Treating allergic conjunctivitis: A once-daily medication that provides 24-hour symptom relief

Warner Carr, Jack Schaeffer, Eric Donnenfeld, Warner Carr, Jack Schaeffer, Eric Donnenfeld

Abstract

Background: Allergic conjunctivitis (AC) is a common ocular inflammatory manifestation of allergen exposure in sensitized individuals. Signs and symptoms of AC can decrease quality of life, interfere with productivity, and lead to considerable economic burden. Consistent suppression of conjunctival inflammation is necessary for managing AC, but currently available medications require frequent administration and exhibit limited duration of action.

Methods: In this review, we summarized AC pathogenesis, diagnosis, and current treatment options as well as their limitations. Findings from the literature were discussed in the context of the unmet need for a once-daily medication with sustained 24-hour effectiveness.

Results: Topical pharmacologic treatments are the most common approach for managing extant AC; however, most available medications require multiple daily instillations. Dual-acting antihistamine-mast cell stabilizing agents are currently considered first-line therapeutics for AC because they provide acute relief of signs and symptoms and block persistent inflammation to promote regression of AC. Recent studies of a newly-developed, higher-concentration formulation of a dual-acting antihistamine-mast cell stabilizer have demonstrated that this formulation provides a 24-hour duration of action with once-daily dosing.

Conclusions: Dual-acting AC medications exhibit a high degree of overall effectiveness and are well tolerated for chronic use. A newly available once-daily medication that manages signs and symptoms of AC for a full 24 hours may be considered a treatment of choice for patients experiencing seasonal or perennial AC. ClinicalTrials.gov NCT01743027 and NCT01479374.

Figures

Figure 1.
Figure 1.
Normal eye (left) and eye with inflammation caused by allergic conjunctivitis (right). The bulbar and palpebral conjunctiva are indicated.
Figure 2.
Figure 2.
Mean treatment differences in ocular itching after conjunctival allergen challenge. Ocular itching was assessed at 3, 5, and 7 minutes. *p 0.001, †p < 0.01, ‡p < 0.05. Reproduced with permission (from Ref. 52).
Figure 3.
Figure 3.
Ocular itching examined after conjunctival allergen challenge. (A) Olopatadine 0.77% versus vehicle at onset and 24 hours after instillation. (B) Olopatadine 0.77% versus olopatadine 0.2% 24 hours after instillation. (C) Olopatadine 0.77% versus olopatadine 0.1% at 24 hours after instillation. *p

