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Eyedrop-induced allergy: clinical evaluation and diagnostic protocol
M T Ventura1, R Di Corato, E Di Leo
1Department of Internal Medicine, Immunology and Infectious Diseases, University of Bari Medical School, Policlinico, Bari, Italy. mt.ventura@allergy.uniba.it
Immunopharmacology and Immunotoxicology
|December 23, 2003
Summary
Phenylephrine is a common cause of allergic conjunctivitis from mydriatic eyedrops. A new diagnostic protocol safely screens for allergic reactions to ophthalmic medications, including atropine.
Area of Science:
- Ophthalmology
- Allergology
- Dermatology
Background:
- Adverse reactions to mydriatic eyedrops are increasingly recognized.
- A standardized protocol to identify the pathogenetic mechanisms of these reactions is lacking.
- This study evaluates a diagnostic protocol using standardized allergen concentrations.
Purpose of the Study:
- To assess the reliability of a diagnostic protocol for identifying allergens in mydriatic eyedrops.
- To evaluate the safety and efficacy of patch testing and specific allergy tests for ophthalmic drug reactions.
Main Methods:
- Utilized patch tests with medicaments, corticosteroids, local anesthetics, eyedrop excipients, and pure active principles.
- Performed skin prick tests with atropine sulfate and intradermal tests with atropine.
- Included the Gruppo Italiano Ricerca Dermatiti da Contatto e Ambientali (GIRDCA) patch test series.
Main Results:
- Identified frequent positive reactions to phenylephrine (7/13).
- Observed positive reactions to benzalkonium chloride (2), thiomersal (1), ethylenediamine (1), and atropine sulfate (1).
- Intradermal tests showed three positive reactions in patients with reported atropine adverse effects.
Conclusions:
- Phenylephrine is a significant cause of allergic conjunctivitis (53.8%).
- The diagnostic protocol is safe and effective for screening allergic reactions to ophthalmic drugs.
- Further studies on atropine's role are warranted due to the limited patient cohort.