Management of ocular allergy

Abstract

Funding informationThis work was done under the approval of EAACI with a TF budget 2015-18. AbstractThe treatment and management of ocular allergy (OA) remain a major concern for different specialties, including allergists, ophthalmologists, primary care physicians, rhinologists, pediatricians, dermatologists, clinical immunologists, and pharmacists.We performed a systematic review of all relevant publications in MEDLINE, Scopus, and Web Science including systematic reviews and meta-analysis. Publications were considered relevant if they addressed treatments, or management strategies of OA.A further wider systematic literature search was performed if no evidence or good quality evidence was found. There are effective drugs for the treatment of OA; however, there is a lack an optimal treatment for the perennial and severe forms. Topical antihistamines, mast cell stabilizers, or double-action drugs are the first choice of treatment. All of them are effective in reducing signs and symptoms of OA. The safety and optimal dosing regimen of the most effective topical anti-inflammatory drugs, corticosteroids, are still a major concern. Topical calcineurin inhibitors may be used in steroid-dependent/resistant cases of severe allergic keratoconjunctivitis.Allergen-specific immunotherapy may be considered in cases of failure of first-line treatments or to modify the natural course of OA disease. Based on the current wealth of publications and on the collective experience, recommendations on management of OA have been proposed.

A contemporary look at allergic conjunctivitis

“…Compared with either antihistamines or mast cell stabilizers, topical dual-activity agents are generally clinically superior due to both symptom/sign relief and tolerability [46]. These are now considered first-line treatment in AC and are the most common ophthalmic agents prescribed by allergists and eyecare practitioners [28].…”

“…Over-the counter-topical vasoconstrictors are readily available. They can help reduce erythema but have a limited effect on pruritus [46]. Moreover they can cause stinging and burning upon instillation, as well as tachyphylaxis and rebound hyperemia upon discontinuation of use [78].…”

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“…In some patients, management commonly starts with selftreatment or the use of over-the-counter regimens with pharmacy input. [96][97][98] Discordance in approach between primary care physicians and eye care specialists also has been shown. 13 Although the diagnosis of most ophthalmic diseases seen in general practice can The cornea may be involved in vernal keratoconjunctivitis, atopic keratoconjunctivits, or contact blepharoconjunctivitis but not in seasonal nor perennial allergic conjunctivitis.…”

Diagnosing and managing allergic conjunctivitis in childhood: The allergist’s perspective

“…There is no consensus about the treatment of AC in childhood. However, the Interest Group for Ocular Allergy of the EAACI recently published an update of the techniques used in management of the disease . They concluded that good understanding and cooperation between the family physician, allergist and ophthalmologist are essential for optimal management.…”

“…However, the Interest Group for Ocular Allergy of the EAACI recently published an update of the techniques used in management of the disease. 24 They concluded that good understanding and cooperation between the family physician, allergist and ophthalmologist are essential for optimal management. Second-line treatments are local symptomatic treatments that can also be prescribed by a physician other than an ophthalmologist.…”