ANTI-ALLERGIC DRUGS

ALLERGIC CONJUNCTIVITIS
 It

is the inflammation of conjunctiva due to reaction from allergy causing substances like pollen, dander , house dust e.t.c

Clinical classification       Acute Allergic Conjunctivitis (AAC) Intermittent/Seasonal Allergic Conjunctivitis (IAC/SAC) Persistent/Perennial Allergic Conjunctivitis (PAC) Giant Papillary Conjunctivitis (GPC) Vernal Keratoconjunctivitis (VKC) Atopic Keratoconjunctivitis (AKC) .

tearing. in addition.  Chronic form of the disease give rise. and disfiguring skin and lid changes. to more severe symptoms including pain. The milder forms of allergic eye diseases have fluctuating symptoms of itching. and swelling. visual loss from corneal scarring. cataract or glaucoma. .

NON PHARMACOLOGICAL APPROACH  Allergen avoidance including physical barriers. sunglasses. allergenimpermeable pillow and mattress covers compresses tears  Cold  Preservative-free . hat. eg.

edema. redness.(mast cell) therapy IL-3.Modes and sites of action of allergic conjunctivitis therapies Sodium cromoglycate Olopatadine Allergen avoidan ce Histamine Leukotrienes Prostaglandins Slide 6 Antihistamines Olopatadine Immediate symptoms • Itch. enhanced pain.chemotaxi s. edema. redness Mast cell Anti-IgE IgE B cell IL-4 VCAM-1 Allergen T cell Immuno. vascular permeability •Sensitized nerves. edema. -5 Steroid s Chronic symptoms Eosinophil Eosinophil and Neutrophil chemotactic factors: GM-CSF •cell destruction •disruption of ocular surface .

levocabastine0.05%.05%. pheniraminenaphazoline . cetirizinepseudoephedrine . emedastine0.05% used 4 times a day  Topical  antihistamine plus vasoconstrictor antazoline-naphazoline .ANTIHISTAMINICS  Used during acute attacks  Topical antihistamines  Azelastine 0.

indicated for multiple allergic symptomatology .unwanted effects of ‘dry eye’ .non-sedating oral antihistamines: loratadine. Oral antihistamines .Less effective than topical therapies . cetirizine . fexofenadine.

Side efffects  Headache – most common  Bad taste  Blurred vision  Burning or stinging  Corneal infiltrates  Dry eye  Rhinitis  sinusitis .

Mast cell stabilizers  They produce stabilization of mast cell membrane & prevent its degranulation  Takes days to weeks to reach its peak efficacy – so not used in acute attacks  Can be used for prophylaxsis .

1% : Highly potent.1 % : Twice or four times daily dosing. Disodium cromoglycolate 4% : QID   Nedocromil 2% : Twice daily Lodoxamide 0. rapid relief anti-eosinophilic effect  Pemirolast 0. effective for itch .

Side effects  Burning . rhinitis . cold & flu symptoms . stinging and discomfort upon installation  Do not produce immediate relief of symptoms  Headache .

stinging . dry eye .Dual-action antihistamine/mast cell stabilizer  Have mast cell antagonism & H1 antagonism  Olopatadine 0. Used twice daily Olopatidine 0.2% used once daily   Side effects .burning . rapid onset & atleat 8 hrs of action . rhinitis . eyelid edema . foreign body sensation . hypermia .1% Highly effective. pruritis . sinusitis . keratitis . asthenia .

025% twice daily Side effects – conjunctival injection .05% Approved for itch . rhinitis  Azelastine0. Ketotifen 0. headache .

45% (Acuvail )  .  Ketorolac 0.1%  Ketorolac 0.5% (Acular )  Ketorolac 0.Non steroidal anti inflammmatory drugs Block the cyclo-oxygenase pathway. Can be used for acute attacks Common drugs used  Diclofenac 0.4% (Acular LS). limiting production of prostaglandins and thromboxanes  Analgesic.

 Stromal infiltration.  Thinning. .  Perforation.1% (Nevanac )  Bromfenac 0.  Ulceration.09% SIDE EFFECTS  Persistent epithelial defect. Nepafenac 0.

the gold standard for inflammation control.topical  Corticosteroids.  prevent the formation of arachidonic acid. effectively block both the cyclooxygenase and lipoxygenase pathways  suppress inflammatory cell migration and fibroblast function and reduce capillary permeability .Corticosteroids .

25%  loteprednol etabonate 0.1% . fluorometholone 0.5% .05%  Rimexolone 1% .1%.2%  prednisolone acetate 0. 0. 0.  Difluprednate 0.12% .1%  Dexamethasone phosphate 0.

For severe cases of AKC. Delayed epithelial healing. HSV flare up.  Oral.   Ocular discomfort.  VKC. . Side effects         Local injection. AKC. Increase IOP. Posterior subcapsular cataract Ptosis Mydriasis.

also has an inhibitory effect on eosinophils activation.  Topical 2% drops . .  S/E: • Intense stinging. • Systemic CsA has been used in patients with AKC.effective as steroid sparing drug in severe VKC and AKC.  effect is usually transient.Cyclosporine  Cyclosporine (cyclosporine A ) is a selective immunosuppressant  inhibits IL2 and T-cell activation. • Keratitis.

Newer drugs Anti IgE -. nasally.  . bronchially.Omalizumab Decreases free IgE levels and down-regulates IgE receptors on basophils used for seasonal and perennial allergic conjunctivitis  immonotherapy Long term administration of low but progressively increasing doses of the offending allergen until the evoked clinical reaction is reduced or eliminated. ocularly. and subcutaneously (usual route ) Recent meta-analysis showed that it is useful for allergic conjunctivitis. sublingually.

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