Management Of Allergic Conjunctivitis Research Articles

Efficacy of an Ancient Vedic Technique in the Management of Allergic Conjunctivitis

Efficacy of an Ancient Vedic Technique in the Management of Allergic Conjunctivitis

Integrating Recommendations to Improve Treatment Outcomes in the Clinical Management of Allergic Conjunctivitis

Allergic conjunctivitis (AC) is an inflammation of the conjunctiva due to allergens that come in contact with the eye. Seasonal AC and perennial AC are the most commonly encountered subtypes. Each can be identified by itching, tearing, and swelling or inflammation of the eye, and these symptoms can contribute to decreased quality of life for patients. Many patients will seek symptomatic relief with topical ophthalmic formulations. Pharmacists and pharmacy technicians should be familiar with the clinical presentation of AC to best recommend appropriate treatments for AC. This review illustrates counseling interactions between a patient and a pharmacist to provide a clear understanding about recommending over-the-counter treatment options for patients. Effective communication is a cornerstone for pharmacists and pharmacy technicians to optimize patient management and relay vital information for the management of AC, such as assisting patients with therapies that can help provide relief of symptoms.

Olopatadine in the management of allergic conjunctivitis

Olopatadine in the management of allergic conjunctivitis

Sliding Scale in the Management of Allergic Conjunctivitis

Purpose: To verify the usability of the sliding scale in the management of allergic conjunctivitis.
 Study Design: Quasi-Experimental.
 Place and Duration of Study: District Headquarter Teaching Hospital/Sahiwal Medical College, Sahiwal, from January 2016 to December 2019.
 Methods: A sliding scale was developed and used to score the severity of the ocular allergy. Patients were instructed to use the sliding scale to adjust the treatment regimen and follow-up at regular intervals. At baseline and at third follow-up visit, sliding scale score and use of drug regimens were noted. At third follow-up visit patient’s satisfaction and disease control were documented.
 Results: There were 398 patients. Mean age of Patients was 29.45 ± 18.77 years. At baseline, 62.8% of patients were using topical steroids while at third follow-up visit only 5% of patients were using topical steroids. Mean interval of patients’ visit to the hospital was 8.53 ± 1.44 weeks. Nonparametric Mann Whitney test was used to calculate the difference in means of sliding scale scores at baseline (4.49 ± 2.39) and third follow-up visit (1.03 ± 1.68). Z score value was -16.917 and significance was 0.000.For patient’s satisfaction at third follow-up visit Chi-square value was 263.759 with significance value of 0.000. For disease control at third follow-up visit chi-square value was 223.123 with significance value of 0.000.
 Conclusion: Use of sliding scale in the management of allergic conjunctivitis was well accepted by the patients. It helped in disease control with minimal use of topical steroids and less frequent visits to the hospital.
 Key Words: Allergic Conjunctivitis, Steroids, Trantas dots.

ICON: Diagnosis and management of allergic conjunctivitis

Ocular allergy (OA), interchangeably known as allergic conjunctivitis, is a common immunological hypersensitivity disorder affecting up to 40% of the population. Ocular allergy has been increasing in frequency, with symptoms of itching, redness, and swelling that significantly impacts an individual's quality of life (QOL). Ocular allergy is an often underdiagnosed and undertreated health problem, because only 10% of patients with OA symptoms seek medical attention, whereas most patients manage with over-the-counter medications and complementary nonpharmacological remedies. The clinical course, duration, severity, and co-morbidities are varied and depend, in part, on the specific ocular tissues that are affected and on immunologic mechanism(s) involved, both local and systemic. It is frequently associated with allergic rhinitis (commonly recognized as allergic rhino conjunctivitis), and with other allergic comorbidities. The predominance of self-management increases the risk of suboptimal therapy that leads to recurrent exacerbations and the potential for development of more chronic conditions that can lead to corneal complications and interference with the visual axis. Multiple, often co-existing causes are seen, and a broad differential diagnosis for OA, increasing the difficulty of arriving at the correct diagnosis(es). Ocular allergy commonly overlaps with other anterior ocular disease disorders, including infectious disorders and dry eye syndromes. Therefore, successful management includes overcoming the challenges of underdiagnosis and even misdiagnosis by a better understanding of the subtleties of an in-depth patient history, ophthalmologic examination techniques, and diagnostic procedures, which are of paramount importance in making an accurate diagnosis of OA. Appropriate cross-referral between specialists (allergists and eyecare specialists) would maximize patient care and outcomes. This would significantly improve OA management and overcome the unmet needs in global health.

