Current Allergy and Asthma Reports

, Volume 6, Issue 4, pp 306–311 | Cite as

Ocular allergy in pediatric practice

  • Mark B. AbelsonEmail author
  • David Granet


Allergies occur frequently in all pediatric age groups, affecting up to 40% of children. Allergic conjunctivitis is the most common ocular allergy syndrome among children, with atopic keratoconjunctivitis and vernal keratoconjunctivitis comprising less common, but potentially more severe, forms of ocular allergy. In this article, we review the impact, diagnosis, potential complications, and treatment of these ocular allergic pediatric conditions. Early detection is necessary to prevent potentially serious consequences of pediatric ocular allergy. Involvement of pediatric ophthalmologists may be necessary to avoid preventable vision loss in severe cases.


Ketotifen Ophthalmic Solution Azelastine Allergic Conjunctivitis Levocabastine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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References and Recommended Reading

  1. 1.
    Nathan R, Meltzer E, Selner J, Storms W: Prevalence of allergic rhinitis in the United States. J Allergy Clin Immunol 1997, 99:S808-S814.CrossRefGoogle Scholar
  2. 2.
    Meltzer EO: Quality of life in adults and children with allergic rhinitis. J Allergy Clin Immunol 2001, 108:S45-S53.PubMedCrossRefGoogle Scholar
  3. 3.
    Juniper EF, Guyatt GH, Dolovich J: Assessment of quality of life in adolescents with allergic rhinoconjunctivitis: development and testing of a questionnaire for clinical trials. J Allergy Clin Immunol 1994, 93:413–423. Results of this study suggest that adolescent patients experience impaired quality of life because of systemic symptoms, activity limitations, and emotional and practical problems and that this impairment may not be the same for adolescents as for adults.PubMedCrossRefGoogle Scholar
  4. 4.
    De Freitas D, Sato EH, Rizzo L: T Lymphocytes. In Allergic Diseases of the Eye. Edited by Abelson MB. Philadelphia: WB Saunders; 2001:37.Google Scholar
  5. 5.
    Irani AM, Schwartz LB: Mast cell heterogeneity. Clin Exp Allergy 1989, 19:143–155. Discussion of two types of human mast cells; includes discussion of difference between human conjunctival mast cells and mast cells in the lungs.PubMedCrossRefGoogle Scholar
  6. 6.
    Dart JK, Buckley RJ, Monnickendan M, Prasad J: Perennial allergic conjunctivitis: definition, clinical characteristics, and prevalence. A comparison with seasonal allergic conjunctivitis. Trans Ophthalmol Soc UK 1986, 105:513–520.PubMedGoogle Scholar
  7. 7.
    Udell IJ, Gleich GJ, Allansmith MR, et al.: Eosinophil granule major basic protein and Charcot-Leyden crystal protein in human tears. Am J Ophthalmol 1981, 92:824–828.PubMedGoogle Scholar
  8. 8.
    Abelson MB, Leonardi AA, Smith LM, et al.: Histaminase activity in patients with vernal keratoconjunctivitis. Ophthalmology 1995, 102:1958–1963. Discussing the.nding that enzymatic degradation of histamine was significantly decreased in patients with VKC compared with control subjects in both tears and plasma, suggesting that this dysfunction may be a primary factor in the pathophysiology of VKC.PubMedGoogle Scholar
  9. 9.
    Abelson MB, Butrus SI, Weston JH, Rosner B: Tolerance and absence of rebound vasodilation following topical ocular decongestant usage. Ophthalmology 1984, 91:1364–1367.PubMedGoogle Scholar
  10. 10.
    Lanier BQ, Abelson MB, Berger WE, et al.: Comparison of the efficacy of combined.uticasone propionate and olopatadine versus combined .uticasone propionate and fexofenadine for the treatment of allergic rhinoconjunctivitis induced by conjunctival allergen challenge. Clin Ther 2002, 24:1161–1174. In this study, concomitant topical use of .uticasone and olopatadine was more effective than concomitant use of .uticasone plus fexofenadine for treatment of allergic rhinoconjunctivitis.PubMedCrossRefGoogle Scholar
  11. 11.
    Ousler GW, Wilcox KA, Gupta G, Abelson MB: An evaluation of the ocular drying effects of two systemic antihistamines: loratadine and cetirizine hydrochloride. Ann Allergy Asthma Immunol 2004, 93:460–464.PubMedGoogle Scholar
  12. 12.
    Kjellman NI, Andersson B: Terfenadine reduces skin and conjunctival reactivity in grass pollen allergic children. Clin Allergy 1986, 16:441–449.PubMedCrossRefGoogle Scholar
