Acute Asthma Attack Caused by Ophthalmic Application of Antiallergic Agents

Abstract

Background

To investigate the induction of acute asthmatic attacks caused by several kinds of antiallergic eyedrops for the treatment of allergic conjunctival diseases in a patient with bronchial asthma and aspirin sensitivity.

Case

A 42-year-old man with a 10-year history of bronchial asthma and with aspirin sensitivity, who had been given disodium cromoglycate (DSCG) to be applied topically, developed asthma after applying DSCG drops.

Observations

After the instillation of DSCG, tranilast, ibudilast, and ketotifen, the peak expiratory flow rate (PEFR) decreased in this patient and asthmatic signs developed. However, there was no decrease in the PEFR after challenge with pemirolast, levocabastine, or fluorometholone (0.1%) eyedrops, or saline as control.

Conclusions

This case suggests that mast-cell-stabilizer eyedrops might induce an asthma attack in patients with a history of asthma and aspirin or nonsteroidal antiinflammatory drug allergy. Mast-cell-stabilizing eyedrops should be prescribed for such patients with special precautions unless the patient is known to tolerate mast cell stabilizers without difficulty.