Allergic conjunctivitis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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
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.
Mast Cell Stablizers
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.