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Antihistamines in Ocular Allergy: Are They All Created Equal?

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Abstract

Use of topical antihistamines in the treatment of allergic conjunctivitis has evolved over the past several decades as our knowledge of the nature of the underlying disease has progressed. Formulations for the eye typically employ H1-receptor antagonists with a dual action, both directly as competitors for histamine receptor occupancy and as mast cell–stabilizing agents. Many of these compounds also display activity against late-phase allergic symptoms. Of the newest available drugs, several have a prolonged duration of action allowing once-daily dosing. Future development is likely to focus on long-acting agents such as these and on drugs that can target additional histamine receptor subtypes.

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References

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  1. Ciprandi G, Buscaglia S, Cerqueti PM, et al. Drug treatment of allergic conjunctivitis. A review of the evidence. Drugs. 1992;43:154–76.

    Article  PubMed  CAS  Google Scholar 

  2. Abelson MB, Smith L, Chapin M. Ocular allergic disease: mechanisms, disease subtypes, treatment. Ocul Surf. 2003;1:127–49.

    PubMed  Google Scholar 

  3. Leonardi A. Emerging drugs for ocular allergy. Expert Opin Emerg Drugs. 2005;3:505–20.

    Article  Google Scholar 

  4. Akdis CA, Blaser K. Histamine in the immune regulation of allergic inflammation. J Allergy Clin Immunol. 2003;112:15–22.

    Article  PubMed  CAS  Google Scholar 

  5. Collum LMT, Kilmartin DJ. Acute allergic conjunctivitis. In Allergic Diseases of the Eye. Philadelphia: WB Saunders Co; 2000. p. 108–32.

    Google Scholar 

  6. Label and approval history, Vasocon; Available at http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Label_ApprovalHistory#apphist. Accessed February 21, 2011.

  7. Abelson MB, Yamamoto GK, Allansmith MR. Effects of ocular decongestants. Arch Ophthalmol. 1980;98:856–8.

    PubMed  CAS  Google Scholar 

  8. Kari O, Salo OP, Halmepuro L, Suvilehto K. Tear histamine during allergic conjunctivitis challenge. Graefe’s Arch Clin Exp Ophthalmol. 1985;223:60–2.

    Article  CAS  Google Scholar 

  9. Abelson MB, Udell IJ. H2-receptors in the human ocular surface. Arch Ophthalmol. 1981;99:302–4.

    PubMed  CAS  Google Scholar 

  10. Abelson MB, Schaefer K. Conjunctivitis of allergic origin: immunologic mechanisms and current approaches to therapy. Surv Ophthalmol. 1993;38(Supplement):115–32.

    Article  PubMed  Google Scholar 

  11. Abelson MB, Leonardi AA, Smith LM, Fregona IA, George MA, Secchi AG. Histaminase activity in patients with vernal keratoconjunctivitis. Ophthalmology. 1995;102:1958–63.

    PubMed  CAS  Google Scholar 

  12. Cook EB, Stahl JL, Barney NP, Graziano FM. Mechanisms of antihistamines and mast cell stabilizers in ocular allergic inflammation. Curr Drug Targets Inflamm Allergy. 2000;1:167–80.

    Article  Google Scholar 

  13. Yanni JM, Weimer LK, Glaser RL, Lang LS, Robertson SM, Spellman JM. Effect of lodoxamide on in vitro and in vivo conjunctival immediate hypersensitivity responses in rats. Int Arch Allergy Immunol. 1993;101:102–6.

    Article  PubMed  CAS  Google Scholar 

  14. Fahy GT, Easty DL, Collum LM, Benedict-Smith A, Hillery M, Parsons DG. Randomised double-masked trial of lodoxamide and sodium cromoglycate in allergic eye disease. A multicentre study. Eur J Ophthalmol. 1992;2:144–9.

    PubMed  CAS  Google Scholar 

  15. Avunduk AM, Avunduk MC, Kapicioglu Z, Akyol N, Tavli L. Mechanisms and comparison of anti-allergic efficacy of topical lodoxamide and cromolyn sodium treatment in vernal keratoconjunctivitis. Ophthalmology. 2000;107:1333–7.

