancet. 1911;1:1572-1574.

Lowell FC, Franklin W. A double-blind study of the effectiveness and specificity of injection therapy in ragweed hay fever. N Engl J Med. 1965;273:675-679. Abstract

Moller C, Dreborg S. Cross-reactivity between deciduous trees during immunotherapy. I. In vivo results. Clin Allergy. 1986;16:135-143. Abstract

Andersen NH, Jeppesen F, Schioler T, et al. Treatment of hay fever with sodium cromoglycate, hyposensitization, or a combination. Allergy. 1987;42:343-351. Abstract

Winther L, Malling HJ, Moseholm L, et al. Allergen-specific immunotherapy in birch- and grass-pollen-allergic rhinitis. I. Efficacy estimated by a model reducing the bias of annual differences in pollen counts. Allergy. 2000;55:818-826. Abstract

Prakash OM, Murthy KR. Immunotherapy in allergic conjunctivitis. Indian J Ophthalmol. 1992;40:9-10. Abstract

Durham SR, Walker SM, Varga EM, et al. Long-term clinical efficacy of grass-pollen immunotherapy. N Engl J Med. 1999;341:468-475. Abstract

Walker SM, Varney VA, Gaga M, et al. Grass pollen immunotherapy: efficacy and safety during a 4-year follow-up study. Allergy. 1995;50:405-413. Abstract

Moller C, Juto P, Dreborg S, et al. Blood lymphocyte proliferation response to pollen extract as a monitor of immunotherapy. Allergy. 1984;39:291-296. Abstract

Winther L, Malling HJ, Mosbech H. Allergen-specific immunotherapy in birch- and grass-pollen-allergic rhinitis. II. Side-effects. Allergy. 2000;55:827-835. Abstract

Del Prete A, Loffredo C, Carderopoli A, et al. Local specific immunotherapy in allergic conjunctivitis. Acta Ophthalmol (Copenh). 1994;72:631-634. Abstract

Juniper EF, Kline PA, Ramsdale EH, et al. Comparison of the efficacy and side effects of aqueous steroid nasal spray (budesonide) and allergen-injection therapy (Pollinex-R) in the treatment of seasonal allergic rhinoconjunctivitis. J Allergy Clin Immunol. 1990;85:606-611. Abstract

Sabbah A, Hassoun S, Le Sellin J, et al. A double-blind, placebo-controlled trial by the sublingual route of immunotherapy with a standardized grass pollen extract. Allergy. 1994;49:309-313. Abstract

Donovan JP, Buckeridge DL, Briscoe MP, et al. Efficacy of immunotherapy to ragweed antigen tested by controlled antigen exposure. Ann Allergy Asthma Immunol. 1996;77:74-80. Abstract

Ciprandi G, Buscaglia S, Pesce GP, et al. Protective effect of loratadine on specific conjunctival provocation test. Int Arch Allergy Appl Immunol. 1991;96:344-347. Abstract

Meltzer EO, Prenner BM, Nayak A. Efficacy and tolerability of once-daily 5mg desloratadine, an H1-receptor antagonist, in patients with seasonal allergic rhinitis: Assessment during the spring and fall allergy seasons. Clin Drug Invest. 2001;21:25-32.

Casale TB, Andrade C, Qu R. Safety and efficacy of once-daily fexofenadine HCl in the treatment of autumn seasonal allergic rhinitis. Allergy Asthma Proc. 1999;20:193-198. Abstract

Wahn U, Meltzer EO, Finn AF, Jr., et al. Fexofenadine is efficacious and safe in children (aged 6-11 years) with seasonal allergic rhinitis. J Allergy Clin Immunol. 2003;111:763-769. Abstract

Schoeneich M, Pecoud AR. Effect of cetirizine in a conjunctival provocation test with allergens. Clin Exp Allergy. 1990;20:171-174. Abstract

Tosca M, Ciprandi G, Passalacqua G, et al. Cetirizine reduces conjunctival nonspecific hyperreactivity in children with mite allergy. J Investig Allergol Clin Immunol. 1998;8:23-26. Abstract

Mansmann HC, Jr., Altman RA, Berman BA, et al. Efficacy and safety of cetirizine therapy in perennial allergic rhinitis. Ann Allergy. 1992;68:348-353. Abstract

Nevius JM, Abelson MB, Welch D. The ocular drying effect of oral antihistamines (Loratadine) in the normal population - An evaluation. Invest Ophthalmol Vis Sci. 1999;40:S549.

