Advances in pharmacotherapy for allergic conjunctivitis

Abstract

The initial step of therapy remains identification and avoidance of allergic triggers. The mainstay of treatment is the new generation of dual-acting antihistamines. Drugs that improve the magnitude and duration of relief, with greater subject responder rates, are gradually making their way into the clinic. Allergic conjunctivitis is a relatively easy disease to study because of the availability of models such as the conjunctival allergen challenge. New classes of drugs that target inflammatory pathways or mediators involved in the early and late-phase allergic response are being screened in these models and we are making progress in identifying the next generation of anti-allergic therapy.

DS‐70, a novel and potent α4 integrin antagonist, is an effective treatment for experimental allergic conjunctivitis in guinea pigs

“…Histamine and eicosanoids are responsible for the typical early phase response (Katelaris, ). However, mast cells also contribute to the synthesis and release of cytokines, chemokines and growth factors, triggering a cascade of inflammatory events on the surface of epithelial and endothelial cells that leads to the late phase reaction, along with the recruitment of eosinophils and neutrophils (Abelson et al, ). These latter cytokines participate in the production of chemokines, including CCL5 and CCL11, from conjunctival cells.…”

“…Based on these findings, the blockade of α 4 β 1 integrin may represent a useful therapeutic strategy to treat allergic eye diseases. Current therapies for allergic conjunctivitis mainly include antihistamines and mast cell‐stabilizing agents that only alleviate clinical symptoms, or glucocorticoids whose use is limited by adverse effects (Abelson et al, ). Therefore, safer and more effective drugs are required to treat allergic eye diseases (Baiula and Spampinato, ).…”

Wraparound eyeglasses improve symptoms and quality of life in patients with seasonal allergic rhinoconjunctivitis

“…Because our aim was to investigate if any reduction in the use of medical treatment could be achieved by means of advising the patients to wear standard wraparound eyeglasses, we prescribed oral loratadine and ocular olopatadine for use only on an as‐needed basis. We aimed to reduce drug intake in order to avoid the reported side effects of oral loratadine, such as ocular drying, and olopatadine, such as headache, hyperemia, burning sensation, bitter taste, and dry eye . Ocular drying is especially an undesirable effect in patients with SAR, because the tear film acts as a diluent and eye wash and provides a protective function.…”

Clinical implications of mast cell involvement in allergic conjunctivitis

“…The eye is a potential target of allergic inflammatory disorders because of its marked vascularity, sensitivity of conjunctival vessels, and direct contact with the environment owing to its anatomical position; thus, to interact with offending antigens, it benefits from a complete array of immune cells and related molecular mechanisms . Allergic conjunctivitis (AC) is a collection of heterogeneous ocular inflammatory conditions mediated by mast cell activation, affecting the conjunctiva, eyelids, and cornea . AC commonly coexists with other allergic diseases including asthma, atopic dermatitis, and rhinitis .…”