    Article  PubMed  CAS  Google Scholar 

  16. Abelson MB, Berdy GJ, Mundorf T, Amdahl LD. Pemirolast study group. Pemirolast potassium 0.1% ophthalmic solution is an effective treatment for allergic conjunctivitis: a pooled analysis of two prospective, randomized, double-masked, placebo-controlled, phase III studies. J Ocul Pharmacol Ther. 2002;18:475–88.

    Article  PubMed  CAS  Google Scholar 

  17. Abelson MB, Wun PJ, Nevius JM. Mast cell stabilizers. In Allergic Diseases of the Eye. Philadelphia: WB Saunders Co; 2000. p. 228–34.

    Google Scholar 

  18. Butrus S, Portela R. Ocular allergy: diagnosis and treatment. Ophthalmol Clin N Am. 2005;18:485–92.

    Google Scholar 

  19. Parys W, Blockhuys S, Janssens M. New trends in treatment of allergic conjunctivitis. Doc Ophthalmol. 1992;82:353–60.

    Article  PubMed  CAS  Google Scholar 

  20. Abelson MB, Chambers WA, Smith LM. Conjunctival allergen challenge: a clinical approach to studying allergic conjunctivitis. Arch Ophthalmol. 1990;108:84–8.

    PubMed  CAS  Google Scholar 

  21. Abelson MB, Paradis A, George MA, Smith LM, Maguire L, Burns R. Effects of Vasocon-A in the allergen challenge model of acute allergic conjunctivitis. Arch Ophthalmol. 1990;108:520–4.

    PubMed  CAS  Google Scholar 

  22. Dockhorn RJ, Duckett TG. Comparison of Naphcon-A and its components (naphazoline and pheniramine) in a provocative model of allergic conjunctivitis. Curr Eye Res. 1994;13:319–24.

    Article  PubMed  CAS  Google Scholar 

  23. Abelson MB, George MA, Schaefer K, Smith LM. Evaluation of the new ophthalmic antihistamine, 0.05% levocabastine, in the clinical allergen challenge model of allergic conjunctivitis. J Allergy Clin Immunol. 1994;94:458–64.

    Article  PubMed  CAS  Google Scholar 

  24. Secchi A, Leonardi A, Discepola M, Deschenes J, Abelson MB, the Emadine Study Group. An efficacy and tolerance comparison of emedastine difumarate 0.05% and levocabastine hydrochloride 0.05%: reducing chemosis and eyelid swelling in subjects with seasonal allergic conjunctivitis. Acta Ophthalmol. 2000;78 Suppl 230:48–51.

    Article  Google Scholar 

  25. • Qasem AR, Bucolo C, Baiula M, Spartà A, Govoni P, Bedini A, Fascì D, Spampinato S. Contribution of alpha4beta1 integrin to the antiallergic effect of levocabastine. Biochem Pharmacol. 2008;76:751–62. This was one of several studies providing insight into mechanisms of late-phase effects of antihistamines.

  26. Abelson MB, Kaplan AP. A randomized, double-blind, placebo-controlled comparison of emedastine 0.05% ophthalmic solution with loratadine 10 mg and their combination in the human conjunctival allergen challenge model. Clin Ther. 2002;24:445–56.

    Article  PubMed  CAS  Google Scholar 

  27. Secchi A, Ciprandi G, Leonardi A, Deschenes J, Abelson MB. Safety and efficacy comparison of emedastine 0.05% ophthalmic solution compared to levocabastine 0.05% ophthalmic suspension in pediatric subjects with allergic conjunctivitis. Emadine Study Group. Acta Ophthalmol Scand Suppl. 2000;230:42–7.

    Article  PubMed  Google Scholar 

  28. Yanni JM, Miller ST, Gamache DA, Spellman JM, Xu S, Sharif NA. Comparative effects of topical ocular anti-allergy drugs on human conjunctival mast cells. Ann Allergy Asthma Immunol. 1997;796:541–5.

    Article  Google Scholar 

  29. Abelson MB. A review of olopatadine for the treatment of ocular allergy. Expert Opin Pharmacother. 2004;59:1979–94.

    Article  Google Scholar 

  30. • Leonardi A, Quintieri L. Olopatadine: a drug for allergic conjunctivitis targeting the mast cell. Expert Opin Pharmacother. 2010;116:969–81. This article provides an excellent synopsis of this first-in-class medication.

