Allergic conjunctivitis. How to alleviate symptoms. The perspective of an allergist and ophthalmologist Review article
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Abstract
Allergic ocular diseases (AO), such as seasonal (SAC) and perennial (PAC), are common, estimated to affect 14–45% of the general population, yet are often underdiagnosed and inadequately treated. Diagnosis is based on the history and the presence of symptoms such as itching, tearing, congestion, watery discharge, and discomfort, as well as a physical examination. Infections, especially viral infections, should be considered in the differential diagnosis. Skin prick testing and/or specific IgE testing are helpful in diagnosing the allergen and potentially initiating specific immunotherapy, the sole causal treatment. Symptomatic treatment of AO is gradual, with the goal of symptom control and improved quality of life. The first step is allergen avoidance and non-pharmacological interventions (cold compresses, artificial tears – preferably preservative-free). In mild cases, a preparation combining ectoine and hyaluronic acid can be effective, stabilizing the tear film and reducing inflammation, while being safe for children and pregnant women. The second step includes topical medications (H1 receptor blockers and mast cell stabilizers) and oral second-generation antihistamines (LH1). Azelastine (topical) deserves consideration due to its strong affinity for H1 receptors and dual antiallergic mechanism (rapid relief, convenient dosing). Oral LH1 is recommended to be initiated two weeks before the pollen season in the SAC. In more severe cases (third step), topical glucocorticosteroids (GCs) are used, always under the supervision of an ophthalmologist. Fludrocortisone acetate ointment is the only GC in this form approved for the treatment of allergic conjunctivitis and blepharitis. Intranasal GCs can alleviate ocular symptoms via the nasal-ocular reflex, especially in concomitant allergic rhinitis. In SAC and PAC, ophthalmological consultation is not usually required, but in other forms of AO, cooperation is essential.
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References
2. Takamura E, Uchio E, Ebihara N et al. Japanese guidelines for allergic conjunctival diseases 2017. Allergol Int. 2017; 66(2): 220-9.
3. Fauquert J-L. Diagnosing and managing allergic conjunctivitis in childhood: The allergist’s perspective. Pediatr Allergy Immunol. 2019; 30: 405-14.
4. Gokhale NS. Current perspectives on topical antiallergics. Indian J Ophthalmol. 2025; 73(4): 521-5.
5. Sybilski AJ. Alergiczne choroby oczu – słabo to widzę! In: Sybilski AJ. Choroby alergiczne u dzieci. Medical Education, Warszawa 2018: 59-67.
6. Bogacka E, Górski P, Groblewska A et al. Polski konsensus diagnostyki i leczenia alergicznych chorób narządu wzroku. Alergia Astma Immunologia. 2009; 15(2): 75-86.
7. Leonardi A, Quintieri L, Presa IJ et al. Allergic Conjunctivitis Management: Update on Ophthalmic Solutions. Curr Allergy Asthma Rep. 2024; 24(7): 347-60.
8. Leonardi A, Silva D, Perez Formigo D et al. Management of ocular allergy. Allergy. 2019; 74(9): 1611-30.
9. Mrukwa-Kominek E. Znaczenie ektoiny w leczeniu alergii ocznej. Ophthalmol J. 2016; 1 (Supl 1): 1-3.
10. Salapatek AM, Werkhauser N, Ismail B et al. Effects of ectoine containing nasal spray and eye drops on symptoms of seasonal allergic conjunctivitis. Clin Transl Allergy. 2021; 11: e12006.
11. Clinicltrials.gov. Evaluation of the safety and efficacy of Ectoin Allergy Nasal Spray and Ectoin Allergy Eye Drops in the treatment of seasonal allergic rhinitis (SAR) in children and adolescents: a multicentre, double-blind, randomized, placebo controlled, parallel group clinical investigation.
12. Ciprandi G, Buscaglia S, Catrullo A et al. Azelastine eye drops reduce and prevent allergic conjunctival reaction and exert antiallergic activity. Clin Exp Allergy 1997; 27: 182-91.
13. Horak F, Berger UE, Menapace R. Dose-dependent protection by azelastine eye drops against pollen-induced allergic conjunctivitis. A double-blind placebo-controlled study. Arzneimittelforschung. 1998; 48: 379-84.
14. Ciprandi G, Cosentino C, Milanese M et al. Rapid anti-inflammatory action of azelastine eyedrops for ongoing allergic reactions. Ann Allergy Asthma Immunol. 2003; 90: 434-8.
15. Nazarov O, Petzold U, Haase H et al. Azelastine eye drops in the treatment of perennial allergic conjunctivitis. Arzneimittelforschung. 2003; 53(3): 167-73.
16. Bielory L, Buddiga P, Bigelson S. Ocular allergy treatment comparisons: azelastine and olopatadine. Curr Allergy Asthma Rep. 2004; 4: 320-5.
17. Kempuraj D, Huang M, Kandere K et al. Azelastine is more potent than olopatadine in inhibiting interleukin-6 and tryptase release from human umbilical cord blood-derived cultured mast cells. Ann Allergy Asthma Immunol. 2002; 88(5): 501-6.
18. Groblewska A. Alergiczne zapalenie brzegów powiek – wybrane zagadnienia. Przegląd Okulistyczny. 2019; 16(3): 1-2.