Formulation and evaluation of nanoparticulate ofloxacin ophthalmic gel using ionic gelation method

Oflaxacin is an ophthalmic and topical anti-bacterial agent used in the management of Allergic conjunctivitis, Trachoma, Blepharitis. The basic idea behind the development of such a system is to maintain a sustained drug release from the dosage form. Oflaxacin is suitable candidate for formulation into sustained dosage form in order to prolong the release of drug. The drug-excipient compatibility studies were carried out by using FTIR technique. Based on the results, excipients were found to be compatible with ofloxacin. In preformulation study, estimation of Ofloxacin was carried out by systronics UV spectrophotometer at λmax 284nm using distilled water, which had a good reproducibility and this method was used in entire study. Formulation was prepared by using ionic gelation method .The response drug content, entrapment efficiency, diffusion, spreadability, In vitro drug release was evaluated Drug content ranging from to 82.6 % to 91.24% entrapment efficiency values are ranged from 91.25% to 94.02% and in -vitro drug release studies are also studied. The In-vitro drug release study of Ofloxacin was carried out by using In-vitro diffusion apparatus.100ml of using tear fluid was taken in a beaker. The solution was stirred with 100rpm by maintaining the temperature of 37˚c ± 5˚c. The drug release data were explored for this type of release mechanism followed. The best fit with the highest determination R2 coefficients was shown by both the models (zero and peppas) followed by Higuchi model which indicate the drug release via diffusion mechanism. However as indicated by the values of R both of the models (zero and peppas) followed by Higuchi model were found to be efficient in describing the release of Ofloxacin.

Diagnosis and Management of Allergic Conjunctivitis

The purpose of this review is to define the classification, diagnosis, and management in adults and children with allergic conjunctivitis with emphasis on recent findings. Current literature divides allergic conjunctivitis according to severity and frequency, facilitating its diagnosis, study, and treatment choices. Novel pharmacological therapies aim at inhibiting inflammatory pathways at a specific molecular level and include selective glucocorticoid receptor agonists, kinase inhibitors, and IL-1 receptor antagonists. Ocular allergies are a group of heterogeneous diseases with varied immunological mechanisms and clinical presentation. Allergic conjunctivitis is an immune-mediated type I hypersensitivity disorder of the eye’s surface. Clinical presentation is characterized by bilateral ocular itching, conjunctival erythema, and ocular edema. Diagnosis is fundamentally clinical and should be supported by evidence of an IgE-mediated mechanism using skin prick tests and/or serum antigen-specific IgE. Treatment encompasses non-pharmacological and pharmacological approaches. The preferred pharmacological medications are topical dual-acting agents, which have both local antihistamine and mast cell stabilizing properties.

Diagnosis and management of allergic conjunctivitis in pediatric patients.

Allergic conjunctivitis (AC), although one of the most common ocular disorders in pediatric patients, is frequently overlooked, misdiagnosed, and undertreated in children. To guide pediatric health care professionals in the optimal diagnosis and management of AC in pediatric patients. To identify any existing best practice guidelines for the diagnosis and treatment of AC in pediatric patients, a review of the literature published between 2004 and January 2015 was conducted. Diagnosis and treatment algorithms and guidelines for pediatric patient referrals were then developed. A literature search to identify best practice guidelines for the treatment of AC in pediatric patients failed to return any relevant articles, which highlighted the need for best practice recommendations. Based on publications on adult AC and clinical experience, this review provides step-by-step guidance for pediatric health care professionals, including recognizing clinical features of AC, establishing a comprehensive medical history, and performing a thorough physical examination to ensure a correct diagnosis and the optimal treatment or referral to an eye care specialist or allergist when required. In addition to established drug treatments, the role of subcutaneous and sublingual immunotherapy is discussed to inform pediatric health care professionals about alternative treatment options for patients who do not tolerate pharmacotherapy or who do not respond sufficiently. The diagnostic and treatment algorithms and guidelines provided in this review help address the current literature and educational gap and may lead to improvements in diagnosis and management of pediatric AC.