  31. Greiner JV, Michaelson C, McWhirter CL, Shams NB. Single dose of ketotifen fumarate.025% vs 2 weeks of cromolyn sodium 4% for allergic conjunctivitis. Adv Ther. 2002;19:185–93.

    Article  PubMed  CAS  Google Scholar 

  32. Torkildsen GL, Abelson MB, Gomes PJ. Bioequivalence of two formulations of ketotifen fumarate ophthalmic solution: a single-center, randomized, double-masked conjunctival allergen challenge investigation in allergic conjunctivitis. Clin Ther. 2008;30:1272–82.

    Article  PubMed  CAS  Google Scholar 

  33. Williams PB, Crandall E, Sheppard JD. Azelastine hydrochloride, a dual-acting anti-inflammatory ophthalmic solution, for treatment of allergic conjunctivitis. Clin Ophthalmol. 2010;4:993–1001.

    Article  PubMed  Google Scholar 

  34. Pradhan S, Abhishek K, Mah F. Epinastine: topical ophthalmic second generation antihistamine without significant systemic side effects. Expert Opin Drug Metab Toxicol. 2009;5:1135–40.

    Article  PubMed  CAS  Google Scholar 

  35. Galatowicz G, Ajayi Y, Stern ME, Calder VL. Ocular anti-allergic compounds selectively inhibit human mast cell cytokines in vitro and conjunctival cell infiltration in vivo. Clin Exp Allergy. 2007;37:1648–56.

    Article  PubMed  CAS  Google Scholar 

  36. Sanchis-Merino ME, Montero JA, Ruiz-Moreno JM, Rodriguez AE. Pastor S Comparative efficacy of topical antihistamines in an animal model of early phase allergic conjunctivitis. Exp Eye Res. 2008;86:791–7.

    Article  PubMed  CAS  Google Scholar 

  37. Finegold I, Granet DB, D'Arienzo PA, Epstein AB. Efficacy and response with olopatadine versus epinastine in ocular allergic symptoms: a post hoc analysis of data from a conjunctival allergen challenge study. Clin Ther. 2006;28:1630–8.

    Article  PubMed  CAS  Google Scholar 

  38. Abelson MB, Turner D. A randomized, double-blind, parallel-group comparison of olopatadine 0.1% ophthalmic solution versus placebo for controlling the signs and symptoms of seasonal allergic conjunctivitis and rhino-conjunctivitis. Clin Ther. 2003;25:931–47.

    Article  PubMed  CAS  Google Scholar 

  39. Avunduk AM, Tekelioglu Y, Turk A, Akyol N. Comparison of the effects of ketotifen fumarate 0.025% and olopatadine HCl 0.1% ophthalmic solutions in seasonal allergic conjunctivities: a 30-day, randomized, double-masked, artificial tear substitute-controlled trial. Clin Ther. 2005;27:1392–402.

    Article  PubMed  CAS  Google Scholar 

  40. Epstein AB, Van Hoven PT, Kaufman A, Carr WW. Management of allergic conjunctivitis: an evaluation of the perceived comfort and therapeutic efficacy of olopatadine 0.2% and azelastine 0.05% from two prospective studies. Clin Ophthalmol. 2009;3:329–36.

    Article  PubMed  CAS  Google Scholar 

  41. Mah FS, Rosenwasser LJ, Townsend WD, Greiner JV, Bensch G. Efficacy and comfort of olopatadine 0.2% versus epinastine 0.05% ophthalmic solution for treating itching and redness induced by conjunctival allergen challenge. Curr Med Res Opin. 2007;23:1445–52.

    Article  PubMed  CAS  Google Scholar 

  42. • Abelson MB, Gomes PJ. Olopatadine 0.2% ophthalmic solution: the first ophthalmic anti-allergy agent with once-daily dosing. Expert Opin Drug Metab Toxicol. 2008; 4:453–61. This article provided a clinical description of this paradigm-shifting reformulation, the first once-daily ocular antihistamine.

  43. Abelson MB, Spangler DL, Epstein AB, Mah FS, Crampton HJ. Efficacy of once-daily olopatadine 0.2% ophthalmic solution compared to twice-daily olopatadine 0.1% ophthalmic solution for the treatment of ocular itching induced by conjunctival allergen challenge. Curr Eye Res. 2007;32(12):1017–22.

