Dual-acting, anti-allergy agent delivers efficacy, safety, convenience

TAKE HOME MESSAGE: Olopatadine 0.2% is a well-tolerated, safe, and effective antihistamine/mast cell stabilizer for treating mild to severe allergic conjunctivitis in children and adults.

By Cheryl Guttman Krader; Reviewed by Francis Mah, MD

La Jolla, CA-Once-daily olopatadine 0.2% (Pataday, Alcon Laboratories) is an excellent choice as first-line therapy for the broad range of patients needing treatment for allergic conjunctivitis, according to Francis Mah, MD.

“Olopatadine has a long safety history, is very well-tolerated, and is a very effective dual-acting antihistamine/mast cell stabilizer,” said Dr. Mah, director, cornea and external disease, and co-director, refractive surgery, Scripps Clinic, La Jolla, CA. “And olopatadine 0.2% provides all-day allergy control with the convenience of once-daily dosing.”

Beneficial for children

The once-daily administration schedule and safety profile of olopatadine 0.2% make it an attractive option when treating children, Dr. Mah noted.

“It can sometimes be a struggle for parents to put drops into a child’s eyes if the medication causes burning or other adverse effects,” he explained. “However, olopatadine is very well-tolerated by children because it does not tend to cause any significant discomfort on instillation or taste changes as some other ocular allergy medications do.”

Case study

The case of a recent pediatric patient who came to Dr. Mah on referral illustrates the efficacy of olopatadine 0.2% for managing severe ocular allergy. The 5-year-old child presented with ocular surface irritation, an epithelial defect, a primary complaint of itching-which was more intense in the right eye than the left-and a differential diagnosis that included blepharitis, allergic conjunctivitis, herpes infection, or bacterial conjunctivitis. He had a history of atopic dermatitis and asthma and a family history of atopy.

In conducting the clinical examination, Dr. Mah flipped the superior lids and found large cobblestone papillae, leading to the diagnosis of vernal keratoconjunctivitis (VKC).

The child was started on a treatment of olopatadine 0.2% once daily with use of an ocular lubricating gel during the day and ointment at bedtime to help restore the ocular surface. His symptoms improved within a week.

“It was important to heal the ocular surface quickly in this child who was in the amblyogenic age group and at risk for permanent loss of vision,” Dr. Mah said. “Although it wasn’t necessary in this case, sometimes pulsed corticosteroid therapy is also indicated to treat the inflammation in patients with VKC, but they still continue with the antihistamine/mast cell stabilizer after tapering off the steroid.”

VKC tends to exacerbate during warmer weather, and so it can be a chronic condition for people living in San Diego, CA, according to Dr. Mah. Olopatadine 0.2% is well suited for long-term use due to its efficacy, safety, and convenient once-daily dosing.

‘Workhorse’ for managing allergies

Olopatadine 0.2% is also a workhorse for management of patients with seasonal and perennial allergic conjunctivitis. Patients with a known history of seasonal allergies will be started on the medication a little before the anticipated start of the allergy season as a pre-emptive strategy.

“However, patients who do not start preventive treatment and become symptomatic can expect immediate relief once they initiate therapy with olopatadine because of its potent antihistaminic activity,” Dr. Mah said. “With its efficacy as a mast cell stabilizer, it provides patients with ongoing control of the allergic response during allergy season.”

Patients with perennial allergic conjunctivitis need year-long treatment, and olopatadine 0.2% fits their needs because of its efficacy and safety

Even some selective ophthalmic antihistamines can cause drying of mucous membranes and dry eye. However, results from clinical trials indicate that is not a problem with olopatadine, he noted.

“Unlike steroids, there are no long-term side effects associated with the dual acting antihistamine/mast cell stabilizers,” Dr. Mah said. “Therefore, I can prescribe olopatadine with confidence for patients with perennial allergic conjunctivitis, and I am not concerned when patients occasionally tell me they used an extra dose later in the days at times when they experienced prolonged or intense allergen exposure.”

All patients with seasonal and allergic conjunctivitis are counseled about allergen avoidance, he noted.

Francis Mah, MD

E: mah.francis@scrippshealth.org

Dr. Mah is an advisor for, receives lecture fees, and/or receives grant support from Alcon Laboratories, Allergan, Valeant/Bausch+ Lomb, and Ocular Therapeutix.