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Allergy: Individualized treatment with common denominators
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It’s that time of year again … spring. It is a time for new beginnings, a time for nature’s rebirth. Every spring brings with it change – new grass grows, trees bud and flowers bloom. And with this natural bounty comes pollen … lots and lots of pollen.
Certainly, without pollens there would be no spring and summer beauty. However, with pollens come allergies. It is estimated between 50 and 80 million Americans suffer from allergies – a good percentage of which experience ocular symptoms. While many ocular allergy sufferers experience symptoms year-round, the vast majority struggle with seasonal exacerbations.
Broad spectrum of presentations
In much the same way that each spring brings us a bounty of colors and fragrances, it also brings us a broad spectrum of ocular allergy presentations. It is for precisely this reason that managing this entity is so challenging. In short, there is no “cookbook” approach to managing ocular allergies.
A fundamental tenet of any disease process is its ability to express itself in a broad spectrum of clinical severity. Ocular allergies are no exception. For some, ocular allergies manifest as a phenotypic hybrid involving dry eye. For others, ocular allergy symptoms are driven by contact lens wear. In some situations, ocular involvement is part of a much more complex picture, such as vernal catarrh. Given the variability and complexity of ocular allergies, it is no surprise that management strategies must be innovative and individualized.
Despite the fact that each allergy patient requires an individualized treatment, there are common denominators to every plan. Allergy avoidance, frequent irrigation and lubrication, and cool compresses serve the majority of patients quite well. While antihistamine/mast-cell stabilizers are the mainstay of treatment, topical corticosteroids are also indicated for acute flare-ups.
For some, nasal inhalers and oral antihistamines are a critical facet of their treatment protocols. Finally, management of ocular allergies occasionally mandates a team approach – requiring the expertise of an allergist and the benefit of systemic immunomodulation.
Allergy season around the corner
For many of us, the ocular allergy season is just around the corner. With it comes a plethora of allergy sufferers with a variety of clinical presentations.
It is the perfect opportunity for all of us to enjoy a rebirth of sorts ourselves. It is an opportunity to rethink just how we treat ocular allergies – not to merely prescribe in rote fashion, but rather to manage comprehensively as well. To do so will assuredly make this a more fulfilling spring for us as clinicians and a more enjoyable one for our allergy patients as well.