    Article  PubMed  CAS  Google Scholar 

  44. Scoper SV, Berdy GJ, Lichtenstein SJ, Rubin JM, Bloomenstein M, Prouty RE, et al. Perception and quality of life associated with the use of olopatadine 0.2% (Pataday) in patients with active allergic conjunctivitis. Adv Ther. 2007;24:1221–32.

    Article  PubMed  CAS  Google Scholar 

  45. Mah FS, O'Brien T, Kim T, Torkildsen G. Evaluation of the effects of olopatadine ophthalmic solution, 0.2% on the ocular surface of patients with allergic conjunctivitis and dry eye. Curr Med Res Opin. 2008;24:441–7.

    Article  PubMed  CAS  Google Scholar 

  46. Li J, Tripathi RC, Tripathi BJ. Drug-induced ocular disorders. Drug Saf. 2008;31:127–41.

    Article  PubMed  Google Scholar 

  47. Khurana S, Sharma N, Agarwal T, Chawla B, Velpandian T, Tandon R, et al. Comparison of olopatadine and fluorometholone in contact lens-induced papillary conjunctivitis. Eye Contact Lens. 2010;36:210–4.

    Article  PubMed  Google Scholar 

  48. • Borazan M, Karalezli A, Akova YA, Akman A, Kiyici H, Erbek SS. Efficacy of olopatadine HCI 0.1%, ketotifen fumarate 0.025%, epinastine HCI 0.05%, emedastine 0.05% and fluorometholone acetate 0.1% ophthalmic solutions for seasonal allergic conjunctivitis: a placebo-controlled environmental trial. Acta Ophthalmol. 2009; 87:549–54. This was a rare head-to- head clinical study with five of the most commonly used topical agents.

  49. Rosenwasser LJ, Mahr T, Abelson MB, Gomes PJ, Kennedy K. A comparison of olopatadine 0.2% ophthalmic solution versus fluticasone furoate nasal spray for the treatment of allergic conjunctivitis. Allergy Asthma Proc. 2008;29:644–53.

    Article  PubMed  Google Scholar 

  50. • Kida T, Fujii A, Sakai O, Iemura M, Atsumi I, Wada T, Sakaki H. Bepotastine besilate, a highly selective histamine H1 receptor antagonist, suppresses vascular hyperpermeability and eosinophil recruitment in in vitro and in vivo experimental allergic conjunctivitis models. Exp Eye Res. 2010; 91:85–91. This was yet another one of several studies providing insight into mechanisms of late-phase effects of antihistamines.

  51. Bohets H, McGowanC, Mannens G, Schroeder N, Edwards-Swanson K, Shapiro A. Clinical pharmacology of alcaftadine, a novel antihistamine for the prevention of allergic conjunctivitis. J Ocul Pharmacol Ther. 2011 Feb 12 (Epub ahead of print).

  52. • Engelhardt H, Smits RA, Leurs R, Haaksma E, de Esch IJ. A new generation of anti-histamines: histamine H4 receptor antagonists on their way to the clinic. Curr Opin Drug Discov Devel. 2009; 12:628–43. This article provides an excellent perspective on the potential for H 4 -targeted pharmacotherapy.

  53. Saravanan C, Bharti SK, Jaggi S, Singh SK. Histamine H(4) receptor: a novel target for inflammation therapy. Mini Rev Med Chem. 2011 Jan 11 (Epub ahead of print).

  54. Leite-de-Moraes MC, Diem S, Michel ML, Ohtsu H, Thurmond RL, Schneider E, et al. Cutting edge: histamine receptor H4 activation positively regulates in vivo IL-4 and IFN-gamma production by invariant NKT cells. J Immunol. 2009;182:1233–6.

    PubMed  CAS  Google Scholar 

  55. Savall BM, Edwards JP, Venable JD, Buzard DJ, Thurmond R, Hack M, et al. Agonist/antagonist modulation in a series of 2-aryl benzimidazole H4 receptor ligands. Bioorg Med Chem Lett. 2010;20:3367–71.