References

    1. Chigbu DI. The pathophysiology of ocular allergy: A review. Cont Lens Anterior Eye 32:3–15; quiz 43–44, 2009.
    1. Bielory L, Meltzer EO, Nichols KK, et al. An algorithm for the management of allergic conjunctivitis. Allergy Asthma Proc 34:408–420, 2013.
    1. Singh K, Axelrod S, Bielory L. The epidemiology of ocular and nasal allergy in the United States, 1988–1994. J Allergy Clin Immunol 126:778–783.e776, 2010.
    1. Butrus S, Portela R. Ocular allergy: Diagnosis and treatment. Ophthalmol Clin North Am 18:485–492, v, 2005.
    1. Gomes PJ. Trends in prevalence and treatment of ocular allergy. Curr Opin Allergy Clin Immunol 14:451–456, 2014.
    1. Hom MM, Nguyen AL, Bielory L. Allergic conjunctivitis and dry eye syndrome. Ann Allergy Asthma Immunol 108:163–166, 2012.
    1. Gelardi M, Leo ME, Quaranta VN, et al. Clinical characteristics associated with conjunctival inflammation in allergic rhinoconjunctivitis. J Allergy Clin Immunol Pract 3:387–391.e1, 2015.
    1. Maspero J, Lee BW, Katelaris CH, et al. Quality of life and control of allergic rhinitis in patients from regions beyond western Europe and the United States. Clin Exp Allergy 42:1684–1696, 2012.
    1. Pitt AD, Smith AF, Lindsell L, et al. Economic and quality-of-life impact of seasonal allergic conjunctivitis in Oxfordshire. Ophthalmic Epidemiol 11:17–33, 2004.
    1. Smith AF, Pitt AD, Rodruiguez AE, et al. The economic and quality of life impact of seasonal allergic conjunctivitis in a Spanish setting. Ophthalmic Epidemiol 12:233–242, 2005.
    1. Virchow JC, Kay S, Demoly P, et al. Impact of ocular symptoms on quality of life (QoL), work productivity and resource utilisation in allergic rhinitis patients—An observational, cross sectional study in four countries in Europe. J Med Econ 14:305–314, 2011.
    1. Bielory L, Skoner DP, Blaiss MS, et al. Ocular and nasal allergy symptom burden in America: The Allergies, Immunotherapy, and RhinoconjunctivitiS (AIRS) surveys. Allergy Asthma Proc 35:211–218, 2014.
    1. Stull DE, Schaefer M, Crespi S, Sandor DW. Relative strength of relationships of nasal congestion and ocular symptoms with sleep, mood and productivity. Curr Med Res Opin 25:1785–1792, 2009.
    1. Bielory L, Syed BA. Pharmacoeconomics of anterior ocular inflammatory disease. Curr Opin Allergy Clin Immunol 13:537–542, 2013.
    1. Azari AA, Barney NP. Conjunctivitis: A systematic review of diagnosis and treatment. JAMA 310:1721–1729, 2013.
    1. American Academy of Ophthalmology Cornea/External Disease Panel. Preferred Practice Pattern® Guidelines. Conjunctivitis. American Academy of Ophthalmology. Available online at ; accessed May 16, 2016.
    1. Vandenbroeck S, De Geest S, Dobbels F, et al. Prevalence and correlates of self-reported nonadherence with eye drop treatment: The Belgian Compliance Study in Ophthalmology (BCSO). J Glaucoma 20:414–421, 2011.
    1. Anderson DF, MacLeod JD, Baddeley SM, et al. Seasonal allergic conjunctivitis is accompanied by increased mast cell numbers in the absence of leucocyte infiltration. Clin Exp Allergy 27:1060–1066, 1997.
    1. Macleod JD, Anderson DF, Baddeley SM, et al. Immunolocalization of cytokines to mast cells in normal and allergic conjunctiva. Clin Exp Allergy 27:1328–1334, 1997.
    1. Morgan SJ, Williams JH, Walls AF, et al. Mast cell numbers and staining characteristics in the normal and allergic human conjunctiva. J Allergy Clin Immunol 87:111–116, 1991.
    1. Leonardi A. The central role of conjunctival mast cells in the pathogenesis of ocular allergy. Curr Allergy Asthma Rep 2:325–331, 2002.
    1. Irkec MT, Bozkurt B. Molecular immunology of allergic conjunctivitis. Curr Opin Allergy Clin Immunol 12:534–539, 2012.
    1. Bielory BP, O'Brien TP, Bielory L. Management of seasonal allergic conjunctivitis: Guide to therapy. Acta Ophthalmol 90:399–407, 2012.
    1. Pawankar R, Canonica G, Holgate S, et al. WAO White Book on Allergy. Milwaukee, WI: World Allergy Organization, 2011.
    1. Van Cauwenberge P, De Belder T, Vermeiren J, et al. Global Resources in Allergy (GLORIA): Allergic rhinitis and allergic conjunctivitis. Clin Exp Allergy Rev 3:46–50, 2003.
    1. Ono SJ, Abelson MB. Allergic conjunctivitis: Update on pathophysiology and prospects for future treatment. J Allergy Clin Immunol 115:118–122, 2005.
    1. Leonardi A, Bogacka E, Fauquert JL, et al. Ocular allergy: Recognizing and diagnosing hypersensitivity disorders of the ocular surface. Allergy 67:1327–1337, 2012.
    1. Leonardi A, Curnow SJ, Zhan H, Calder VL. Multiple cytokines in human tear specimens in seasonal and chronic allergic eye disease and in conjunctival fibroblast cultures. Clin Exp Allergy 36:777–784, 2006.