  13. 13.
    Ciprandi G, Buscaglia S, Marchesi E, et al.: Protective effect of loratadine on late phase reaction induced by conjunctival provocation test. Int Arch Allergy Immunol 1993, 100:185–189.PubMedCrossRefGoogle Scholar
  14. 14.
    Santos CI, Huang AJ, Abelson MB, et al.: Efficacy of lodoxamide 0.1% ophthalmic solution in resolving corneal epitheliopathy associated with vernal keratoconjunctivitis. Am J Ophthalmol 1994, 117:488–497.PubMedGoogle Scholar
  15. 15.
    Abelson MB, Berdy GJ, Mundorf T, et al.: Pemirolast study group. Pemirolast potassium 0.1% ophthalmic solution is an effective treatment for allergic conjunctivitis: a pooled analysis of two prospective, randomized, doublemasked, placebo-controlled, phase III studies. J Ocul Pharmacol Ther 2002, 18:475–488.PubMedCrossRefGoogle Scholar
  16. 16.
    Verin PH, Dicker ID, Mortemousque B: Nedocromil sodium eye drops are more effective than sodium cromoglycate eye drops for the long-term management of vernal keratoconjunctivitis. Clin Exp Allergy 1999, 29:529–536.PubMedCrossRefGoogle Scholar
  17. 17.
    Sharif NA, Xu SX, Miller ST, et al.: Characterization of the ocular antiallergic and antihistaminic effects of olopatadine (AL-4943A), a novel drug for treating ocular allergic diseases. J Pharmacol Exp Ther 1996, 278:1252–1261.PubMedGoogle Scholar
  18. 18.
    Yanni JM, Stephens DJ, Miller ST, et al.: The in vitro and in vivo ocular pharmacology of olopatadine (AL-4943A), an effective anti-allergic/antihistaminic agent. J Ocul Pharmacol Ther 1996, 12:389–400. Details the in vitro and in vivo pharmacologic profile of olopatadine.PubMedCrossRefGoogle Scholar
  19. 19.
    Yanni JM, Miller ST, Gamache DA, et al.: Comparative effects of topical ocular anti-allergy drugs on human conjunctival mast cells. Ann. Allergy Asthma Immunol 79, 541–545, 1997. Discusses the efficicacy of olopatadine, a combination antihistamine/ mast cell stabilizer, at stabilizing mast cells and binding to H1 receptorsPubMedGoogle Scholar
  20. 20.
    Yanni JM, Sharif NA, Gamache DA, et al.: A current appreciation of sites for pharmacological intervention in allergic conjunctivitis: effects of new topical ocular drugs. Acta Ophthalmol Scand Suppl 1999, 228:33–37.PubMedGoogle Scholar
  21. 21.
    Cook EB, Stahl JL, Barney NP, Graziano FM: Olopatadine inhibits NFalpha release from human conjunctival mast cells. Ann Allergy Asthma Immunol 2000, 84:504–508. Details olopatadine’s ability to inhibit mast cell release of TNF-α and subsequent recruitment of migrating inflammatory cells.PubMedGoogle Scholar
  22. 22.
    Leonardi A, Abelson MB:. Double-masked, randomized, placebo-controlled clinical study of the mast cell-stabilizing effects of treatment with olopatadine in the conjunctival allergen challenge model in humans. Clin Ther 2003, 25:2539–2552. Discusses the effect of olopatadine on inhibition of mediator release correlated with the reduction of itching and redness.PubMedCrossRefGoogle Scholar
  23. 23.
    Katelaris CH, Cipriandi G, Missotten L, et al.: A comparison of the efficacy and tolerability of olopatadine hydrochloride 0.1% ophthalmic solution and cromolyn sodium 2% ophthalmic solution in seasonal allergic conjunctivitis. Clin Ther 2002, 24:1561–1575.PubMedCrossRefGoogle Scholar
  24. 24.
    Butrus S, Greiner JV, Discepola M, Finegold I: Comparison of the clinical efficacy and comfort of olopatadine hydrochloride 0.1% ophthalmic solution and nedocromil sodium 2% ophthalmic solution in the human conjunctival allergen challenge model. Clin Ther 2000, 22:1462–1472.PubMedCrossRefGoogle Scholar
  25. 25.
    Ciprandi G, Turner D, Gross R: Double-masked, randomized, parallel-group study comparing olopatadine 0.1% ophthalmic solution with cromolyn sodium 2% and levocabastine 0.05% ophthalmic preparations in children with seasonal allergic conjunctivitis. Curr Ther Res Clin Exp 2004, 65:186–199. Demonstrated comfort with olopatadine use in pediatric allergy patients; an important consideration for encouraging compliance.CrossRefGoogle Scholar
  26. 26.
    Berdy GJ, Stoppel JO, Epstein AB: Comparison of the clinical efficacy and tolerability of olopatadine hydrochloride 0.1% ophthalmic solution and loteprednol etabonate 0.2% ophthalmic suspension in the conjunctival allergen challenge model. Clin Ther 2002, 24:918–929.PubMedCrossRefGoogle Scholar
