Cetirizine Eye Drops for Allergic Conjunctivitis - Zerviate 1 drop twice daily

The US Food and Drug Administration (FDA) approved the first topical ocular formulation of the antihistamine cetirizine for the treatment of ocular itching associated with allergic conjunctivitis.
The efficacy of cetirizine ophthalmic solution 0.24% (Zerviate) was shown in 3 clinical trials.

Patients had less ocular itching within 15 minutes and the effect persisted for 8 hours after treatment.

In PR-focused wording, the company quotes cetirizine "world-wide exposure representing more than 300 million patient-years".

The recommended dose of Zerviate is one drop in each affected eye twice daily, 8 hours apart.

The most commonly reported adverse reactions were ocular hyperemia (redness), instillation site pain, and reduction in visual acuity, which occurred in roughly 1% to 7% of patients.



Treatment options for allergic conjunctivitis (eye drops) (click here for larger image).

References:

FDA Clears Cetirizine Eye Drops for Allergic Conjunctivitis http://buff.ly/2swY4Sp

Histaminergic Angioedema

Angioedema is frequently categorized into:

- histamine-mediated disease
- bradykinin-mediated disease

It is critical to determine the underlying mediator of symptoms as it directs treatment.

Histaminergic angioedema is the most frequent cause of angioedema. It is classified as:

- acute (lasting less than 6 weeks)
- chronic (symptoms for longer than 6 weeks)

It is further classified into angioedema presenting with or without urticaria.

Mast cells and basophils are central to the underlying pathophysiology of histamine-mediated angioedema.

The underlying treatments of histamine-mediated angioedema are:

- antihistamines
- corticosteroids
- epinephrine

References:

Histaminergic Angioedema http://buff.ly/2ryJ5dn

Acquired C1 Inhibitor Deficiency (C1-INH-AAE)

Acquired angioedema due to C1-INH deficiency (C1-INH-AAE) can occur when there are acquired (not inherited) deficiencies of C1-INH.

A quantitative or functional C1-INH deficiency with negative family history and low C1q is diagnostic of C1-INH-AAE.

The most common conditions associated with C1-INH-AAE are:

- autoimmunity
- B-cell lymphoproliferative disorders

A diagnosis of C1-INH-AAE can precede a diagnosis of lymphoproliferative disease and confers an increased risk for developing non-Hodgkin lymphoma.

Treatment focuses on symptom control with:

- therapies that regulate bradykinin activity (C1-INH concentrate, icatibant, ecallantide, tranexamic acid, androgens)
- treatment of any underlying conditions

References:

Acquired C1 Inhibitor Deficiency http://buff.ly/2sx8r8B

Acute Management of Hereditary Angioedema Attacks (HAE)

Several treatment modalities have become available for management of acute hereditary angioedema (HAE) attacks in the last 15 years. Preferred contemporary use of the treatments is “on demand,” because control remains with the patient and delays in treatment access avoided.

Four treatments are available:

— plasma-derived C1 inhibitor concentrate
- recombinant C1 inhibitor concentrate
- ecallantide
- icatibant

References:

Acute Management of Hereditary Angioedema Attacks http://buff.ly/2ryJDzV

The Burden of Chronic Urticaria Is Substantial

Hives are raised, itchy, red bumps (welts) on the surface of the skin. They can be caused by an allergic reaction to food, drugs, or other causes. Urticaria affects up to 20% of people at some point in their lives.

Chronic spontaneous urticaria (CSU) can be debilitating, difficult to treat, and frustrating for patients and physicians.

This international observational study included 600 adult patients with CSU whose symptoms persisted for longer than 12 months despite treatment.

Almost 50% of patients had moderate-to-severe disease activity as reported by Urticaria Activity Score.

CSU markedly interfered with sleep and daily activities.

Angioedema in the previous 12 months was reported by 66% of enrolled patients and significantly affected health-related quality of life (HRQoL).

More than 20% of patients reported more than 1 hour per week of missed work; productivity impairment was 27%.

CSU has considerable humanistic and economic impacts. Patients with greater disease activity and with angioedema experience greater HRQoL impairments.



Urticaria (hives): what is the cause? (click to enlarge the image).



Chronic Urticaria Treatment Options in 6 Steps (click to enlarge the image). En EspaƱol.



Laboratory Diagnosis of Chronic Urticaria (click to enlarge the image).



Anti-FceR1 autoantibodies in chronic autoimmune urticaria: IgG against FceRI (receptor for IgE) (click to enlarge the image).

References:

The Burden of Chronic Spontaneous Urticaria Is Substantial: Real‐World Evidence From ASSURE‐CSU http://buff.ly/2swQJ5d

Related reading

CIU & You - Patient support website about Chronic Idiopathic Urticaria, sponsored by the makers of Xolair http://buff.ly/1zypqKg 
Urticaria and angioedema. Allergy, Asthma & Clinical Immunology 2011, 7(Suppl 1):S9.
Blog articles from AllergyNotes
Questions to ask if a patient has a suspected episode of anaphylaxis

Image source: Urticaria, Wikipedia, public domain.
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