Clinical Efficacy and Safety of Mahatriphaladya Ghrita in the Management of Allergic Conjunctivitis: A Prospective Open Label Multicenter Study

Clinical Efficacy and Safety of <i>Mahatriphaladya Ghrita</i> in the Management of Allergic Conjunctivitis: A Prospective Open Label Multicenter Study

Efficacy of topical application of 0.03% tacrolimus eye ointment in the management of allergic conjunctivitis.

Background:Allergic conjunctivitis is commonly observed eye diseases in Sikkim, India due to the abundance of seasonal pollens, environmental pollutants, and house dust. We evaluated the efficacy of topical 0.03% tacrolimus eye ointment in the management of simple allergic conjunctivitis.Materials and Methods:A prospective observational study was designed consisting of 41 patients with refractory simple allergic conjunctivitis, whose condition responded very poorly to conventional anti-allergic eye drops (azelastine, olopatadine, chlorpheniramine maleate, sodium chromoglycate). Simple allergic conjunctivitis cases were diagnosed and followed up evaluating both subjective and objective findings (itching, photophobia, tearing, chemosis, conjunctival congestion, tarsal papilla, and eyelid edema). Existing ocular treatment was discontinued at enrolment and 0.03% tacrolimus ointment was applied into the conjunctival sac of the affected eyes twice daily for 4 weeks followed by a 2 weeks washout period. Patients were followed up at the end of 1st week, 4th week, and at 7th week (2 weeks washout period).Results:Symptoms of simple allergic conjunctivitis (itching, tearing and photophobia) were significantly reduced at the end of 1st week. Signs such as conjunctival chemosis, congestion, tarsal papillae, and eyelid edema were effectively treated in all cases at the end of 1st week. At the end of 4th week, all cases were fully cured and none of the patient had any recurrences up to 7th week. Mean score at 1st day (9.6 ± 3.27) was significantly (P < 0.0001) reduced by 7th day (1.35 ± 1.19) of treatment.Conclusion:Topical application of tacrolimus ointment is an excellent alternative to anti-allergic and steroids eye drops for the treatment of simple allergic conjunctivitis as it significantly reduces recurrences.

Evaluating the effect of an aqueous extract of Pistia stratiotes Linn (Araceae) on tear secretion and tear film stability in ICR mice

Article history: Management of allergic conjunctivitis with conventional anti-allergic drugs usually cause the discomfort of dry eyes. This study, therefore, sought to evaluate the effect of Pistia stratiotes, a herbal remedy with anti-allergic properties, on tear secretion and tear film stability. ICR mice were grouped and treated with 5 mg/kg cetirizine, 10 mg/kg prednisolone, 100 mg/ kg leaf extract of P. stratiotes (LEPS), or 2 ml/kg normal saline per os for 7 consecutive days. With the phenol red thread test and the determination of fluorescein tear film break-up time, tear secretion and tear film stability before and after drug interventions were determined. Results recorded indicated that tear secretion and tear film stability declined significantly with cetirizine treatment (1.188 ± 0.4369 mm; P ≤ 0.05, and 2.688 ± 0.6185 s; P ≤ 0.001 respectively), while only tear secretion reduced significantly (P ≤ 0.05) in mice treated with prednisolone (0.9380 ± 0.4422 mm). Treatment with LEPS showed no significant effect (P > 0.05) on tear secretion and tear film stability (0.7050 ± 0.4236 mm, and 0.9790 ± 0.6145 s respectively); comparable to normal saline treatment. Per the findings, Pistia stratiotes does not affect tear secretion and tear film stability and hence is not likely to exhibit the adverse effect of dry eyes, as conventional anti-allergic drugs do, in the management of allergic conjunctivitis.

