What is the treatment for allergic conjunctivitis?

From the Guidelines

Treatment for allergic conjunctivitis should start with dual-action agents, such as olopatadine (Pataday, Patanol) or ketotifen (Alaway, Zaditor), which possess both antihistamine and mast cell stabilizer activities, due to their rapid onset of action and effectiveness in relieving symptoms. These agents are suitable for acute and longer-term treatment of allergic conjunctivitis symptoms, as they have been shown to be more effective in preventing or treating ocular itching than other ocular agents 1.

When considering treatment options, it's essential to weigh the benefits and risks of each medication. Vasoconstrictors, such as naphazoline (AK-Con, Albalon) or tetrahydrozoline (Visine), can provide relief of ocular redness but do not reduce the allergic response and may lead to rebound hyperemia or conjunctivitis medicamentosa with prolonged use 1. Antihistamines, like emedastine (Emadine) or levocabastine (Livostin), can be used for acute relief of ocular allergy symptoms but may not be as effective as dual-action agents. Mast cell stabilizers, such as cromolyn (Opticrom) or lodoxamide (Alomide), have a slow onset of action and are more suitable for prophylactic or longer-term treatment of chronic ocular allergies.

In severe cases of allergic conjunctivitis, ocular corticosteroids like loteprednol etabonate (Alrex) may be used short-term under medical supervision, as they can have vision-threatening side effects, including cataract formation, elevated IOP, and secondary infections 1. Oral antihistamines, such as loratadine or cetirizine, can be used to relieve multiple allergic symptoms but are generally less effective in relieving ocular allergy symptoms than topical ophthalmic agents and have slower onset of action.

Key considerations for treatment include:

• Identifying and avoiding allergens that trigger symptoms
• Using artificial tears to flush allergens from the eyes and provide lubrication
• Applying cold compresses to closed eyes for 5-10 minutes to provide additional relief
• Monitoring for signs of infection or other complications, such as eye pain, vision changes, or discharge, and consulting an eye care professional promptly if symptoms persist or worsen.

From the FDA Drug Label

CLINICAL PHARMACOLOGY Corticosteroids inhibit the inflammatory response to a variety of inciting agents and probably delay or slow healing. INDICATIONS AND USAGE Loteprednol Etabonate Ophthalmic Suspension, 0.2% is indicated for the temporary relief of the signs and symptoms of seasonal allergic conjunctivitis. Clinical Studies:In two double-masked, placebo-controlled six-week environmental studies of 268 patients with seasonal allergic conjunctivitis, Loteprednol Etabonate Ophthalmic Suspension, 0. 2%, when dosed four times per day was superior to placebo in the treatment of the signs and symptoms of seasonal allergic conjunctivitis.

The treatment for allergic conjunctivitis is Loteprednol Etabonate Ophthalmic Suspension, 0.2%, which is indicated for the temporary relief of the signs and symptoms of seasonal allergic conjunctivitis 2. The recommended dosage is four times per day. Key benefits of this treatment include:

• Reduction in bulbar conjunctival injection
• Reduction in itching, beginning approximately 2 hours after instillation of the first dose and throughout the first 14 days of treatment 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, 5.
• A meta-analysis study found that olopatadine intervention was associated with substantially lower hyperaemia compared with ketotifen intervention for allergic conjunctivitis 4.
• Newer second-generation antihistamines, such as cetirizine, fexofenadine, loratadine, and desloratadine, are preferred over older first-generation antihistamines due to their reduced sedative and anticholinergic effects 6.
• Topical antihistaminic agents, such as olopatadine, ketotifen, azelastine, and epinastine, have been shown to prevent activation of neutrophils, eosinophils, and macrophages, or inhibit release of leukotrienes, platelet-activating factors, and other inflammatory mediators 6.

Efficacy and Safety of Topical Olopatadine

• Topical olopatadine has been shown to be safe and effective in treating allergic conjunctivitis, with a pooled-mean difference in ocular itch of -1.33 and ocular hyperemia of -0.92 compared with placebo 7.
• Olopatadine was found to be inferior to alcaftadine on ocular itch, but comparable with epinastine and ketotifen 7.
• A systematic review and meta-analysis found that topical olopatadine is a safe and effective treatment modality for allergic conjunctivitis 7.

Comparison of Ketotifen and Olopatadine

• A study found that ketotifen and olopatadine diminished the expression of cell adhesion molecules and inflammatory markers on the conjunctival surface cells effectively, and were well tolerated 3.
• Another study found that the responder rate was higher with ketotifen than with olopatadine on day 5 and day 21, and global efficacy ratings were higher with ketotifen 5.
• A meta-analysis study found that olopatadine intervention was associated with substantially lower hyperaemia compared with ketotifen intervention for allergic conjunctivitis 4.