What are suitable ophthalmic (eye) drops for pediatric patients with allergic conjunctivitis?

From the Guidelines

For pediatric eye allergies, I recommend over-the-counter antihistamine eye drops like ketotifen (Zaditor, Alaway) which are approved for children 3 years and older, as they have a dual action of antihistamine and mast cell stabilizer, providing quick relief and reducing the risk of rebound hyperemia 1. Use 1 drop in each affected eye twice daily. Prescription options include olopatadine (Pataday, Patanol) for children 3 and up, with dosing typically 1 drop once or twice daily depending on the formulation 1. For children under 3, consult a pediatrician first. Some key points to consider when choosing an eye drop for pediatric eye allergies include:

• The onset of action, with dual action agents like ketotifen and olopatadine having an onset of action within 30 minutes 1
• The risk of side effects, such as rebound hyperemia with prolonged use of vasoconstrictors 1
• The suitability for acute or chronic treatment, with mast cell stabilizers being more suitable for prophylactic or longer-term treatment 1 Cold compresses can provide additional relief. These medications work by blocking histamine receptors in the eye, reducing itching, redness, and tearing 1. Avoid having children rub their eyes as this can worsen symptoms. If symptoms don't improve within a week, if there's eye pain, vision changes, or discharge, seek medical attention promptly. For severe or persistent allergies, a pediatric allergist or ophthalmologist may prescribe stronger medications like mild steroid drops for short-term use, such as loteprednol etabonate (Alrex), which has a reduced risk of causing increased IOP compared to other ocular corticosteroids 1.

From the FDA Drug Label

Azelastine hydrochloride ophthalmic solution 0.05% is indicated for the treatment of itching of the eye associated with allergic conjunctivitis. In environmental studies, adult and pediatric patients with seasonal allergic conjunctivitis were treated with azelastine hydrochloride ophthalmic solution 0.05% for two to eight weeks.

Pediatric eye drops for allergies are available, specifically azelastine hydrochloride ophthalmic solution 0.05%, which is indicated for the treatment of itching of the eye associated with allergic conjunctivitis in pediatric patients 2.

• The solution has been shown to be effective in relieving itching associated with allergic conjunctivitis in pediatric patients 2.
• It is also rapidly acting, with an onset of effect within 3 minutes, and has a duration of effect of approximately 8 hours 2.

From the Research

Pediatric Eye Drops for Allergies

• Ketotifen fumarate 0.025% ophthalmic solution is an effective and safe treatment option for children with allergic conjunctivitis, as shown in a study published in 2004 3.
• The study found that ketotifen fumarate significantly inhibited ocular itching compared to placebo at all post-challenge timepoints and also significantly reduced hyperemia, chemosis, and lid swelling.
• Another study published in 2003 found that ketotifen 0.025% eye drops were effective in reducing the signs and symptoms of seasonal allergic conjunctivitis in an environmental setting 4.
• The study compared ketotifen to placebo and levocabastine and found that ketotifen produced a significantly better outcome than both.

Efficacy and Safety

• A study published in 2004 found that ketotifen fumarate 0.05% eye drops were effective in treating seasonal allergic conjunctivitis, with subjective symptoms disappearing in 60-80% of patients after 10 days of treatment 5.
• The study also found that the onset of action was 20 minutes or less, and the duration of action was 8-13 hours.
• Another study published in 2002 found that a single dose of ketotifen fumarate 0.025% ophthalmic solution was effective in inhibiting the signs and symptoms of allergic rhinoconjunctivitis as induced by the conjunctival allergen challenge model 6.
• A study published in 2003 compared the efficacy, onset, and duration of action of ketotifen 0.025% and emedastine 0.05% in seasonal allergic conjunctivitis and found that ketotifen had a faster onset of action and provided better symptom relief than emedastine during the first 2 hours after dosing 7.