Lack of cross-reactive allergic response to brimonidine in patients with known apraclonidine allergy

Gordon, Richard; Liebmann, Jeffrey M.; Greenfield, David S.; Lama, Paul; Ritch, Robert

doi:10.1038/eye.1998.171

Cited by 18 publications

(4 citation statements)

References 16 publications

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“…This is supported by the lack of cross-reactivity in patients with allergy to apraclonidine who are subsequently treated with clonidine 2 or brimonidine. [3][4][5] Butler et al 6 have suggested that 'adrenergic agents may reduce the volume of conjunctival cells, thereby producing a widening of the intercellular spaces through which potential allergens may reach the subepithelial tissues', causing allergy. This is supported by earlier findings by Alvarado et al 7 in a study, which demonstrated that adrenergic agents decrease the cell volume of cultured human trabecular meshwork and Schlemm's canal endothelial cells.…”

Section: Discussionmentioning

confidence: 99%

Alphagan allergy may increase the propensity for multiple eye-drop allergy

Osborne

Montgomery

Morris

et al. 2004

Eye

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Aims Since its introduction in 1996, brimonidine tartrate 0.2% ophthalmic solution (Alphagan, Allergan) twice daily has become established as an effective intra ocular pressure-lowering treatment. While the efficacy of Alphagan cannot be questioned, we gained the clinical impression that the drug has an unacceptably high rate of allergy. Of greater concern, we suspected that patients suffering from local Alphagan allergy had a higher rate of allergy to subsequently used topical preparations. We analysed data from a large scale study of glaucoma patients to establish whether our suspicions were correct. Subjects and methods We have created a database of the entire glaucoma treatment histories for consecutive patients attending a single consultant's clinics (DMIM) at Glasgow Royal Infirmary between May 1999 and September 2001. All have undergone medical treatment for primary open angle glaucoma, ocular hypertension, or normal tension glaucoma. Patients with any other form of glaucoma, and patients in whom a full record of treatment was not available were excluded from the study. Results Alphagan was discontinued due to allergy on 73 per 100 000 patient treatment days. This was a far higher frequency than for other preparations. In patients allergic to both Alphagan and another preparation (Timoptol, Trusopt and Xalatan), the mean interval between the first and second allergy was shorter when Alphagan allergy occurred first. This was statistically significant in Timoptol and Trusopt cross-reactivity. Conclusions Alphagan has high allergenicity, and may increase the likelihood of allergy to subsequently used preparations.

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Section: Discussionmentioning

confidence: 99%

Alphagan allergy may increase the propensity for multiple eye-drop allergy

Osborne

Montgomery

Morris

et al. 2004

Eye

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“…In the extension study, the ocular allergy rate with brimonidine therapy was reported to drop to 4.2% during year 3 of continuous use (6). The finding of "ocular allergy" with brimonidine has raised several questions and interpretations: it does not include the typical signs and symptoms of a true allergic reaction, there is no cross reactivity with apraclonidine and patients who were allergic to the latter did not react when treated with brimonidine (9). In all cases, the "allergy" was mild-to-moderate in severity and all symptoms and signs resolved rapidly after discontinuation of the drug.…”

Section: Long-term Safetymentioning

confidence: 99%

Brimonidine (Alphagan®): A Clinical Profile Four Years after Launch

David

2001

European Journal of Ophthalmology

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The early information on the clinical efficacy, safety, and tolerability of brimonidine 0.2% were obtained from studies that compared brimonidine monotherapy with timolol and betaxolol. These studies showed its intra-ocular pressure lowering efficacy to be comparable with timolol and superior to betaxolol. The data from the timolol studies showed consistent results after four years. These findings have been confirmed by additional studies in the clinical setting. More recently, several clinical trials have been completed investigating the role of brimonidine as adjunctive medication to beta-blockers and as replacement therapy to other intraocular pressure lowering compounds. When added to beta-blockers, brimonidine is superior to dorzolamide, similar in efficacy but better tolerated than pilocarpine, and more predictable than latanoprost. Data from replacement studies have indicated that there may be advantages in replacing rather than adding medications in the treatment of glaucoma.

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“…Ocular allergy was also found after the topical administration of brimonidine with a similar incidence, with about 20.2% (20 of 99 patients) discontinuing before 1 year of treatment (Krupin et al 2011), but the exact causative mechanisms are unknown (Gordon et al 1998;Shin et al 1999;Williams et al 2000). Generally speaking, drug-induced inflammatory reactions are mainly caused by sensitization and/or irritation of the drug.…”

mentioning

confidence: 93%

One‐year clinical evaluation of 0.4% ripasudil (K‐115) in patients with open‐angle glaucoma and ocular hypertension

Tanihara

Inoue

Yamamoto

et al. 2015

Acta Ophthalmologica

116

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ABSTRACT.Purpose: To investigate the intra-ocular pressure (IOP)-lowering effects and safety of 0.4% ripasudil (K-115), a Rho kinase inhibitor, twice daily for 52 weeks, in patients with open-angle glaucoma or ocular hypertension (OHT). Methods: In this multicentre, prospective, open-label study, 388 patients with primary open-angle glaucoma, OHT or exfoliation glaucoma were enrolled and 354 of them were subdivided into four cohorts (monotherapy, 173; additive therapy to prostaglandin analogs, 62; b-blockers, 60; or fixed combination drugs, 59). The IOP reduction at trough and peak from baseline and adverse events was investigated. Results: Ripasudil showed IOP-lowering effects over 52 weeks in all the analyses of monotherapy, additive therapy and both subgroups (baseline IOP ≥21 mmHg and <21 mmHg) of monotherapy. The mean IOP reductions at trough and peak at week 52 were À2.6 and À3.7 mmHg for monotherapy, and À1.4 and À2.4, À2.2 and À3.0, and À1.7 and À1.7 mmHg, respectively, for additive therapy described above. The most frequently observed adverse events were conjunctival hyperaemia (n = 264, 74.6%), blepharitis (n = 73, 20.6%) and allergic conjunctivitis (n = 61, 17.2%). Most of the conjunctival hyperaemia findings were mild (97.0%), transient and resolved spontaneously (78.0%). Although 51 patients discontinued from the study due to blepharitis and/or allergic conjunctivitis (blepharitis, 28; allergic conjunctivitis, 17; both, 6), all the events resolved with or without treatment after the discontinuation of ripasudil administration. Conclusion: Fifty-two week administration of 0.4% ripasudil revealed IOPlowering effects and an acceptable safety profile when administered as monotherapy or as additive therapy, in patients with open-angle glaucoma or OHT.

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Lack of cross-reactive allergic response to brimonidine in patients with known apraclonidine allergy

Cited by 18 publications

References 16 publications

Alphagan allergy may increase the propensity for multiple eye-drop allergy

Alphagan allergy may increase the propensity for multiple eye-drop allergy

Brimonidine (Alphagan®): A Clinical Profile Four Years after Launch

One‐year clinical evaluation of 0.4% ripasudil (K‐115) in patients with open‐angle glaucoma and ocular hypertension

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