    Article  PubMed  CAS  Google Scholar 

  56. Cramp S, Dyke HJ, Higgs C, Clark DE, Gill M, Savy P, et al. Identification and hit-to-lead exploration of a novel series of histamine H4 receptor inverse agonists. Bioorg Med Chem Lett. 2010;20:2516–9.

    Article  PubMed  CAS  Google Scholar 

  57. Zampeli E, Thurmond RL, Tiligada E. The histamine H4 receptor antagonist JNJ7777120 induces increases in the histamine content of the rat conjunctiva. Inflamm Res. 2009;58:285–91.

    Article  PubMed  CAS  Google Scholar 

  58. Hsieh GC, Chandran P, Salyers AK, Pai M, Zhu CZ, Wensink EJ, et al. H4 receptor antagonism exhibits anti-nociceptive effects in inflammatory and neuropathic pain models in rats. Pharmacol Biochem Behav. 2010;95:41–50.

    Article  PubMed  CAS  Google Scholar 

  59. Kiss R, Keseru GM. Histamine H4 receptor ligands and their potential therapeutic applications. Expert Opin Ther Pat. 2009;19:119–35.

    Article  PubMed  CAS  Google Scholar 

  60. Cowden JM, Riley JP, Ma JY, Thurmond RL, Dunford PJ. Histamine H4 receptor antagonism diminishes existing airway inflammation and dysfunction via modulation of Th2 cytokines. Respir Res. 2010;11:86.

    Article  PubMed  Google Scholar 

  61. Smuda C, Bryce PJ. New developments in the use of histamine and histamine receptors. Curr Allergy Asthma Rep. 2010 Nov 23 (Epub ahead of print).

  62. Deml KF, Beermann S, Neumann D, Strasser A, Seifert R. Interactions of histamine H1-receptor agonists and antagonists with the human histamine H4-receptor. Mol Pharmacol. 2009;76:1019–30.

    Article  PubMed  CAS  Google Scholar 

  63. Thurmond RL, Gelfand EW, Dunford PJ. The role of histamine H1 and H4 receptors in allergic inflammation: the search for new antihistamines. Nat Rev Drug Discov. 2008;7:41–53.

    Article  PubMed  CAS  Google Scholar 

  64. • Nakano Y, Takahashi Y, Ono R, Kurata Y, Kagawa Y, Kamei C. Role of histamine H4 receptor in allergic conjunctivitis in mice. Eur J Pharmacol. 2009;608:71–5. This was a simple, elegant study establishing the potential importance of H 4 -receptors in ocular allergy.

  65. Strakhova MI, Cuff CA, Manelli AM, Carr TL, Witte DG, Baranowski JL, et al. In vitro and in vivo characterization of A-940894: a potent histamine H4 receptor antagonist with anti-inflammatory properties. Br J Pharmacol. 2009;157:44–54.

    Article  PubMed  CAS  Google Scholar 

  66. Torkildsen G, Shedden A. The safety and efficacy of alcaftadine 0.25% ophthalmic solution for the prevention of itching associated with allergic conjunctivitis. Curr Med Res Opin. 2011;3:623–31.

    Article  Google Scholar 

  67. Greiner JV, Edwards-Swanson K, Ingerman A. Evaluation of alcaftadine 0.25% ophthalmic solution in acute allergic conjunctivitis at 15 min and 16 h after instillation versus placebo and olopatadine 0.1%. Clinical. Ophthalmology. 2011;5:87–93.

    CAS  Google Scholar 

  68. • Ono SJ, Lane K. Comparison of effects of alcaftadine and olopatadine on conjunctival epithelium and eosinophil recruitment in a murine model of allergic conjunctivitis. Drug Design, Development and Therapy 2011;5:77–84. This was yet another one of several studies providing insight into mechanisms of late-phase effects of antihistamines.

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Disclosure

Dr. Abelson has served as a consultant for Alcon.

Dr. McLaughlin and Mr. Gomes are employees of Ora Inc.

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Correspondence to Mark B. Abelson.

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Abelson, M.B., McLaughlin, J.T. & Gomes, P.J. Antihistamines in Ocular Allergy: Are They All Created Equal?. Curr Allergy Asthma Rep 11, 205–211 (2011). https://doi.org/10.1007/s11882-011-0188-5

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