Allergy

Question 1

How do you treat a patient’s symptom of “burning = itching”?

Answer 1

If the patient cannot decide which symptom is more bothersome, use a topical corticosteroid for both complaints

Question 2

What is the best treatment for minimal signs of allergy (chemises, conjunctival injection and eyelid edema)?

Answer 2

antihistamine/mast cell stabilizer

Question 3

What are the 6 combination antihistamine/mast cell stabilizer drugs?

What is the dosing schedule?

Answer 3

Bepreve (Bepostastine)

Elestat (Epinastine)

Zaditor (Ketotifen)

Patanol/Pataday (olopatadine)

Optivar (Azelastine)

Lastacaft (alcaftadine)

BEZ POL

Dose BID (except Pataday and Lastacaft which is QD) and then after 2 weeks, reduce to qd maintenance therapy. Once symptomatic itching is under control, you can maintain control without pharmacological intervention

Question 4

What combo allergy drop is now generic?

Answer 4

Zaditor

Question 5

What are OTC combo allergy drops?

Answer 5

Zaditor, Alaway and Refresh Eye Itch Relief

Question 6

Compare and contrast Tx for the symptoms of itching and burning

Answer 6

Itching symptoms only = antihistamine/mast cell stabilizer combo

Itching with accompanying signs = steroid (Lotemax, Alrex, or FML)

Burning = Dry eye evaluation and Tx

Question 7

What is the most appropriate treatment for the complaint of itching plus signs like conjunctival redness/chemosis/lid edema?

Answer 7

Topical corticosteroids:

Alrex, lotemax gel, FML

Dose: q2h x 2 days; aid x 1 week; bid x 1 week

After inflammatory signs are controlled, consider switch to combo drop (mast cell/anti-histamine)

Question 8

T/F Pure mast cell stabilizing drugs have little to no clinical use

Answer 8

True - at least according to world-renowned ocular allergist Mark Abelson MD from Harvard Med School

Combo drugs are more effective at stabilizing mast cell membranes

Question 9

When are cool vs warm compresses appropriate in treatment?

Answer 9

Cool = surface inflammation

Warm = infectious process