Match patient with suitable ocular allergy drug criteria

Carlsbad, CA-In his private practice here, Bill G. Bell, MD, has established a system by which he matches patients with what he hopes is the optimum ocular allergy therapy-especially important in southern California where "every month is allergy month."

In that climate or in other areas in the United States, there is also substantial concern about ocular surface inflammation and lubrication, Dr. Bell said.

"When working up a patient with ocular allergies, these problems often co-exist and rarely exist independently of one another," he said. "The primary focus I have when patients present is to provide a balance in the treatment by causing the least side effects, producing the least direct effect on the ocular surface lubrication, and not exacerbating any of the co-existing problems."

"The newer-generation medications are much kinder to the ocular surface," he said.

Azelastine HCl (Optivar, MedPointe Pharmaceuticals) is a drug Dr. Bell prescribes often since it has a number of favorable characteristics that work to patients' advantage, he said.

Drug checklist

Dr. Bell uses a checklist when determining the best ocular allergy therapy for patients.

"Patients tend to comply with therapy if a few drug characteristics are present, the first being how fast the drug works," he said. "Importantly, if the drug does not contain an antihistamine, it will not, for example, block itching in less than a few minutes."

Another factor Dr. Bell considers when choosing a drug is whether it does more than mask symptoms and actually addresses the problem.

"This is where medications such as azelastine HCl really shine. These drugs are very good mast cell stabilizers," he said.

He also prefers medications that require no more than twice-daily dosing to achieve its maximum effect.

"Because of patients' schedules, it is difficult for many patients to comply with a dosing regimen that requires instillation of three or more daily doses," he said.

Another consideration for Dr. Bell is a drug that can be prescribed for an extended period.

"I want to prescribe a medication that maintains a very high safety profile after weeks to months of use-a drug that does not impair the patient's immune response, does not disrupt the ocular surface lubrication, has little or no toxicity to the surface epithelium of the corneal or conjunctival cells, and especially that stabilizes the entire inflammatory process," he emphasized.

Finally, he explains to the patient the rationale for his drug choice in relation to his or her allergy scenario.

"If the patients understand your thought process, they will participate in their treatment," he said.

In line with all of these factors is insurance coverage. If the drug is well established, it will likely be covered by most insurance plans, he added.

Considering these criteria, he pointed out, azelastine HCl is a good choice for many of his patients because of its rapid onset of action, its mast cell stabilizing action, the twice-daily dosing regimen, its safety profile, its effectiveness over an extended period, and the fact that its molecule has been well studied since the 1980s.

Additional considerations

"An important point to remember when dealing with patients being treated for ocular allergies is that no drug works for everyone," Dr. Bell said. "In addition, a patient's profile may change over time. The patient may get a good response from one antiallergy drug over a long duration, but after a while the drug doesn't work as well."