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Allergic Diseases of the Eye
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
For patients presenting with acute symptoms, it is usual to prescribe a moderately potent topical steroid with low ocular penetration, such as fluorometholone or loteprednol, three or four times a day for around two weeks. Along with this a mast cell stabilizer or a dual action drug is started as a preventive medication, intended for long term instillation (Mantelli et al. 2007). Prophylactic treatment is usually continued through the expected period of allergen exposure. As drugs such as olopatadine and alcaftadine are available as once-a-day preparations for this purpose, compliance is usually good.
Efficacy of Alcaftadine 0.25% (AGN-229666) for Once-daily Prevention of Cedar-Pollen Allergic Conjunctivitis: A Phase 3 Randomized Study
Published in Ocular Immunology and Inflammation, 2021
Hiroshi Fujishima, Tomoko Hasunuma, Tetsuya Kawakita, Takuro Sekiya, Paul Gomes, David A. Hollander
Previous studies compared once-daily treatment with Alcaftadine 0.25% with Olopatadine 0.2%, a formulation also approved for once-daily dosing in the USA. In these studies, the two treatments were comparable over most time points, although Alcaftadine efficacy on itch was numerically greater at the 16-h post-dosing challenges.21,22 Among ocular antihistamines, Alcaftadine is unique in that it exhibits antagonistic activity against H1 and H2 receptors, as well as H4 receptors.10,11,23,24 Alcaftadine 0.25% has shown an earlier onset of action than Olopatadine 0.1%, achieving lower itching scores 3 min post Ora-CAC® challenge at 15 min post treatment, and a sustained duration of action up to 24 h post treatment.12,21,22,25 There is also evidence that Alcaftadine has an anti-inflammatory effect, reducing eosinophil recruitment and maintaining stability of the epithelial junctional protein, zonula occludens-1, as demonstrated in a murine model of allergic conjunctivitis.16 Further, Alcaftadine demonstrated superiority over Olopatadine in the maintenance of epithelial gap junctions, which may lead to the more sustained duration of Alcaftadine compared to Olopatadine.16
Alcaftadine 0.25% versus Olopatadine 0.1% in Preventing Cedar Pollen Allergic Conjunctivitis in Japan: A Randomized Study
Published in Ocular Immunology and Inflammation, 2019
Hiroshi Nakatani, Paul Gomes, Ron Bradford, Qiang Guo, Eleonora Safyan, David A. Hollander
Among ocular antihistamines, alcaftadine is unique in that it exhibits antagonistic activity against H1 and H2 receptors, and has demonstrated activity against H4 receptors.14,25,26 Alcaftadine 0.25% has shown an earlier onset of action than olopatadine 0.1%, achieving lower itching scores 3 min post CAC at 15 min post treatment, and a sustained duration of action up to 24 h post treatment.21–23 Alcaftadine has also demonstrated a greater effect than olopatadine on reducing eosinophil recruitment and maintaining stability of the epithelial junctional protein, zonula occludens-1, in a murine model of allergic conjunctivitis.27 There is evidence that pro-inflammatory cytokines can disrupt the corneal epithelial barrier and increase cell permeability.28 Further studies are recommended to establish whether the differences observed between alcaftadine and olopatadine reflect a greater ability of alcaftadine to prevent allergen-activated disruption of conjunctival epithelial barriers.