In the phase of appearance of symptoms we will use eyewashes with medicines simpaticomiméticos and/or antihistamine, or sometimes it is necessary to use steroids. They are used of punctual form for some days.
To support the stable conjunctivitis and with few symptoms we have the stabilizers of the mastocito, the anti-inflammatory notesteroideos, and the antialérgicos/antihistamínicos. In this case they are used during periods as preventive.
As treatment of the etiology or of the causes there are two possibilities:
The avoidance alergénicaó environmental control.
The immunotherapy or vaccines of allergy that is based on the alteration in the formation of Th2 to Th1.
The cromoglicatodisódico to 4 % 1 drop in every eye every 6 hours is also beneficial. With this treatment although any patients recount improvement at 24-48 hours of the beginning of his administration, his maximum effect generally is not reached up to 10-14 days. The medication in general is well tolerated and lacking in side effects. Also, an extra charitable effect is produced in the rinitis symptoms, on having drained the ophthalmic CGDS in the nostrils across the lachrymal conduits.
The nedocromilsódico administered only 2 times a day presents to 2 % at least the same efficacy as the CGDS 4 %, 4 times a day in the seasonal allergic conjunctivitis. This one presents a rapid beginning of action and a profile of safety similar to that of the CGDS. Also, the nedocromil 4 times a day turns out to be more effective than the CGDS in the perennial allergic conjunctivitis.
The lodoxamida 0,1 % administered 4 times a day, although initially used only for the KCJV, CJPG and KCJA, also turns out to be useful in the CJA, being even more effective than the CGDS 4 % and with a good safety profile. The improvement begins to be evident generally to 3 days, although approximately 4 weeks can be necessary to obtain his maximum effect.
Antinflamatoriosnotesteroideos(AINEs)
The ketorolaco 0,5 % and the pranoprofeno 0,1 % is anti-inflammatory local notesteroideos that seem to have something of efficacy to relieve the ocular itching in the allergic conjunctivitis. It has been suggested that they act for inhibition of the synthesis of prostaglandin (in the lachrymal secretion), which are capable of inducing itching; nevertheless, his effectiveness is poor. They usually collaborate to other preventive treatments.
Local antihistamines
Inside the local antihistamines we can describe two big groups:
classic local antihistamines
local antihistamines of last generation
The local classic local Antihistamines are generally associated with the vasoconstrictoresdescongestivos of the type of the adrenérgicos, where the pharmacological action is directed to control the itch (antihistamine action) and the congestion conjuntival (action vasoconstrictora).
Inside this group we can code fundamentally the following associations: antazolina-nafazolina, and feniramina-nafazolina. They present a rapid beginning of the action, but his effect is slightly lasting and limited, therefore they need frequent and continuous daily instillations. His action on the declarations of the allergic conjunctivitis is more powerful that the one that the systemic antihistamines exercise, but they can provoke increase of the intraocular pressure, dry eye, dependency and effect bounces vascular (hiperemia).
The local Antihistamines of last generation: In the last years, there has developed a series of antihistamines of local use which pharmacological effect has been significantly bigger than the observed one with the classic antihistamines. These drugs of last generation can simultaneously, split into two sub-groups:
Antihistamines of dual action (antihistamine action and stabilizing action of the mastocito)
The principal mechanism of the antihistamines of monoaction is of blocking the recipients histamínicos (fundamentally H1). Inside this group they are:
The Azelastina (Afluón ®). It is a derivative of her derived from ftalazinona In our country it is free for his local use in nasal spray for the allergic rinitis and in eyewash for the allergic conjunctivitis. It has demonstrated efficacy in the control of the symptoms of the conjunctivitis comparable to that of several systemic antihistamines, being the disgeusia - alterations in the perception of the flavor - the most connected adverse effect.
The Levocabastina 0.5 %. The Levocabastina 0.5 % is a derivative 4-arilcicloexilpiperidínico. It is an antihistamine of monoaction indicated for the treatment of the sharp allergic conjunctivitis since it is effective in the reduction of the hiperemia and of the itching associated with this pathology. His local dose is 4 daily instillations. As adverse reactions the ardor has been brought fundamentally at the moment of his instillation. It is indicated to be used in children from 12 years of age.
Recently antihistamine agents have joined to the pharmacopeia oftalmológica with stabilizing action on the mastocito. These antihistamines of dual action, it allows to control the signs and symptoms of the allergic conjunctivitis in his sharp phase, as well as also to provide the answer degranulatoria with the long-term mastocito. Inside this group we find Fumarato de Ketotifeno 0.05 %.
Fumarato de Ketotifeno 0.05 % derives from the ciproheptadina, an antagonist of the serotonina. His clinical use has been studied extensively in the bronchial asthma.
It presents antihistamine action across a mechanism of not competitive and not selective opposition, and his function like stabilizer of the mastocito is comparable to that of the Cromoglicatosódico in asthmatic patients. His dose as local antihistamine in ophthalmology is from 2 to 4 daily instillations. His efficacy increases to concentrations of 0.1 %, but this concentration increases significantly his adverse effects. There exist up to the date neither studies nor precedents that indicate his use as local antihistamine in children.
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