  27. 27.
    Deschenes J, Discepola M, Abelson MB: Comparative evaluation of olopatadine ophthalmic solution (0.1%) versus ketorolac ophthalmic solution (0.5%) using the provocative antigen challenge model. Acta Ophthalmol Scand Suppl 1999, 228:47–52.PubMedGoogle Scholar
  28. 28.
    Berdy GJ, Spangler DL, Bensch G, et al.: A comparison of the relative efficacy and clinical performance of olopatadine hydrochloride 0.1% ophthalmic solution and ketotifen fumarate 0.025% ophthalmic solution in the conjunctival antigen challenge model. Clin Ther 2000, 22:826–833.PubMedCrossRefGoogle Scholar
  29. 29.
    Spangler DL, Bensch G, Berdy GJ: Evaluation of the efficacy of olopatadine hydrochloride 0.1% ophthalmic solution and azelastine hydrochloride 0.05% ophthalmic solution in the conjunctival allergen challenge model. Clin Ther 2001, 23:1272–1280.PubMedCrossRefGoogle Scholar
  30. 30.
    Lanier R, Finegold I, D’Arienzo P, et al.: Clinical efficacy of olopatadine vs. epinastine ophthalmic solution in the conjunctival allergen challenge model. Curr Med Res Opin 2004, 20:P1-P7.CrossRefGoogle Scholar
  31. 31.
    Artal MN, Luna JD, Discepola M: A forced choice comfort study of olopatadine hydrochloride 0.1% versus ketotifen fumarate 0.05%. Acta Ophthalmol Scand Suppl 2000, 230:64–65.PubMedCrossRefGoogle Scholar
  32. 32.
    Leonardi A, Zafirakis P: Efficacy and comfort of olopatadine versus ketotifen ophthalmic solutions: a double-masked, environmental study of patient preference. Curr Med Res Opin 2004, 20:1167–1173.PubMedCrossRefGoogle Scholar
  33. 33.
    Berger W, Abelson MB, Gomes PJ, et al.: Effects of adjuvant therapy with 0.1% olopatadine hydrochloride ophthalmic solution on quality of life in patients with allergic rhinitis using systemic or nasal therapy. Ann Allergy Asthma Immunol 2005, 95:361–371.PubMedCrossRefGoogle Scholar
  34. 34.
    Novartis: Zaditor Prescribing Information. http://www. Accessed January 18, 2005.Google Scholar
  35. 35.
    Abelson MB: A review of olopatadine for the treatment of ocular allergy. Expert Opin Pharmacother 2004, 5:1979–1994.PubMedCrossRefGoogle Scholar
  36. 36.
    Aguilar A: Comparative study of clinical efficacy and tolerance in seasonal allergic conjunctivitis management with 0.1% olopatadine hydrochloride versus 0.05% ketotifen fumarate. Acta Ophthalmol Scand Suppl 2000, 230:52–55.PubMedCrossRefGoogle Scholar
  37. 37.
    Sabbah A, Marzetto M: Azelastine eye drops in the treatment of seasonal allergic conjunctivitis or rhinoconjunctivitis in young children. Curr Med Res Opin 1998, 14:161–170.PubMedGoogle Scholar
  38. 38.
    Allergan: Elestat Prescribing Information. http://www. Accessed January 29, 2006.Google Scholar
  39. 39.
    Amon U, Gibbs BF, Buss G, Nitschke M: In vitro investigations with the histamine H1 receptor antagonist, epinastine (WAL 801 CL), on isolated human allergic effector cells. Inflamm Res 2000, 49:112–116.PubMedCrossRefGoogle Scholar
  40. 40.
    Eakins KE: Prostaglandin and inflammatory reactions in the eye. Methods Find Exp Clin Pharmacol 1980, 2:17.Google Scholar
  41. 41.
    Abelson MB, Butrus SI, Weston JH:. Aspirin therapy in vernal conjunctivitis. Am J Ophthalmol 1983, 95:502–505.PubMedGoogle Scholar
  42. 42.
    Akpek EK, Dart JK, Watson S, et al.: A randomized trial of topical cyclosporin 0.05% in topical steroid-resistant atopic keratoconjunctivitis. Ophthalmology 2004, 111:476–482.PubMedCrossRefGoogle Scholar
  43. 43.
    Cetinkaya A, Akova YA, Dursun D, Pelit A: Topical cyclosporine in the management of shield ulcers. Cornea 2004, 23:194–200.PubMedCrossRefGoogle Scholar
  44. 44.
    Sperr WR, Agis H, Semper H, et al.: Inhibition of allergeninduced histamine release from human basophils by cyclosporine A and FK-506. Int Arch Allergy Immunol 1997, 114:68–73.PubMedCrossRefGoogle Scholar
  45. 45.
    Spiegelberg HL, Orozco EM, Roman M, Raz E: DNA immunization: a novel approach to allergen-specific immunotherapy. Allergy 1997, 52:964–970.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2006

Authors and Affiliations

  1. 1.ORA Clinical Research and DevelopmentNorth AndoverUSA

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