4 ways to help patients manage allergies

Excerpted from page 50 of the June 2015 edition of AOA Focus.

Autumn is just around the corner, and for seasonal allergy sufferers, that can mean itchy, tear-laden eyes. Fortunately, an adequate treatment plan and a few clinical recommendations from an doctor of optometry can make all the difference in the world.

Renée Reeder, O.D., associate professor at Illinois College of Optometry and chief of the Cornea Center for Clinical Excellence at the Illinois Eye Institute, shares suggestions for helping patients with allergies.

1. Ocular allergies may be isolated. Many of these patients even state they do not have allergies; however, doctors of optometry will see the classic papillary response in the outer canthus, Dr. Reeder says. Patients may complain of dryness, watering and/or itching, and these patients respond well to topical ophthalmic anti-allergy preparations of which there are many options, both over-the-counter (OTC) (ketotifen) and prescription (olopatadine, emadine, epinastine, azelastine, loteprednol).
   
   
2. But often these allergies are not isolated. In order to better manage allergies, it's helpful to understand what is causing them. If patients are unaware of those allergens, refer for testing or (if you are in states that allow it) do the testing to help tailor your treatments, she says.
   • Patients with pollen allergies cannot avoid it, but minimize the impact by recommending showering before
     bed to rinse away allergens, or recommend frequent changing of air filters in the A/C system when allergen levels are elevated.
   • Patients with perennial allergies—including dust and animal dander—can be counseled on changes to their homes to minimize exposure, including: minimizing carpet, using allergy-reducing bed covers, and
     HEPA-filtered vacuums and A/C systems.
     
     
3. Allergies not isolated to the eyes will require a more comprehensive approach. Patients might find excellent adjunct treatment allowing for greater relief and inflammation reduction in OTC nasal (cromolyn, fluticasone) and oral (cetirizine, loratidine, fexofenadine) preparations. Some patients may require multiple delivery methods to reduce their symptoms and improve their day-to-day function, Dr. Reeder adds. Still, others will fail with OTC options and prescription alternatives will be needed.
   
   
4. And don't forget palliative measures. Artificial tears can dilute allergen and wash away mucous thereby reducing discomfort. Cool compresses are very effective against itching, and some homeopathic preparations may also provide relief, Dr. Reeder says.