Paul Karpecki, OD, FAAO
Cornea Services and Ocular Surface Disease Research Cincinnati
Eye Institute
Spring allergy season is rapidly approaching. According to the
American College of Asthma, Allergy, and Immunology, as many as
22 million Americans suffer from ocular allergies. Ocular symptoms
can significantly curtail patients' activities. One study showed
that more than 70% of ocular allergy patients avoided going outdoors,
and more than half had trouble sleeping.1 Patients are beginning
to present with typical signs and symptoms including redness,
lid swelling and the hallmark symptom of allergic conjunctivits
- itch. Over 80% of patients claim that itching is their most
bothersome symptom. It is important to begin thinking about how
to handle the influx of this patient type.
The key clinical considerations in choosing the optimal therapeutic
regimen include the length of time the patient has had the allergy
and the severity of symptoms. Antihistamines with mast cell-stabilizing
abilities are desirable because, theroretically, they have the
potential to disrupt the allergic process and reduce the intensity
of future responses. Elestat® (epinastine HCl 0.05%), a rapid
and potent H1 antagonist with mast cell stabilizing and anti-inflammatory
properties, offers rapid onset of action with all-day relief from
allergy symptoms.
In a pivotal clinical trial, Elestat® showed rapid efficacy in
a conjunctival allergen challenge model, within 3 minutes of contact
with the allergen2. Ocular itching was assessed 3, 5, and 10 minutes
after allergen challenge; other ocular symptoms were evaluated
at 5, 10, and 20 minutes. Elestat®-treated eyes had significantly
less itching, hyperemia, and eyelid swelling compared with vehicle-treated
eyes at all time points (P < .001). When compared with the level
of symptoms seen after allergen challenge in the absence of any
drug (similar to the natural situation), Elestat® reduced itching
by 81%, hyperemia by 41%, and lid swelling by 72%.
In an additional trial, Elestat® illustrated long lasting relief
of symptoms at 12-hours post instillation3. This study was also
a conjunctival allergen challenge model. To evaluate duration
of efficacy Elestat® was administered to one eye and vehicle to
the other eye 12 hours prior to antigen challenge. Itching was
graded on a 0 to 4 scale 5, 10 and 15 minutes after antigen challenge.
Patients treated with Elestat® reported a 61% improvement in itch
at the 5 minute measurement.