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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
He was not able to get an appointment for the ophthalmologist, but returned a week later with complete resolution of the symptoms and disappearance of the conjunctival redness and swelling. Topical steroids were stopped and he was asked to continue the Olopatadine till he could see the ophthalmologist. He returned in three days with a recurrence of the symptoms and signs. Loteprednol was restarted, and this time continued for two weeks, before reduction in dosage and gradual tapering. A visit to the ophthalmologist confirmed the diagnosis of vernal conjunctivitis. The boy remained symptom free through the summer on Olopatadine, apart from one episode of itching which responded to addition of loteprednol for two weeks. Olopatadine was discontinued when he rejoined school in the fall term, with no recurrence. His parents have been told that it will probably be advisable to restart the drop in March-April of the following year.
Nasal problems in the athlete
Published in John W. Dickinson, James H. Hull, Complete Guide to Respiratory Care in Athletes, 2020
A number of useful guidelines exist concerning the pharmacological management of allergic rhinitis. The ARIA (Allergic Rhinitis and its Impact on Asthma) document provides a simple system for classification and treatment; the BSACI (British Society of Allergy and Clinical Immunology) has recently published updated detailed guidelines and associated algorithm. In brief, mild symptoms can be treated with an as-required non-sedating anti-histamine, but anything more persistent or troublesome should be treated with an intranasal corticosteroid (see Table 8.1). Nasal corticosteroids are more effective than anti-histamines and the combination of anti-histamine and anti-leukotriene (e.g. montelukast). Many preparations are available, but newer drugs with lower systemic bioavailability (mometasone furoate, fluticasone propionate, fluticasone furoate) are preferable. Regular use and correct application are essential for optimal benefit (Figure 8.5). Failure to respond to an intranasal steroid alone should prompt consideration of a combined corticosteroid plus topical anti-histamine preparation. Anti-cholinergic sprays (ipratropium bromide) can help reduce watery rhinorrhoea. Intranasal steroids also have a beneficial effect on allergic conjunctivitis, but more troublesome symptoms warrant treatment with topical sodium cromoglicate, nedocromil sodium or topical antihistamine (azelastine, olopatadine). Athletes should be treated along the same lines.
United Airways
Published in Jonathan A. Bernstein, Mark L. Levy, Clinical Asthma, 2014
Glenis K. Scadding, Guy Scadding
Antihistamines are useful for mild symptoms, either intermittent or persistent. In the latter case, regular daily use is advisable because when they are withdrawn the histamine receptor becomes more active and the symptoms can increase. Antihistamines are active against sneezing, rhinorrhea, and nasal itch, but are inferior to nasal corticosteroids in reducing nasal congestion. Most second-generation oral antihistamines (loratidine, cetirizine, fexofenadine, desloratidine, levocetirizine, misolastine, rupatadine) reduce symptoms within 1 hour and are used once daily. Acrivastine is an exception to this rule; it has a rapid onset of action, but lasts only 8 hours. Topical nasal antihistamines are available as azelastine and olopatadine, which have a 15-minute onset of action.
Understanding ocular comfort differences between 0.7% olopatadine and 0.3% pheniramine maleate/0.025% naphazoline hydrochloride eye drops
Published in Clinical and Experimental Optometry, 2023
Chris Lievens, Andrew D. Pucker, Gerald McGwin, Amy Logan, Quentin Franklin, Randy Brafford, Catherine Hogan, Laurel R Kelley, Mike Christensen
The comfort of this higher concentration of olopatadine has not been fully studied, and the literature currently lacks information on how this new formulation compares to 0.3% pheniramine maleate/0.025% naphazoline hydrochloride combination drops (VISINE® Allergy Eye Relief Multi-Action Antihistamine and Redness Reliever Eye Drops, Johnson & Johnson Vision, Jacksonville, FL, USA).5 Thus, this prospective, randomised, clinical study was conducted to address this knowledge gap by comparing the perceived initial ocular comfort and safety of these two drops directly after instillation. This study is clinically important because understanding patient comfort differences between drops may assist the eye care professional in selecting a topical treatment that increases patient compliance while subsequently minimising chair time by reducing patient follow-ups.
Efficacy of 2% Rebamipide Suspension for Vernal Keratoconjunctivitis: A Clinical Comparison with Topical Immune Modulators Cyclosporine and Tacrolimus
Published in Ocular Immunology and Inflammation, 2022
Chintan Malhotra, Himanshi Singh, Arun Kumar Jain, Amit Gupta, Jagat Ram
Patients fulfilling the inclusion criteria were allocated using a Tippet’s random number table into 2 groups. Group A consisted of patients where one eye was assigned to receive 2% topical rebamipide suspension (Rebacer eye drops, Ajanta Pharma Limited, Mumbai, India) 4 times a day for 12 weeks (subgroup A1) while the contralateral eye received 0.03% tacrolimus ointment (Talimus eye ointment, Ajanta Pharma Limited, Mumbai,India) twice a day for the same duration (subgroup A2). For group B, one eye was assigned to receive 2% topical rebamipide suspension 4 times a day for 12 weeks (subgroup B1), while the contralateral eye received 0.05% cyclosporine eye drops(Hydroeyes, LUPINE Pure and Cure Healthcare Pvt. Ltd, Mumbai, India) 4 times a day for the same duration(subgroup B2). All recruited patients were instructed to maintain a gap of at least 15 minutes between medicine instillation in the two eyes, for them to better appreciate any side effects of the drugs instilled. Topical olopatadine 0.2% eye drops twice daily was continued and a tear substitute containing 1% carboxymethylcellulose 4 times a day in both eyes was also added to the treatment regimen for all eyes.
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
Topical antihistamines represent the primary therapy option for treating AC.10 Alcaftadine 0.25% is approved for once-daily use in the United States11 but is not approved for use in Japan. Olopatadine is approved in once-daily (0.7%, 0.2%) and twice-daily (0.1%) dosing formulations in the US and is also approved as a four-times-daily formulation (Olopatadine 0.1%) in Japan.12–14 Both Alcaftadine and Olopatadine are classified as dual-action anti-allergic agents as they are competitive inhibitors of histamine receptor activation and also mediate a stabilization of mast cells that inhibits IgE-mediated degranulation.15 Alcaftadine is known to protect epithelial tight junction protein markers from allergic inflammation-based degradation while Olopatadine, in contrast, failed to prevent tight junction protein degradation.16 Differences in antihistamine efficacy in relief of AC are potentially due to differences in the relative potency in mediating histamine receptor activation and in the ability of Alcaftadine to prevent epithelial gap junction degradation.15,17