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Allergy treatment based on fundamentals
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As I write this editorial we are nearing an event of epic proportion – the Super Bowl. It is the pinnacle of a sport that consumes this country for 7 months a year. This is for good reason – make no doubt about it, America loves football.
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Whether it is high school, college or professional, football is more than just a sport for many. It is a passion, one which commands a lot of media attention. Hours and hours of it.
We have radio and television shows that begin analyzing games a week in advance. We have game day “pre-game” coverage, followed by a half-time analysis. Last, but not least, we have the post-game wrap up, in which every pivotal play is painstakingly analyzed.
Given the shear amount of time our media outlets devote to football, it is only logical there has got to be some substance and content. So the football gurus analyze everything from statistics to off-field shenanigans in an effort to predict who will ultimately prevail.
Interestingly enough, while each network puts a different spin on its analysis, there is a common thread. It is the thread that stresses the fundamentals. Every pre-game, half time and post-game analysis comes down to this. The team that blocks, runs, passes and tackles best is usually who wins. It is as true at the high school level as it is in the Super Bowl. It is really that simple.
For eye care providers, February marks the beginning of a different sort of season. With spring approaching, it is the time of year we battle ocular allergies. While we approach the season with a deep therapeutic roster and well conceived game plan, it is equally important that we, too, execute on the fundamentals.
For allergy sufferers, the therapeutic fundamentals are obvious but often overlooked. For many, simply avoiding allergens and using saline irrigation, cool compresses and ocular lubricants can go a long way. Emphasizing these strategies requires only a minute of our time and may prove to be the most important aspect of our treatment regimen. Likewise, educating patients on the potential pitfalls of self medicating with over-the-counter oral antihistamines is equally important for those with co-existing dry eye.
This treatment paradigm is important, as only when the fundamentals are in place do patients fully realize the benefits of additional therapies. While topical antihistamine/mast-cell stabilizers – olopatadine, epinastine, ketotifen and azelastine – are still our best first-line therapies, we occasionally need other options. For those requiring a more aggressive approach, loteprednol provides a reasonable balance of potency and safety. For certain chronic allergy presentations, even topical cyclosporine plays a role.
Like the perennial football fan, we have good reason to be optimistic this allergy season. We have a firm understanding of the ocular allergy cascade and a variety of great drugs. Let us just remember to execute the fundamentals.