Children achieve relief of ocular allergies

Chicago-Ketotifen fumarate 0.025% ophthalmic solution (Zaditor, Novartis) offers rapid-onset, long-lasting relief of allergy-associated itching along with excellent local tolerability and a long-standing record of safety. Those features combined make it an outstanding therapeutic choice for all patients with allergic conjunctivitis and a particularly attractive option for the pediatric population, said Kimberlee M. Curnyn, MD.

"When I need to use a pharmacologic agent to control ocular allergy in children, I want something that will be safe, comfortable on instillation, and work quickly to relieve itching. Ketotifen fumarate fulfills all of those criteria and has been the treatment of choice in my practice," she said.

Dr. Curnyn is an assistant clinical professor of ophthalmology, University of Illinois, Chicago, and is in a group practice in Elk Grove Village and Arlington Heights, IL, where she specializes in treating pediatric patients.

"The cold helps to keep down the swelling and decreases itching, while the compresses serve as a barrier against rubbing when the symptoms are most acute. Lid manipulation induces histamine release and so is best avoided," she explained.

If those measures are not adequate and prescription treatment seems indicated, ketotifen fumarate is an excellent choice because it acts through multiple mechanisms to address early and delayed mediators of the allergic reaction to bring fast and sustained relief. Ketotifen fumarate is a histamine-1 receptor antagonist, mast cell stabilizer, and decreases recruitment and activation of eosinophils.

Due to its relatively prolonged duration of action, ketotifen fumarate is recommended for use twice a day. However, Dr. Curnyn observed that many parents tell her that after a few weeks of initial use, they are able to reduce the frequency of administration to just once a day without compromising control of allergy-related itching.

As other benefits, Dr. Curnyn finds that medication run-off into the nasal passages after ketotifen fumarate is instilled into the eye helps to control concomitant allergic rhinitis, and the product is particularly well tolerated.

"If an ocular drop causes stinging or burning, kids simply will not let you put the medication in again. When I prescribe ketotifen fumarate, I never get phone calls from parents complaining about discomfort with administration," she said.

Once instilled, patients can derive benefit within just a few minutes. Dr. Curnyn noted she will instruct parents to administer the drop of ketotifen fumarate and then place a cold washcloth over the eyes for 2 to 3 minutes.

"By the time the compress is ready to come off, the drug has already begun to take effect. Therefore, there is less of a chance that the child will be compelled to rub the eyes to relieve itching," she said.

Safety is a critical issue when selecting medication for any patient, but there is often heightened concern in treating children. Against that background, however, Dr. Curnyn said she feels very comfortable prescribing ketotifen fumarate because it has been around for more than 30 years, has established safety as a systemic medication to treat asthma in children, and has been used in Japan as an ocular medication at a concentration two-fold higher than that found in Zaditor.

"With all of that evidence supporting the safety of ketotifen fumarate, I feel confident using it on a longer-term basis in children who need to continue treatment throughout an entire allergy season or for even longer periods to control environmental allergies," she said.