Progress in pediatrics in 2013: choices in allergology, endocrinology, gastroenterology, hypertension, infectious diseases, neonatology, neurology, nutrition and respiratory tract illnesses.

This review will provide new information related to pathophysiology and management of specific diseases that have been addressed by selected articles published in the Italian Journal of Pediatrics in 2013, focusing on allergology, endocrinology, gastroenterology, hypertension, infectious diseases, neonatology, neurology, nutrition and respiratory tract illnesses in children. Recommendations for interpretation of skin prick test to foods in atopic eczema, management of allergic conjunctivitis, hypertension and breastfeeding in women treated with antiepileptic drugs and healthy breakfast have been reported. Epidemiological studies have given emphasis to high incidence of autoimmune disorders in patients with Turner syndrome, increasing prevalence of celiac disease, frequency of hypertension in adolescents, incidence and risk factor for retinopathy of prematurity. Advances in prevention include elucidation of the role of probiotics in reducing occurrence of allergies and feeding intolerance, and events of foetal life that influence later onset of diseases. Mechanistic studies suggested a role for vitamin D deficiency in asthma and type 1 diabetes and for reactivation of Varicella-Zoster virus in aseptic meningitis. Regarding diagnosis, a new mean for the diagnosis of hyperbilirubinaemia in newborns, a score for recognition of impaired nutritional status and growth and criteria for early Dyke-Davidoff-Masson Syndrome have been suggested. New therapeutic approaches consist of use of etanercept for reducing insulin dose in type 1 diabetes, probiotics in atopic eczema, and melatonin in viral infections.

Comparing the Efficacy of Topical Anti- Allergic Preparations in the Treatment of Allergic Conjunctivitis

Objectives : This research study compared the efficacy of three anti-allergic preparations commonly used in the treatment of allergic conjunctivitis. Materials and Method : A randomized, double-masked, placebo-controlled multicenter study was conducted for four weeks in 4 centers to evaluate the efficacy of topical Antazoline (0.5mg), Sodium Cromoglycate (20mg) and Lodoxamide (1.78mg) for the treatment of active bilateral allergic conjunctivitis. Sixty patients diagnosed with allergic conjunctivitis completed the study; they were divided into four groups of 15 each. Group A was treated with a masked bottle of 0.5mg Antazoline (Spersallerg eyedrop) labelled ‘R’, Group B was treated with a masked bottle of 20mg Sodium Cromoglycate (Ivycrom eyedrop) labelled ‘S’, Group C was treated with a masked bottle of 1.78mg Lodoxamide (Alomide eyedrop) labelled ‘T’ and Group D was treated with a matching placebo (the drug vehicle). Objective clinical signs were graded weekly by the clinicians while patients kept a daily record of the severity of their symptoms. Results : 1.78mg Lodoxamide was found to be more effective than 20mg Sodium Cromoglycate and 0.5mg Antazoline in treating the signs and symptom of allergic conjunctivitis to a statistically significant level (p<0.001). The least effective of these three eyedrops is 0.5mg Antazoline, although it was found to be significantly more effective than the placebo in treating the signs and symptoms of allergic conjunctivitis. Conclusion : It was clear that patients with allergic conjunctivitis responded better to 1.78mg Lodoxamide therefore 1.78mg Lodoxamide has the highest efficacy and it may be a recommended drug in the management of allergic conjunctivitis. Keywords : 0.5mg Antazoline, 20mg Sodium Cromoglycate, 1.78mg Lodoxamide, Allergic conjunctivitis.

