This article is sponsored by Eyevance Pharmaceuticals, developing innovative and impactful ophthalmic therapies for the ocular surface and anterior segment. 

Allergic conjunctivitis (AC) is a common ocular condition. Worldwide, 15% to 20% of the population is affected by some form of allergic disease with ocular symptoms present in about 40% to 60% percent of those patients. More than a mere nuisance for many, ocular allergies have been shown to have an adverse impact on quality of life (QOL). In a cross-sectional study of 220 patients with ocular allergy, 25% had more than five episodes in the previous year and nearly 60% had episodes all year round. There was a significant impairment on overall QOL during an allergic conjunctivitis episode, with 46% rating their disease greater than 6 on a 10-point severity scale. Only 5.1% said their allergic conjunctivitis was mild or not severe. A total of 16% missed work or school due to their ocular allergy episode. Most patients (86%) reported allergic eye symptoms during the previous year, including itching (94.2%), tearing (84.3%), photophobia (67.4%), and half of them also reported ocular pain (51.1%).

Most recent estimates in the United States suggest that 15% to 25% of Americans—50 to 85 million people—suffer from ocular allergy. Other studies have estimated the prevalence of allergic conjunctivitis at anywhere from 15% to 40% percent of the U.S. population. The National Health and Nutrition Examination Survey III found that 40% of the adult population had ocular symptoms, defined as “episodes of tearing and ocular itching.” The prevalence of allergic conjunctivitis is similar in Europe, Japan, and Australia, and is increasing worldwide.

Ocular surface insults are piling up

Patients can suffer from seasonal allergies with triggers like pollen in the spring and ragweed in the fall, and perennial allergies due to household irritants like pets, dust, and mold. In fact, with more people working from home, staying indoors, and adopting pets during the pandemic, eye care specialists are seeing an uptick in patients with household allergies.

There is also a large overlap between allergic conjunctivitis, whether perennial or seasonal, and dry eye disease (DED). As noted in the in the Tear Film & Ocular Surface Society’s Dry Eye Workshop II report, AC is a known risk factor for DED. Now, eye care specialists are reporting an increase in patients who did not previously experience dry eye complaining of symptoms associated with mask-wearing to mitigate the spread of COVID-19. Termed MADE or mask-associated dry eye, it stems from exhaled air being forced up and toward the eye, which exacerbates ocular surface dryness and causes tear film instability.

And it is not just masks. Nearly 80% of Americans reported their screen time increased during the pandemic, and nearly half of those reported their eyes feel dry as a result of it, according to a recent survey. These factors are combining to create a perfect storm of ocular surface discomfort.

Educate and empower patients

When patients visit an eye care specialist to address their symptoms associate with allergic conjunctivitis, they are looking for a definitive recommendation made with confidence. Most patients have tried over-the-counter products by the time they see a physician and are therefore expecting a prescription medication to address their symptoms. In our experience, the last thing these patients want is a suggestion to return to the pharmacy for more over-the-counter medications. Advising patients to self-treat with a product they select does the patients a disservice as they often become confused and overwhelmed with the choices. More importantly, they may select the wrong product and inadvertently make their eyes feel even worse, particularly if they have co-existing DED.

By providing patients a prescription, eye care specialists can be assured their patients are getting the correct medication. Our preferred ocular anti-itch prescription product is topical Zerviate® (cetirizine ophthalmic solution 0.24; Eyevance Pharmaceuticals) for ocular itch associated with allergic conjunctivitis. The drop contains the same active ingredient as the oral antihistamine Zyrtec (Johnson & Johnson Consumer), the number one oral antihistamine allergy treatment recommended by allergists. Zerviate is the first new topical antihistamine to be approved by the Food and Drug Administration in more than a decade.

Highly specific agent

Cetirizine is different from other topical antihistamines, such as olopatadine. As a highly specific H1 receptor antagonist, cetirizine has no anti-muscarinic receptor activity; therefore, it may not exacerbate symptoms associated with existing DED. Only one patient in 511 reported dry eye as an adverse event. Plus, the drop contains the vehicle Hydrella™, a combination of glycerin and hydroxypropyl methylcellulose that is similar to the ingredient in artificial tears, making it very comfortable for patients. In the product’s Phase 3 clinical trial, Zerviate’s mean comfort score was <1 at all time points (scale of 1 to 10 with 1 being very comfortable) with an excellent safety profile.

Getting quick relief without making coexisting DED worse is crucial for patients who are often extremely uncomfortable from ocular symptoms of allergic conjunctivitis. Zerviate works within 3 minutes of instillation, giving patients and providers confidence in the drop’s efficacy. Two phase 3 efficacy studies revealed strong ocular itch relief with Zerviate compared to vehicle, and it was effective in patients with both moderate and severe allergic conjunctivitis.

Conclusion

Ocular allergy and ocular surface disease are highly prevalent and they often co-exist; our masks, more and more screen time, being indoors for extended periods, and we hope those new pets too, will be a part of our lives for the foreseeable future. Eye care providers can confidently prescribe Zerviate, knowing they will empower their patients to effectively treat ocular itch associated with allergic conjunctivitis without causing further dryness.

Cynthia Matossian is an ophthalmologist and founder and medical director, Matossian Eye Associates. Edward J. Meier is an ophthalmologist and director, Apex Eye Clinical Research, Cincinnati Eye Institute, Mason, OH. Drs. Matossian and Meier are consultants to Eyevance.

Image credit: Eyevance Pharmaceuticals