Contact Allergens in Prescription Topical Ophthalmic Medications

Abstract

Background/Objective: Both active and inactive ingredients in topical ophthalmic agents may cause allergic contact dermatitis. Here, we examined ingredients in prescription topical ophthalmic medications available in the United States.Methods: A comprehensive list of topical ophthalmic medications was generated using AccessPharmacy. Categories included antiglaucoma, antibiotic, antibiotic/corticosteroid, corticosteroid, antiviral, antifungal, mydriatic, and miotic agents. For each formulation, ingredients were investigated using the National Institutes of Health US National Library of Medicine database and/or manufacturer websites. Counts and proportions were calculated for inactive ingredients, including those in the American Contact Dermatitis Society (ACDS) Core 90 Allergen Series.Results: Two hundred sixty-four unique prescription ophthalmic medications met the inclusion criteria. The most common ACDS Core 90 allergen/cross-reactor inactive ingredient was benzalkonium chloride (68.1%, 180/264), followed by sorbates (11.7%, 31/264), parabens (6.8%, 18/264), sodium metabisulfite (3.8%, 10/264), propylene glycol (3.0%, 8/264), and lanolin (3.0%, 8/264). Approximately 21% (20.8%, 55/264) of products had no ACDS Core 90 allergens/cross-reactor inactive ingredients. The most common ACDS Core 90 allergen/cross-reactor active ingredients were aminoglycoside antibiotics, bacitracin/polymyxin B, and corticosteroids. Important non-ACDS Core 90 allergens included inactive ingredients, such as EDTA 28.0% and thimerosal 2.7%, as well as active ingredients, especially b-blockers.Conclusions: Benzalkonium chloride, sodium metabisulfite, propylene glycol, and lanolin were common inactive ingredient allergens. Most ophthalmic categories had low allergen formulations available for patients with contact allergy.

Tobramycin and antiglaucoma agents as increasing culprits of periorbital allergic contact dermatitis from topical ophthalmic medications: A 24‐year study from Turkey

“…33 In a recent study that screened the ingredients of TOMs in the United States, only seven TOMs containing thimerosal were identified among 264 commercial items. 34 In the present study, none of the patients sensitized to thimerosal were using thimerosal-containing TOMs.…”

Sodium Metabisulfite Inhibits Acanthamoeba Trophozoite Growth through Thiamine Depletion

“…Sodium metabisulfite is a constituent of several eye care solutions [ 11 , 12 , 13 , 14 , 15 ] and has been shown to have antimicrobial properties in other organisms [ 16 , 17 ]. Further investigation examined the effect of different concentrations of this compound on Acanthamoeba growth ( Figure 1 ).…”

“…The impact of many commercially available compounds on Acanthamoeba is yet to be explored, yet understanding these interactions provides a potential route for compound repurposing using solutions already deemed safe for use in humans [ 31 ]. Compounds commonly used for mydriasis often contain sodium metabisulfite [ 11 , 12 , 13 , 14 , 15 ] and have been shown to possess antimicrobial activity in other organisms [ 16 , 17 ]. Here, we have provided evidence to demonstrate that this compound can also reduce Acanthamoeba trophozoite viability after 96 h.…”

“…Identifying new preventative or therapeutic compounds to ease the burden of AK is important, and elucidating the role of existing compounds is useful in that it provides opportunity for compound repurposing or opens avenues for synergistic combinations to be trialled. Indeed, eye drops containing phenylephrine hydrochloride that are frequently used to dilate the pupil and facilitate fundus examination often contain excipients such as sodium metabisulfite [ 10 , 11 , 12 , 13 , 14 , 15 ], shown to have antimicrobial activity against organisms such as Staphylococcus spp., Escherichia coli , Candida albicans , and Aspergillus flavus [ 16 , 17 ] and widely used as a food preservative [ 18 , 19 , 20 , 21 ]. The antimicrobial mode of action of sodium metabisulfite is unclear, but it has been suggested that sulfite can react with various biological molecules.…”