    1. Mimura T, Usui T, Yamagami S, et al. Relation between total tear IgE and severity of acute seasonal allergic conjunctivitis. Curr Eye Res 37:864–870, 2012.
    1. Bousquet J, Heinzerling L, Bachert C, et al. Practical guide to skin prick tests in allergy to aeroallergens. Allergy 67:18–24, 2012.
    1. O'Brien TP. Allergic conjunctivitis: An update on diagnosis and management. Curr Opin Allergy Clin Immunol 13:543–549, 2013.
    1. Bilkhu PS, Wolffsohn JS, Naroo SA, et al. Effectiveness of nonpharmacologic treatments for acute seasonal allergic conjunctivitis. Ophthalmology 121:72–78, 2014.
    1. Sanchez M, Parra BF, Matheu V, et al. Allergic conjunctivitis. J Investig Allergol Clin Immunol 21:1–19, 2011.
    1. Calderon MA, Penagos M, Sheikh A, et al. Sublingual immunotherapy for allergic conjunctivitis: Cochrane systematic review and meta-analysis. Clin Exp Allergy 41:1263–1272, 2011.
    1. Lin SY, Erekosima N, Kim JM, et al. Sublingual immunotherapy for the treatment of allergic rhinoconjunctivitis and asthma: A systematic review. JAMA 309:1278–1288, 2013.
    1. Joint Task Force on Practice Parameters; American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology; and Joint Council of Allergy, Asthma and Immunology. Allergen immunotherapy: A practice parameter second update. J Allergy Clin Immunol 120(suppl. 3):S25–S85, 2007.
    1. Blaiss MS, Dykewicz MS, Skoner DP, et al. Diagnosis and treatment of nasal and ocular allergies: The Allergies, Immunotherapy, and RhinoconjunctivitiS (AIRS) surveys. Ann Allergy Asthma Immunol 2014;112:322–328.e321, 2014.
    1. Anolik R, Schwartz AM, Sajjan S, Allen-Ramey F. Patient initiation and persistence with allergen immunotherapy. Ann Allergy Asthma Immunol 113:101–107, 2014.
    1. Gane J, Buckley R. Leukotriene receptor antagonists in allergic eye disease: A systematic review and meta-analysis. J Allergy Clin Immunol Pract 1:65–74, 2013.
    1. Kim SJ, Flach AJ, Jampol LM. Nonsteroidal anti-inflammatory drugs in ophthalmology. Surv Ophthalmol 55:108–133, 2010.
    1. Swamy BN, Chilov M, McClellan K, Petsoglou C. Topical non-steroidal anti-inflammatory drugs in allergic conjunctivitis: Meta-analysis of randomized trial data. Ophthalmic Epidemiol 14:311–319, 2007.
    1. Carnahan MC, Goldstein DA. Ocular complications of topical, peri-ocular, and systemic corticosteroids. Curr Opin Ophthalmol 11:478–483, 2000.
    1. Greiner JV, Edwards-Swanson K, Ingerman A. Evaluation of alcaftadine 0.25% ophthalmic solution in acute allergic conjunctivitis at 15 minutes and 16 hours after instillation versus placebo and olopatadine 0.1%. Clin Ophthalmol 5:87–93, 2011.
    1. Ackerman S, D'Ambrosio F, Jr, Greiner JV, et al. A multicenter evaluation of the efficacy and duration of action of alcaftadine 0.25% and olopatadine 0.2% in the conjunctival allergen challenge model. J Asthma Allergy 6:43–52, 2013.
    1. Abelson MB, Gomes PJ. Olopatadine 0.2% ophthalmic solution: The first ophthalmic antiallergy agent with once-daily dosing. Expert Opin Drug Metab Toxicol 4:453–461, 2008.
    1. Noecker R. Effects of common ophthalmic preservatives on ocular health. Adv Ther 18:205–215, 2001.
    1. Robin AL, Covert D. Does adjunctive glaucoma therapy affect adherence to the initial primary therapy? Ophthalmology 112:863–868, 2005.
    1. Robin AL, Novack GD, Covert DW, et al. Adherence in glaucoma: Objective measurements of once-daily and adjunctive medication use. Am J Ophthalmol 144:533–540, 2007.
    1. Sleath B, Robin AL, Covert D, et al. Patient-reported behavior and problems in using glaucoma medications. Ophthalmology 113:431–436, 2006.
    1. McLaurin E, Narvekar A, Gomes PJ. Phase 3 study of efficacy and safety of once-daily olopatadine hydrochloride, 0.77% ophthalmic formulation in patients with allergic conjunctivitis using the ora conjunctival allergen challenge model (Ora-CAC™) (NCT01743027). Invest Ophthalmol Vis Sci 55:2488, 2014.
    1. Pataday (olopatadine hydrochloride ophthalmic solution 0.2%). Full Prescribing Information. Alcon Laboratories, Inc., Fort Worth, TX, 2010.
    1. Torkildsen G, Narvekar A, Bergmann M. Efficacy and safety of olopatadine hydrochloride 0.77% in patients with allergic conjunctivitis using a conjunctival allergen-challenge model. Clin Ophthalmol 9:1703–1713, 2015.
    1. McLaurin E, Narvekar A, Gomes P, et al. Phase 3 randomized double-masked study of efficacy and safety of once-daily 0.77% olopatadine hydrochloride ophthalmic solution in subjects with allergic conjunctivitis using the conjunctival allergen challenge model. Cornea 34:1245–1251, 2015.

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