Allergic contact dermatits and conjunctivitis from epinephrine

Area of Science:

• Ophthalmology
• Allergology
• Dermatology

Background:

• Chronic open-angle glaucoma management often involves topical medications.
• Allergic reactions to ophthalmic solutions can complicate treatment.
• Epinephrine is a medication sometimes used in glaucoma treatment.

Observation:

• A patient with glaucoma suspected of allergic reactions to epinephrine was evaluated.
• Patch testing was performed using epinephrine, common eye drop ingredients, and other potential contactants.
• The patient exhibited positive allergic patch test reactions to epinephrine chloride solution.

Findings:

• The patient demonstrated a positive allergic reaction to epinephrine.
• An unexpected positive reaction was observed when tested with di-isopropyl fluorophosphate (DFP).
• This highlights the potential for varied sensitivities in patients with ocular allergies.

Implications:

• Routine patch testing is crucial in ophthalmic practice for diagnosing contact allergies.
• Identifying specific allergens like epinephrine and DFP can guide treatment adjustments.
• This case underscores the need for comprehensive allergy assessment in patients with suspected ocular sensitivities.