Pediatric ocular allergy can be alleviated

Chicago-High allergen counts this season combined with increased parental awareness about the potential functional impact of allergic conjunctivitis are leading to an increase in the number of pediatric patients being seen for control of ocular allergy.

While nonpharmacologic interventions play an important and sometimes sufficient role in managing these children, when the decision is made to prescribe an anti-allergy medication, ketotifen fumarate 0.025% (Zaditor, Novartis) offers an excellent choice because it can provide rapid, safe, and effective relief, said Kimberlee M. Curnyn, MD.

"Ketotifen offers a triple mechanism of action that targets early and delayed mediators of the allergic reaction. It has antihistamine activity but also prevents mast cell degranulation and decreases the recruitment and activation of eosinophils," explained Dr. Curnyn, assistant clinical professor of ophthalmology, University of Illinois, Chicago, and a private practitioner specializing in pediatric ophthalmology. "Therefore, ketotifen acts within 3 minutes to decrease itching, but also provides potent, sustained control of allergy signs and symptoms. Its rapid onset and continued efficacy are important factors for promoting compliance."

"The formulation of ketotifen is non-stinging. Comfort on instillation is important to all patients, but is particularly critical in the pediatric setting where compliance depends on the child cooperating with the parent to administer the medication," she added.

Ketotifen also has an excellent safety track record, having been used for decades both systemically to treat asthma in children and topically for ocular allergy outside of the United States.

Multipronged intervention

In managing pediatric allergic conjunctivitis, Dr. Curnyn said she relies strongly on nonpharmacologic interventions. Those include:

"Parents are often surprised at how effective a cold compress can be for rapidly decreasing puffiness and redness. The acute relief achieved with that measure also helps limit rubbing of the eyes that causes histamine release and perpetuates the allergic cascade," she explained.

Dr. Curnyn noted she has also seen an increasing trend for parents to consider making household changes to reduce allergen exposure, whether that involves replacing a household pet, changing an air conditioning system, or removing carpeting that may harbor mold spores.

"A few years ago, it seemed parents who brought their children in for medical care were primarily interested in getting a quick fix with medications. Now they seem to be looking for more definitive steps they can take to reduce environmental exposure and address the underlying cause of the allergy," she said.

Dr. Curnyn also observed that parents have a greater appreciation for the adverse influence ocular allergy may have on a child. Whereas parents were often likely to consider watery eyes and a running nose as unavoidable sequelae of playing outdoors, they seem to be recognizing that the symptoms of ocular allergy are causing discomfort and may be interfering with their child's vision and ability to concentrate.

"As a result of this awareness, parents are asking about methods to address ocular allergies with either nonpharmacologic or pharmacologic solutions," Dr. Curnyn said.

Dr. Curnyn also reminds her colleagues not to overlook vision testing in any child who is brought in to the office with complaints of ocular allergy.

"Children should not be evaluated simply for allergy. These visits provide an important opportunity to screen for amblyopia, and it is important to be sure each child you see has 20/20 vision in each eye," Dr. Curnyn said.