Welch D, Ousler GW, III, Nally LA, et al. Ocular drying associated with oral antihistamines (loratadine) in the normal population-an evaluation of exaggerated dose effect. Adv Exp Med Biol. 2002;506:1051-1055. Abstract

Crampton HJ. Comparison of ketotifen fumarate ophthalmic solution alone, desloratadine alone, and their combination for inhibition of the signs and symptoms of seasonal allergic rhinoconjunctivitis in the conjunctival allergen challenge model: a double-masked, placebo- and active-controlled trial. Clin Ther. 2003;25:1975-1987. Abstract

Lanier BQ, Gross RD, Marks BB, et al. Olopatadine ophthalmic solution adjunctive to loratadine compared with loratadine alone in patients with active seasonal allergic conjunctivitis symptoms. Ann Allergy Asthma Immunol. 2001;86:641-648. Abstract

Newson-Smith G, Powell M, Baehre M, et al. A placebo controlled study comparing the efficacy of intranasal azelastine and beclomethasone in the treatment of seasonal allergic rhinitis. Eur Arch Otorhinolaryngol. 1997;254:236-241. Abstract

LaForce C, Dockhorn RJ, Prenner BM, et al. Safety and efficacy of azelastine nasal spray (Astelin NS) for seasonal allergic rhinitis: a 4-week comparative multicenter trial. Ann Allergy Asthma Immunol. 1996;76:181-188. Abstract

Konno A, Togawa K. Role of the vidian nerve in nasal allergy. Ann Otol Rhinol Laryngol. 1979;88:258-266. Abstract

Wagenmann M, Baroody FM, Desrosiers M, et al. Unilateral nasal allergen challenge leads to bilateral release of prostaglandin D2. Clin Exp Allergy. 1996;26:371-378. Abstract

Malmberg H, Binder E, Fraki J, et al. Nasal reactions elicited by unilateral allergen challenge. Acta Otolaryngol. 1989;107:446-449. Abstract

Raphael GD, Igarashi Y, White MV, et al. The pathophysiology of rhinitis. V. Sources of protein in allergen-induced nasal secretions. J Allergy Clin Immunol. 1991;88:33-42. Abstract

Sheahan P, Walsh RM, Walsh MA, et al. Induction of nasal hyper-responsiveness by allergen challenge in allergic rhinitis: the role of afferent and efferent nerves. Clin Exp Allergy. 2005;35:45-51. Abstract

Loth S, Bende M. Effect of nasal anaesthesia on lacrimal function after nasal allergen challenge. Clin Exp Allergy. 1994;24:375-376. Abstract

Lebel B, Bousquet J, Morel A, et al. Correlation between symptoms and the threshold for release of mediators in nasal secretions during nasal challenge with grass-pollen grains. J Allergy Clin Immunol. 1988;82:869-877. Abstract

Patel P, Benninger P, Cooper A, et al. Testing a direct, highly sensitivity method for quantitation of fluticasone propionate in human plasma: contrasting nasal and inhaled exposure. J Allergy Clin Immunol. 2006;117:S190.

Brannan MD, Herron JM, Affrime MB. Safety and tolerability of once-daily mometasone furoate aqueous nasal spray in children. Clin Ther. 1997;19:1330-1339. Abstract

Spangler DL, Abelson MB, Ober A, et al. Randomized, double-masked comparison of olopatadine ophthalmic solution, mometasone furoate monohydrate nasal spray, and fexofenadine hydrochloride tablets using the conjunctival and nasal allergen challenge models. Clin Ther. 2003;25:2245-2267. Abstract

Weiner JM, Abramson MJ, Puy RM. Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials. BMJ. 1998;317:1624-1629. Abstract

Stempel DA, Thomas M. Treatment of allergic rhinitis: an evidence-based evaluation of nasal corticosteroids versus nonsedating antihistamines. Am J Manag Care. 1998;4:89-96. Abstract

Darnell R, Pecoud A, Richards DH. A double-blind comparison of fluticasone propionate aqueous nasal spray, terfenadine tablets and placebo in the treatment of patients with seasonal allergic rhinitis to grass pollen. Clin Exp Allergy. 1994;24:1144-1150. Abstract

Boner A, Sette L, Martinati L, et al. The efficacy and tolerability of fluticasone propionate aqueous nasal spray in children with seasonal allergic rhinitis. Allergy. 1995;50:498-505. Abstract

Settipane G, Korenblat PE, Winder J, et al. Triamcinolone acetonide Aqueous nasal spray in patients with seasonal ragweed allergic rhinitis: a placebo-controlled, double-blind study. Clin Ther. 1995;17:252-263. Abstract

Munk ZM, Gross GN, Hampel FC, Jr., et al. Preseasonal, once daily triamcinolone acetonide nasal aerosol for seasonal allergic rhinitis. Ann Allergy Asthma Immunol. 1997;78:325-331. Abstract

Bielory L, Danzig M, Gates D. Ocular symptoms of seasonal allergic rhinitis can be treated effectively with an inhaled corticosteroid (mometasone furoate nasal spray). J Allergy Clin Immunol. 2007; 119:S61.

