Prevalence of Contact Allergens in Best-Selling Ophthalmic Products

Abstract

BackgroundOphthalmic products are a common but often overlooked contributor to allergic contact dermatitis. Frequency of allergenic ingredients in over-the-counter ophthalmic products has not been well characterized.ObjectiveThe purpose of this study was to determine the prevalence of allergenic ingredients in most commonly bought eye lubricants and contact lens solutions.MethodsA product list of Amazon.com's best-selling ophthalmic products was curated by searching for “Best Sellers in Eye Drops, Lubricants & Washes” and “Best Sellers in Contact Lens Care Products.” For exploratory analysis, indication, price, consumer ratings, number of reviews, and US Food and Drug Administration approval status were recorded. The products' ingredients were compiled using NLM DailyMed, and products that had 1 or more allergens or relevant cross-reactors on either the 2018 American Contact Dermatitis Society Core Allergen Series or the 2015–2016 North American Contact Dermatitis Group Standard Allergen Series were noted.ResultsForty-eight percent (n = 49) of the total products, (57.8% [n = 37] of eye lubricants, and 31.6% [n = 12] of contact lens solutions) had 1 or more allergens or associated cross-reactors. Identified allergens were benzalkonium chloride, propylene glycol, sorbic acid, amidoamine, sorbitan sesquioleate, chlorhexidine digluconate, lanolin alcohol, parabens, benzyl alcohol, and butylated hydroxytoluene.ConclusionsAwareness of potential allergens is crucial to diagnosing allergic contact dermatitis to ophthalmic products and helping patients navigate online pharmacological chaos.

Contact Allergens in Prescription Topical Ophthalmic Medications

“…A recent report found that more than 30% of top-selling OTC eye lubricant products contained benzalkonium chloride. 3 In our study, benzalkonium chloride was most prevalent in antiglaucoma (88.9%, 80/90), steroid (81.5%, 22/27), and antibiotic (68.2%, 58/85) agents. Topical ophthalmic ointments were typically free from this preservative; other benzalkonium chloride-free formulations are listed in Table 3.…”

“…The NACDG data estimate the prevalence of propylene glycol allergy in patients referred for patch testing to be 2.8% to 4.0% 20 . Propylene glycol was found to be the second highest (12.7%, 13/102) ACDS Core 90 allergen/cross-reactor present in the best-selling OTC eye lubricants and contact lens solutions 3 . We found propylene glycol most frequently in antiglaucoma medications (3.3%, 3/90).…”

“…A prior study found sorbates in 11.8% (12/102) of the best-selling OTC eye lubricants and contact lens solutions. 3 Although sorbates are widely used in several product categories, such as surgical disinfectants 13 and facial cleansing wipes, 14 sorbate allergy is uncommon. Topical exposure to sorbic acid may cause immediate reactions/nonimmunologic contact urticaria 15 ; allergic contact dermatitis (ACD) is less common.…”

“…A literature search revealed only 1 study examining ingredients of ophthalmic agents in the United States; that study focused on OTC products. 3 In this study, we examine ingredients in prescription ophthalmic medications available in the United States.…”

Patients with patch test reactions associated with eye care products: Retrospective analysis of North American contact dermatitis group data, 2001‐2018

“…In Europe, positivity to BAC associated with eye drops is estimated to be 1.1% 5 . A recent ingredient analysis of US products found that roughly one‐third of top selling OTC eye lubricants contained BAC; other common allergens were propylene glycol, sorbic acid, amidoamine, and sorbitan sequioleate 7 . Reactions to BAC should be interpreted carefully because of its propensity to cause irritation when patch tested 8 .…”