EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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58 EW SECONDARY FEATURE Combination continued from page 57 Dr. Leonardi said his first line of treatment is using double multiple- action drugs, which contain a single molecule with multiple effects. Dual-action antihistamine/mast cell stabilizers available on the mar- ket now are effective in many pa- tients, he said. "Antihistamines with mast cell stabilizing abilities, also known as dual-acting agents, inhibit mast cell degranulation. They have a pretty good safety profile and have been used for a number of years with sta- ble side effects," Dr. Leonardi said. "Combination antihistamines and vasoconstrictors can be used for oc- casional symptoms and redness, but I think they are usually preserved and the patients tend to use them chronically, which may give them drug-induced conjunctivitis." The latest combination drop, Bepreve (bepotastine besilate oph- thalmic solution 1.5%, Ista Pharma- ceuticals, Irvine, Calif.), was approved by the FDA in 2009 for the treatment of ocular itching associ- ated with allergic conjunctivitis. Others include Patanol (olopatadine hydrochloride ophthalmic solution 0.1%, Alcon, Fort Worth, Texas) and Elestat (epinastine HCl ophthalmic solution 0.05%, Allergan, Irvine, Calif.). Combination therapy drops are a "mainstay treatment," Dr. O'Brien said. "They not only provide rapid relief of the itch, but there is the mast cell stabilization that prevents a cascade of symptoms," he said, adding that he has SAC patients keep the drops "at the ready" before allergy season and has them admin- ister the drops twice a day during that time. Dr. Abelson suggesting having the patients store the eye drops in the refrigerator for added cooling ef- fects. Over-the-counter drops such as Claritin Eye (ketotifen, Schering- Plough, Kenilworth, N.J.), Zyrtec (ketotifen, McNeil Consumer Healthcare, Fort Washington, Pa.), and Zaditor (ketotifen fumarate oph- thalmic solution, Novartis, Basel, Switzerland) are readily available for a quick fix, but don't always work. Antihistamine drops alone aren't as effective either, Dr. Abelson said. "Regular antihistamines are very Right On Target... The New A-Scan Plus®4.20 short acting and don't have any anti-inflammatory effects," he said. Patients also may use mast cell stabilizers alone. Those include sodium cromoglicate (various manu- facturers), nedocromil (Alocril, Allergan), and lodoxamide (Alomide, Alcon), but the doctors agreed that they aren't as effective as combination drops. "We do not have a really good Meeting the Needs of Your Premium IOL Patient • Industry Leading Resolution • 100% Measurement Capability including dense cataracts • Automatic Alignment Detection • Simplified Personalization of Lens Constants • Unlimited patient data storage, recall, and transfer via USB Memory Stick Every purchase of an A-Scan Plus 4.20 comes with an on-site training program. Product #24-4200 Receive a Free Toric Marker with Purchase Visit us at ASCRS Booth #2139 mast cell stabilizer alone," Dr. Abelson said. "Cromolyn was never approved for SAC, contrary to peo- ple's thoughts, and it has fallen out of use," Dr. Abelson said. "Others are very weak and rarely used." Dr. O'Brien agreed that combina- tion therapy is the standard of care. "It is very rare that you want to separate those actions—the antihis- tamine and the mast cell stabilizer," Dr. O'Brien said. "Drugs that reduce eosinophil activation such as lodoxamide and spaglumic acid and systemic antihis- tamines also can be used as a stan- dard treatment," for severe forms of allergy such as vernal keratocon- junctivitis or atopic keratoconjunc- tivitis, Dr. Leonardi said. EW Editors' note: Dr. Abelson is the founder of Ora. Mr. Gomes is vice president of allergy research at Ora. Dr. Leonardi has no financial interests related to this article. Dr. O'Brien is an ad-hoc, non- salaried consultant for Alcon, Allergan, and Bausch + Lomb (Rochester, N.Y.). Contact information Abelson: mbabelson@oraclinical.com Gomes: p.gomes@oraclinical.com Leonardi: andrea.leonardi@unipd.it O'Brien: 561-515 1544, tobrien@med.miami.edu 3222 Phoenixville Pike, Malvern, PA 19355 • USA 800-979-2020 • 610-889-0200 • FAX 610-889-3233 • www.accutome.com February 2011 Ocular allergies April 2012