Ratner PH, Wingertzahn MA, van Bavel JH, et al. Efficacy and safety of ciclesonide nasal spray for the treatment of seasonal allergic rhinitis. J Allergy Clin Immunol. 2006;118:1142-1148. Abstract

Strachan D, Sibbald B, Weiland S, et al. Worldwide variations in prevalence of symptoms of allergic rhinoconjunctivitis in children: the International Study of Asthma and Allergies in Childhood (ISAAC). Pediatr Allergy Immunol. 1997;8:161-176. Abstract

The authors thank Deborah Burrage, PhD, and Anna Koundouris, PhD, for writing assistance.}

Cite this: Treating the Ocular Component of Allergic Rhinoconjunctivitis and Related Eye Disorders - Medscape - Aug 15, 2007.

Therapy Options for Ocular Allergy
Nonpharmacologic
	Allergen avoidance
	Cold compress
	Artificial tears
Pharmacologic
Topical	Antihistamine	Levocabastine hydrochloride, azelastine hydrochloride, pheniramine maleate
	Decongestant	Naphazoline hydrochloride, oxymetazoline hydrochloride, tetrahydrozoline hydrochloride, tetrahydrozoline hydrochloride
	Multiple action antihistamine	Azelastine hydrochloride, emedastine difumarate, epinastine hydrochloride, ketotifen fumarate, levocabastine hydrochloride, olopatadine hydrochloride
	Mast-cell stabilizer	Cromolyn sodium, lodoxamide tromethamine, nedocromil sodium, pemirolast potassium
	NSAID	Ketorolac tromethamine
	Corticosteroid	Loteprednol etabonate, rimexolone, fluorometholone, prednisolone, dexamethasone
Sublingual / subcutaneous	Immunotherapy
Oral	Antihistamine	Cetirizine hydrochloride, desloratadine, fexofenadine hydrochloride, loratadine, diphenhydramine hydrochloride, chlorpheniramine maleate, brompheniramine maleate, clemastine fumarate
	Decongestant	Pseudoephedrine
Nasal	Corticosteroid	Fluticasone propionate,^* mometasone furoate^*
	Antihistamine	Azelastine hydrochloride

NSAID, nonsteroidal anti-inflammatory drug; ^*indicated for the management of nasal symptoms only

Topical Ophthalmic Agents for Allergic Conjunctivitis
Generic (trade) name	Mechanism of Action	Dosage	Most Common Side Effects
Azelastine hydrochloride (Optivar)	Competes with H₁ receptor sites on effector cells and inhibits release of histamine and other mediators involved in allergic response	Age ≥ 3 y: 1 drop twice daily	Ocular burning (approx. 30%), Headache (approx. 5%), Bitter taste (approx. 10%)
Emedastine difumarate (Emadine)	Relatively selective histamine receptor antagonist	Age ≥ 3 y: 1 drop up to 4 times daily	Headache (11%)
Epinastine hydrochloride (Elestat)	Direct H₁-receptor antagonist, mast-cell stabilizer, inhibits cytokine activation	Age ≥ 3 y: 1 drop twice daily	Upper respiratory infection/cold symptoms (10%)
Ketorolac tromethamine (Acular)	Pyrrolopyrrole NSAID, inhibits prostaglandin synthesis	Age ≥ 12 y: 1 drop up to 4 times daily	Ocular burning, stinging, itching (10%)
Ketotifen fumarate (Zaditor)^*	^{Noncompetitive H₁-receptor antagonist and mast-cell stabilizer}	^{Age ≥ 3 y: 1 drop up to 3 times daily}	^{Conjunctival injection, headache, rhinitis (10%-25%)}
^{Levocabastine hydrochloride (Livostin)}	^{Selective H₁-receptor antagonist}	^{Age ≥ 12 y: 1 drop up to 4 times daily}	^{Ocular burning, stinging, itching (10%)}
^{Lodoxamide tromethamine (Alomide)}	^{Mast-cell stabilizer}	^{Age ≥ 2 y: 1-2 drops up to 4 times daily}	^{Ocular burning, stinging, itching (10%)}
^{Loteprednol etabonate (Lotemax, Alrex)}	^{Decreases inflammation and late-phase response, decreases capillary permeability}	^{Age ≥ 3 y: 1-2 drops twice up to 4 times daily}	^{Headache (10%), pharyngitis (10%), rhinitis (10%)}
^{Nedocromil sodium (Alocril)}	^{Interferes with mast-cell degranulation, release of leukotrienes and platelet-activating factor}	^{Age ≥ 3 y: 1-2 drops twice daily}	^{Headache (10%), bitter taste (10%), ocular burning (10%), nasal congestion (10%)}
^{Olopatadine hydrochloride (Patanol)^**}	^{Selective H₁-receptor antagonist, inhibitor of histamine release from mast cells, inhibits mediators from mast-cell fibroblasts and epithelial cells}	^{Age ≥ 3 y: 1-2 drops up to 4 times daily}	^{Headache (7%)}

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Treating the Ocular Component of Allergic Rhinoconjunctivitis and Related Eye Disorders

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