Nonpharmacologic care for ocular allergies

Allergic diseases have greatly increased in industrialized countries. About 30 percent of people suffer from allergic symptoms, and from 40 to 80 percent of these have ocular symptoms.¹ We all prescribe topical medicines for our patients with ocular allergies; their use has become almost second nature. These medications do a truly remarkable job of helping our patients who suffer from seasonal or perennial ocular allergies. I like to temper these pharmacologic recommendations with some common sense ideas that will complement the pharmacological treatment and greatly alleviate the patient’s symptomatology.

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Prevention

As with any allergy, the first step for successful management of either the seasonal or perennial forms of ocular allergy should be prevention, or avoidance of the allergens that trigger symptoms. Avoidance of allergens can result in up to a 30 percent decrease in allergy symptoms.² Advise your patients to stay indoors when pollen counts are highest, usually in midmorning and the early evening. Pollen is one of the most common allergens, and unfortunately it is one of the most difficult to avoid. Keep windows closed and run the air conditioner instead of window fans because window fans can draw in pollen and mold spores. The dust in buildings contains a mixture of potential allergens, including fabric fibers, feathers, animal and human dander, bacteria, particles of food, plants and insects, and microscopic dust mites (Dermatophagoides species).³

Use high-quality furnace filters that trap common allergens, and replace the filters frequently. Clean floors with a damp mop because sweeping tends to stir up allergens. Limit the use of pillows, bedding, draperies, and other linens, such as dust ruffles and bed canopies. Consider using blinds instead of curtains for window covers. To prevent mold from growing inside your home, keep the humidity under 50 percent. That might require the use of a dehumidifier, especially in a damp basement. Clean your kitchens and bathrooms with a five percent bleach solution to cut down on mold.

In a warm, humid house, dust mites can thrive year-round in bedding, upholstery, carpets, and the like. Their protein waste products stimulate the allergic reaction. Limit dust mite exposure by encasing your pillows in allergen-impermeable covers. Wash bedding frequently in water that is at least 130°F. Old mattresses are often teeming with allergens, so if your mattress is more than a few years old, think about replacing it with a new one.

If a pet is causing the allergies, advise the patient to keep the home free of pet dander and keep pets off the furniture. Clean carpets regularly and thoroughly to remove dust and allergens, and consider replacing area rugs and carpets, which trap and hold allergens, with hardwoods, tile, or other flooring materials that are easier to clean. Try to keep the pet outside as much as possible. For goodness sakes, keep the pet out of your bed. Wash your hands immediately after petting any animals, and remove and wash clothing after visiting friends with pets.

When the patient is outdoors, recommend wraparound sunglasses to help shield eyes from allergens, and a wide-brim hat can likewise reduce the amount of allergens blowing into the eyes. Remind the patient to drive with the car windows closed during allergy season. Another strategy for minimizing allergen exposure is to have the patient wash her hands and brush her hair more frequently and to change clothes when she comes in from outdoors.

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Regardless of the allergen, recommend cold compresses and/or ice packs because patients find that the cool temperature quells the allergy-associated itching and burning. Artificial tears and preservative-free lubricants may be soothing, and they dilute and wash away allergens in the eye. Refrigerating eye drops prior to their use may provide additional relief of symptoms. Try to not rub the eyes. Increased levels of tear tryptase have been reported following eye rubbing, indicating increased mast cell degranulation.⁴ Rubbing the eye releases histamine from the mast cells, which potentiates the allergic response, and avoiding eye rubbing can reduce the time course of the disease.⁵

If the patient wears contact lenses, consider temporarily discontinuing contact lens wear during the peak allergy season, or consider switching to daily disposable contact lenses.

There are a lot of environmental modifications a patient can make to help alleviate his ocular allergies. Reminding the patient of these will go along way toward alleviating his suffering not only during peak allergy season but year-round.ODT

References

1. Kari O, Saari KM. Updates in the treatment of ocular allergies. J Asthma Allergy. 2010 Nov;3:149-58.

2. Bielory L. Update on ocular allergy treatment. Expert Opin Pharmacother. 2002 May;3(5):541-53.

3. Ronge LJ. Ocular allergies: Fight the Mite. Available at: wew.aao.org/publications/eyenet/200402/feature.cfm. Accessed 6/12/2014.

4. Butrus SI, Ochsner KI, Abelson MB, et al. The level of tryptase in human tears. An indicator of activation of conjunctival mast cells. Ophthalmology. 1990 Dec;97(12):1678-83.

5. Azari AA, Barney NP. Conjunctivitis: a systematic review of diagnosis and treatment. JAMA. 2013 Oct;310(16):1721-9.