Anti-Histamine Eye Drops

Allergies often cause eye symptoms of itching, swelling, redness, and tearing.

If other allergy symptoms are also present involving the nose and skin, it is best to try an oral anti-histamine as a first step.

This one oral drug may be able to resolve all these symptoms. As I am fond of telling patients, oral medications affect the whole body as the medication goes to the stomach after swallow, gets digested, and spreads to the big toe just as much as the skin, nose, and eyes.

However, if symptoms are limited to just the eye, it is best to use topical medications like eye drops rather than an oral medication which goes everywhere (where it is not needed).

There are in essence two anti-histamine eye drops available over-the-counter.

The first is the combination of naphazoline and pheniramine found in NaphCon-A and Visine-A (formerly called Ocuhist). Naphazoline is a decongestant that helps eliminate the red eyes whereas pheniramine is an anti-histamine to help eliminate itching. It can be used up to 4X per day for relief.

The other contains the active ingredient ketotifen and has 3 modes of action: anti-histamine, mast cell stabilizer, and eosinophil inhibition. All three actions in essence help resolve current as well as future allergy eye symptoms. It's also why it can be used only twice a day opposed to 4X per day required with naphazoline/pheniramine.

There are three main brands of ketotifen that basically are the same thing:

- Zaditor

- Alaway

- Zyrtec Eye Drops

- Claritin Eye Drops

The "zyrtec" and "claritin" eye drops names are quite misleading in that the eye drops do NOT contain the same ingredient as that found in the oral medication by the same name.

Personally, I prefer ketotifen over naphazoline/pheniramine due to longer-lasting relief per use, 2X per day dosing, and less risk (glaucoma and hypertension specifically). Ketotifen can be used from the age of 3 years (age 6 years for the other).

Of course, if these eye drops don't work, there are prescription antihistamine eye drops that work quite well including pataday/patanol (olopatadine), bepreve (bepotastine),  and lastacaft (alcaftadine). Of course, most insurance companies require trial of OTC eye drops first before they will authorize these prescriptions.

On a final note, there is one steroid nasal spray called Veramyst that has an FDA indication for eye allergies though I suspect all steroid nasal sprays can help similarly. As such, if a patient has only ocular and nasal allergy symptoms, it may be worth trying a steroid nasal spray, though I'm not sure how often this is practiced in reality.

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Migraine Headaches Associated with Allergies & Response to Allergy Shots

A recent study published this month in the journal Headache reported an association of migraine headaches with allergy severity and response to allergy shots... but only in those less than 45 years of age.

The study suggested that lower "degrees of atopy" (or allergy) were associated with less frequent and disabling migraine headaches in younger subjects while higher degrees were associated with more frequent migraines. The administration of allergy shots was associated with a decreased prevalence, frequency, and disability of migraine headache in younger subjects.

The age cut-off used to described "younger" subjects depending on the measure described was either 40 years or 45 years.

Read the abstract here.

Of course, one must consider the possibility that perhaps what these patients are suffering from is not migraine headaches, but allergy triggered sinus headaches.

Our office provides allergy testing, allergy shots, and allergy drops. We also offer botox injections in the treatment of migraine headaches.

Reference:
Allergy and immunotherapy: are they related to migraine headache? Headache. 2011 Jan;51(1):8-20. doi: 10.1111/j.1526-4610.2010.01792.x. Epub 2010 Nov 4.

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Different Types of Immunotherapy for Allergy Cure

Most people are already familiar with allergy shots and even sublingual (under the tongue) allergy drops as treatment to try and achieve cure (or tolerance) to the things they are allergic to.

However, there are other forms of immunotherapy that may one day provide just as good if not better allergy cure rates. These include (most currently under research):

- Intra-Lymphatic Injections (ILIT): Rather than weekly shots in the arm, one research paper reported only 3 injections into a groin lymph node over 2 months provided equivalent results to allergy shots in the arm after 3 years!

- Allergy Tablets: Potentially in the next year or 2, tablets may become available to treat certain allergies. Grazax by Merck which treats grass allergy is the first which is currently undergoing FDA approval.

- Epicutaneous immunotherapy (EPIT) involves lightly scraping a patient’s skin and then applying a patch that delivers the allergens through the bloodstream.

- Intra-Nasal Spray: Declared effective and safe by WHO.

- Bronchial Inhalers: Marginal effectiveness and risky.

At this time, our office only provides allergy shots and allergy drops.

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Can A Person Have Allergies Even if Allergy Testing Comes Back Negative?

YES!!! But how can that be?!! Well, here is the simplified answer. When allergy testing is performed whether by skin prick or blood testing (RAST), one is testing to certain specific proteins known to cause allergic reactions in majority but not all patients (these are called major allergen).

