The availability of Pataday™ and over-the-counter Zaditor® and Alaway® can benefit ocular allergy sufferers.
As many as 40% of my patients suffer ocular allergy symptoms at some point, but only a small percentage will mention their symptoms if I don’t ask about them. Therefore, it is important to be proactive when screening for ocular allergy symptoms. Patients with ocular allergy will benefit greatly from counseling regarding effective medications, behavioral and environmental modifications, and palliative measures.
Two recent advances in the treatment of ocular allergy are worthy of note: the introduction of a 0.2% olopatadine drop (Pataday™ Ophthalmic Solution; Alcon) and the over-the-counter (OTC) availability of topical ketotifen drops (Zaditor®, Novartis; Alaway®, Bausch & Lomb). Pataday is a double-strength version of Patanol® that offers convenient once-a-day dosing and a higher concentration of olopatadine, which makes the drop more effective.
Zaditor and Alaway are a welcome addition to the OTC range of drops. These drops contain a potent antihistamine and do not contain a vasoconstrictor, which can cause rebound hyperemia and tachyphylaxis. Previously, it was hard for patients to find an OTC drop that contained enough antihistamine to be effective (many OTC drops also contained vasoconstrictors).
While medications are important in the treatment of ocular allergies, simple behavioral and environmental modifications can go a long way toward preventing bothersome symptoms. My first rule for allergy patients is: Don’t rub your eyes! Rubbing causes mast cell degranulation, releasing a mix of histamine and inflammatory mediators onto the ocular surface. It is also helpful to avoid allergy triggers as much as possible. This includes washing face, hands, and even hair (or at least brushing it) after coming in from the outdoors, keeping windows closed,and not allowing pets in the bedroom.
Patients may be able to prevent allergy symptoms by starting on an antihistamine/mast cell stabilizer drop a few weeks before the start of their allergy season and following the above behavioral tips. However, for those symptoms that break through, simple palliative measures such as chilled artificial tears (which both soothe the eye and serve to wash out allergens) and cool compresses can provide some relief. In addition, patients who have trouble wearing contact lenses during allergy season may benefit by switching to daily disposable lenses for the duration. Using fresh lenses every day minimizes exposure to allergen build up on lenses.
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