What is the treatment for allergic conjunctivitis?

From the Guidelines

Treatment for allergic conjunctivitis should prioritize the use of antihistamine eye drops, such as ketotifen (Zaditor, Alaway) or olopatadine (Pataday), as first-line treatments, used 1-2 drops per eye twice daily, due to their effectiveness in reducing symptoms and minimizing potential side effects, as supported by the most recent evidence 1. When considering treatment options, it's essential to weigh the benefits and risks of each medication. The use of vasoconstrictors, for example, may provide temporary relief of ocular redness but can lead to rebound hyperemia or conjunctivitis medicamentosa with prolonged use, as noted in the study by 1. Key considerations for treatment include:

• Identifying and avoiding the allergen causing the reaction when possible
• Using over-the-counter artificial tears to flush allergens from the eyes
• Employing antihistamine eye drops as first-line treatments
• Considering prescription-strength antihistamine/mast cell stabilizer combinations for more severe symptoms
• Using cold compresses to reduce itching and swelling
• Oral antihistamines, such as loratadine (10mg daily) or cetirizine (10mg daily), may be helpful when eye symptoms are part of a broader allergic reaction
• Short courses of corticosteroid eye drops, like loteprednol (0.2-0.5%), may be prescribed for persistent or severe cases, but should only be used under medical supervision due to potential side effects, as advised in the study by 1. It's crucial to note that allergic conjunctivitis occurs when allergens trigger mast cells in the eye to release histamine and other inflammatory mediators, causing the characteristic redness, itching, tearing, and swelling. In terms of treatment approaches, the most recent evidence suggests that dual-action agents, which possess both antihistamine and mast cell stabilizer activities, are effective for acute and longer-term treatment of allergic conjunctivitis symptoms, as discussed in the study by 1. Ultimately, the goal of treatment is to alleviate symptoms, prevent complications, and improve quality of life, while minimizing the risk of adverse effects, as emphasized in the study by 1.

From the FDA Drug Label

Loteprednol etabonate ophthalmic suspension is indicated for the treatment of steroid-responsive inflammatory conditions of the palpebral and bulbar conjunctiva, cornea and anterior segment of the globe such as allergic conjunctivitis, acne rosacea, superficial punctate keratitis, herpes zoster keratitis, iritis, cyclitis, selected infective conjunctivitides, when the inherent hazard of steroid use is accepted to obtain an advisable diminution in edema and inflammation A placebo-controlled clinical study demonstrated that loteprednol etabonate was effective in reducing the signs and symptoms of allergic conjunctivitis during peak periods of pollen exposure.

Treatment for allergic conjunctivitis: Loteprednol etabonate ophthalmic suspension is indicated for the treatment of allergic conjunctivitis.

• The drug has been shown to be effective in reducing the signs and symptoms of allergic conjunctivitis during peak periods of pollen exposure 2.
• It is a steroid-responsive treatment, and its use should be considered when the benefits of diminished edema and inflammation outweigh the inherent hazards of steroid use 2.

From the Research

Treatment Options for Allergic Conjunctivitis

• Topical antiallergic agents, such as antihistamines and mast-cell stabilizers, are the main therapeutic options for seasonal allergic conjunctivitis (SAC) 3.
• Ketotifen fumarate and olopatadine HCl have dual action that offers a combination of these 2 mechanisms, and have been shown to be effective in the treatment of SAC 3, 4.
• A study comparing the efficacy of ketotifen fumarate 0.025% and olopatadine HCl 0.1% ophthalmic solutions found that both were effective in reducing clinical scores and inflammatory markers, but ketotifen was more effective in reducing the expression of cell adhesion molecules (CAMs) and inflammatory markers in conjunctival surface cells 3.
• Another study found that ketotifen fumarate 0.025% was more effective and better tolerated than olopatadine hydrochloride 0.1% in the treatment of SAC, with a higher responder rate and lower severity scores for hyperemia and itching 4.
• A comparison of ketotifen 0.025% and 0.05% eye drops found that the 0.025% concentration was more effective and better tolerated, with a significant reduction in total signs and symptoms scores (TSSS) and a better responder rate 5.
• A single dose of ketotifen fumarate 0.025% was found to be superior to a 2-week regimen of cromolyn sodium 4% in alleviating symptoms of allergic conjunctivitis in a conjunctival allergen-challenge model 6.
• A study comparing the ocular comfort and drying effects of three topical antihistamine/mast cell stabilizers (epinastine, azelastine, and ketotifen) found that epinastine was rated as more comfortable than azelastine and ketotifen, with no significant differences in fluorescein staining or ocular protection index (OPI) 7.

Key Findings

• Ketotifen fumarate and olopatadine HCl are effective treatments for SAC, with ketotifen being more effective in reducing CAMs and inflammatory markers 3.
• Ketotifen 0.025% is more effective and better tolerated than olopatadine hydrochloride 0.1% and ketotifen 0.05% 4, 5.
• A single dose of ketotifen fumarate 0.025% is superior to a 2-week regimen of cromolyn sodium 4% in alleviating symptoms of allergic conjunctivitis 6.
• Epinastine is rated as more comfortable than azelastine and ketotifen, with no significant differences in ocular drying effects 7.