Etiological diagnosis of acute drug contact allergic reaction occurred during ophthalmic surgery

Abstract

Drug allergy is one of the most common problems in clinical medicine, including ophthalmology. The frequency and severity of drug-induced eye lesions are continuously increasing as the arsenal of active drugs increases. Among the common causes of eye contact allergy, along with the traditionally noted antibiotics and anesthetics, in recent years an expansion of the list of the most significant drug allergens has been registered, including mydriatics (tropicamide and phenylephrine), beta-blockers, dorzolamide, latanoprost, and topical corticosteroids. In addition to active ingredients, ophthalmic preparations contain a number of auxiliary substances, such as benzalkonium chloride, chlorhexidine and thiomersal, which have sensitizing properties. The article presents a clinical case of a patient suffering from cataracts, who developed an acute local allergic reaction during the introductory period of the lens replacement surgery, which was the reason for canceling the surgical intervention. At the same time, several drugs were used simultaneously, each of which, as well as excipients in their composition, could cause allergies. Approaches to specific diagnostics are described, including the choice of skin tests depending on the clinical phenotype of drug allergy. After determining the cause of the allergy, recommendations were given for further treatment, both to the patient and to the ophthalmologist, which made it possible to subsequently perform the operation without complications.