Treating severe eye allergy

Abstract

Allergic eye conditions, particularly seasonal allergic conjunctivitis (SAC), are common. Itching, oedema and hyperaemia are relieved with topical H1-antagonists or sodium cromoglycate. The newer mast-cell stabilizing agent nedocromil sodium has a similar safety profile to sodium cromoglycate, but is more potent and has a more convenient twice-daily dosing regimen. When several placebo-controlled studies of its use in the treatment of SAC were analysed, it was found that 80% of patients reported symptom relief. In a further study, nedocromil sodium eyedrops (twice-daily dosing) had similar overall efficacy to sodium cromoglycate eyedrops (four-times-daily dosing) in subjects with SAC during the birch season, but during the period of highest pollen challenge, only the former agent was significantly more effective than placebo. Another study found that nedocromil sodium had efficacy equivalent to levocabastine over 7 days, but tended to have a more rapid onset of action. In patients with perennial allergic conjunctivitis (PAC) unresponsive to sodium cromoglycate, both clinicians and patients reported significantly better control of symptoms with nedocromil sodium eyedrops than with placebo. Recently, in a long-term study of treatment for vernal keratoconjunctivitis (VKC), it was found that nedocromil sodium 2% eyedrops produced a more rapid and marked improvement in symptoms than sodium cromoglycate 2% eyedrops and enabled lower use of steroid rescue medication. Both drugs were well tolerated and without serious side-effects.

Overview of ocular allergy treatment

“…Perennial allergic conjunctivitis is similar in appearance to SAC [4], but it is caused by airborne allergens that are present throughout the year. Cat dander is one of the most common allergens.…”

Allergic and Immunologic Eye Disease

“…Nedocromil 2% (Alocril) is a pyranoquinoline derivative of cromolyn that inhibits various activities on multiple cells involved in allergic inflammation including eosinophils, neutrophils, macrophages, mast cells, monocytes and platelets. 86 In a study comparing nedocromil (2%) with cromolyn eye drops, nedocromil was more efficacious in its impact on hyperemia, keratitis, papillae and pannus formation with less time to have an effect on itching, grittiness, hyperemia and keratitis. The mechanism of action of nedocromil may be due partly to inhibition of axon reflexes and release of sensory neuropeptides, such as substance P, neurokinin A and calcitonin gene-related peptides.…”

Comparação do uso tópico de cetotifeno com a olopatadina no tratamento de conjuntivites alérgicas

“…A instilação duas vezes por dia é um fator importante em facilitar a manutenção dos pacientes em tratamento, principalmente em casos de doença alérgica da conjuntiva de caráter sazonal ou perene, onde algumas medicações são instiladas mais freqüentemente para garantir o seu efeito terapêutico. Algumas drogas antialérgicas preconizadas para instilação de três ou quatro vezes ao dia, são a lodoxamida, levocabastina e o ketorolac (19) . A comparação das soluções oftálmicas de cetotifeno a 0,025% e 0,05% instiladas quatro vezes ao dia em pacientes com conjuntivite alérgica apresenta resultados de melhora dos sintomas entre os pacientes que instilaram o cetotifeno a 0,025% em 23% dos casos, 85% dos pacientes que instilaram solução oftálmica de cetotifeno a 0,05% obtiveram melhora.…”