Patients need to remember that for a given allergy like CAT (or tree, mold, dust, etc)... there are millions of proteins (minor allergen) that have the potential to cause an allergic reaction in people. Allergy testing to cat ONLY tests for ONE of these proteins called Fel d1 as well as a few other minor allergens. As such, if a patient is CAT allergic, but not to the Fel d1 protein, then the allergy testing will come back normal!

Given this information, that's why skin testing is a bit more "accurate" when it comes to determining whether a patient has allergies or not as there are more "proteins" for a given allergen like CAT being tested than the blood test like RAST which STRICTLY tests for a single protein.

Of course, it is possible that a patient may TRULY not have any allergies. So, how can a person tell? Look at the total IgE serum levels. If it is high, than you most likely have allergies even if everything comes back negative.

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Allergy Shots in Britain Require a LONG Waiting Period Afterwards

I recently heard that one reason why allergy shots are rare in England (and why sublingual "under-the-tongue" drops aka SLIT, are so common) is that British patients are required to wait under observation for anaphylaxis as long as ONE HOUR after each and every injection!!!

In fact, initially the waiting period was as long as TWO HOURS when the British Committee for Safety of Medicines became alarmed with some deaths that followed allergy injections in 1986. Subsequently, the safety committee decreed that these injections could only be administered when full equipment to cope with any emergency was at hand and further required that the patient must remain under supervision in the clinic for two hours after the injection. This had the effect of stopping this method of treatment completely, mainly because of the long waiting period.

That's quite a pity especially when considering that allergy shots were first "invented" in 1911 by two British physicians, Drs. Leonard Noon and John Freeman.

Read more about the history of allergy desensitization in England here.

Of note, our clinic provides allergy testing, allergy shots, and under-the-tongue allergy drops. And no... we do not make patients wait 1 hour after an injection.

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One-Size-Fits-All Injection that Can Cure Allergies!

Cytos Biotechnology has recently completed patient trials that suggests that a one-size-fits-all allergy injection can alleviate and potentially cure allergies, asthma, eczema and other allergy conditions including even food allergies!

This innovative medical treatment is known only as CYT003-QbG10. It is composed of pieces of synthetic DNA similar to those found in the bug that causes tuberculosis. The DNA fools the body into thinking it is under attack from a dangerous bug, kick-starting a multi-pronged immune response. The ability of a single formula to protect against more than one allergy suggests the jab is reprogramming the immune system by tackling the root cause of allergies.

Current allergy shots (as well as allergy drops) work by injecting the actual proteins that cause allergy in small doses that are slowly increased. For example, if you are allergic to cat, than actual cat protein is injected into you in slowly increasing amounts over time.

With CYT003-QbG10, there would be no need for allergy testing and in essence, if truly successful, patients can be cured of allergies with this type of vaccination, just like the childhood vaccines have near-eradicated polio, mumps, measles, etc. It is not clear how often the new vaccine would have to be given. But scientists envisage an initial short course of jabs, followed up by a booster session two or three years later.

Large scale human trials are supposed to begin in 2011.

Read more in this media report here.

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Hidden Costs of Allergy Shots

Many people know what allergy shots are and do. What many may not realize are the hidden costs associated with them and it behooves a patient interested in getting them to know what they are getting into, not just in terms of medical, but also financial.

For those who don't know... Allergy shots are typically 1-2 injections administered to the upper arm once a week for a period of years… potentially as long as 5-10 years. These shots are given in an attempt to “cure” a person of their allergies such that after the shots are completed, there will be no more allergies OR the allergies have improved to the point that medications work quite well and taken only when needed. These shots MUST be administered in a medical office.

And as such, that's where the hidden costs behind the allergy shots begin. First, there are the copays involved with EACH allergy shot administered in the office as well as making of the allergy vials themselves. Given you have to be in a medical office to get them, there is also the time, travel, gas, and missed time from work to also take into consideration. At least in our office, we require all patients to have an up-do-date epipen at all times, so there's the prescription cost of this as well.

Ways to minimize or at the very least, anticipate the potential costs involved are as follows:

- Once you get established with the shots (in our office, typically 4 injections), you can get the shots administered in a medical office closer to your place of residence or work (thereby saving time, gas, and travel).
- Ask if it's possible to get the shots at home once you reach maintenance.
- See if you are a candidate for allergy drops (SLIT) which is NOT covered by insurance, but is a fixed cost AND they do not need to be administered in a medical office, but rather the comfort of your home/work.

Regarding possible copays, please check with your insurance company regarding amount of copays involved with allergy shots such that there won’t be any surprises with any bills you may receive due to this treatment.

The CPT codes to inquire with your insurance regarding potential copay amounts are:

95165 (Allergy Vial)
95115 (1 shot)
95117 (2+ shots)

Typically, the copays are much smaller than what you pay for a physician office visit, but rarely is it free.

For more information on allergy shots and testing, click here.

For more information on allergy drops, click here.

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