Comparison of the therapeutic efficacy of 0.1% olopatadine hydrochloride and 0.025% ketotifen fumarate in allergic conjunctivitis

Aims: To study whether 0.1% olopatadine hydrochloride (OHCL) is more effective and safer than 0.025% ketotifen fumarate (KF) in the management of allergic conjunctivitis. Methods: 83 patients with the sign (hyperemia) and symptoms of allergic conjunctivitis (i.e., tearing, itching and photophobia) were randomized (stratifying by age and sex) 1:1 to receive either 0.1% OHCL or 0.025% KF (one drop in each eye every 12 h). Signs and symptoms were scored before and after 2 weeks of drug therapy using a four-point scale (range: 0–3) while side effects were scored 30 min and 2 weeks after treatment initiation. A composite score of signs and symptoms was defined by adding all measures of signs and symptoms and then subtracting the week 2 sum from the pretreatment sum. Results: Both drugs reduced signs and symptoms of allergic conjunctivitis at 2 weeks from baseline. The treatment with 0.1% OHCL was more effective compared with 0.025% KF, as the mean (SD) composite score of 6.3 (±1.3) for the OHCL group was signi...

Management of allergic conjunctivitis: an evaluation of the perceived comfort and therapeutic efficacy of olopatadine 0.2% and azelastine 0.05% from two prospective studies

Results from 2 patient-reported outcome studies of allergic conjunctivitis sufferers who used olopatadine 0.2% and azelastine 0.05% are analyzed. The PACE (Pataday Allergic Conjunctivitis Evaluation) multi-center, prospective, open-label study examined patient perceptions of olopatadine 0.2% once daily (qd) and previous twice daily (bid) allergic conjunctivitis medications via questionnaire in allergic conjunctivitis sufferers who had previously used bid medication and then initiated olopatadine. A second conjunctival antigen challenge (CAC) study evaluated comfort of 4 allergic conjunctivitis medications. Forty-nine patients from the PACE study (N = 125) with prior azelastine use were examined. Significantly more patients rated themselves "very satisfied" with current olopatadine use compared with past azelastine use on drop comfort (p < 0.0001), speed of relief (p = 0.0004), and overall satisfaction (70% vs 16%, p < 0.0001). Significantly more patients reported olopatadine "very effective" against swelling compared with azelastine (47% vs 8%, p = 0.0404). In the CAC study (N = 36), data from olopatadine (n = 8), azelastine (n = 9) and placebo (N = 36) groups were reported. Olopatadine was rated significantly more comfortable than azelastine upon instillation (p = 0.0223), at 30 seconds (p = 0.0479), and at 1 minute after instillation (p = 0.0240). In the reported studies, olopatadine 0.2% qd was more comfortable than azelastine 0.05% and preferred by patients with allergic conjunctivitis by a ratio of 4:1.

Management of Allergic Conjunctivitis

Allergic conjunctivitis, unlike several other ocular diseases, is very seldom followed by permanent visual impairment; nevertheless its importance is due to both its frequency and its severity. A thorough knowledge of the pathophysiological aspects and clinical features of allergic conjunctivitis allows physicians to choose the best and most suitable management from the many alternatives. Management varies according to symptom severity and the characteristics of the allergic reaction; generally, it is based on environmental control, pharmacotherapy and, sometimes, specific immunotherapy.

A study on the Therapeutic Efficacy of Olopatadine Hydrochloride in the Management of Allergic Conjunctivitis

A prospective interventional study was conducted to see the efficacy and safety of a ophthalmic preparation olopatadine hydrochloride (0.1%) on 40 allergic conjunctivitis patients attended the out-patient department of Ophthalmology, Sylhet M.A.G. Osmani Medical College Hospital. One drop of ophthalmic solution was administered 12 hourly in each eye for 2 weeks. Scoring of hyperaemia, itching, tearing, and photophobia were estimated before and 2 weeks after administration of the drug. After 30 min. &amp; 2 weeks of administration of drug adverse effects were assessed if there was any. The mean scores of hyperaemia, tearing, itching and photophobia were reduced after 2 weeks of treatment. The scores of hyperaemia, itching, tearing, photophobia were found to be lower compared to Day 0. This change was statistically significant (p &lt; 0.001). Olopatadine appeared to reduce ocular signs and symptoms in Allergic conjunctivitis . Key words: Olopatadine hydrochloride; Allergic conjunctivitis; Hyperaemia; Tearing; Itching; Photophobia. DOI: 10.3329/medtoday.v22i1.5599 Medicine Today Vol.22(1) 2010. 15-19