title: Long-term brimonidine therapy in glaucoma patients with apraclonidine allergy.
abstract: OBJECTIVE
  To report the use of brimonidine in patients with a documented ocular allergy to apraclonidine.
  
  
  METHODS
  We conducted a prospective, open-label study on the use of long-term brimonidine therapy in 57 patients with chronic glaucoma with documented allergy to apraclonidine. The study patients were placed on brimonidine tartrate 0.2%, 1 drop three times daily in one or both eyes, either as additive therapy to a medical regimen devoid of apraclonidine for further lowering of intraocular pressure (25 patients) or as a replacement for apraclonidine at the time of diagnosis of apraclonidine ocular allergy for maintenance of intraocular pressure control (32 patients). Clinical symptoms and signs of ocular allergy to brimonidine were monitored for up to 18 months.
  
  
  RESULTS
  During the treatment period of up to 18 months, six (10.5%) of 57 patients developed slit-lamp biomicroscopic findings and subjective symptoms of an ocular allergic reaction that led to discontinuation of brimonidine treatment. All six patients developed ocular allergy to topical brimonidine 0.2% during the first 4 months of therapy. The addition of brimonidine 0.2% topical medication or the replacement of apraclonidine with brimonidine resulted in a significant decrease in mean intraocular pressure from 20.5+/-5.3 to 16.5+/-4.2 mm Hg (P < .0001) at the mean treatment period of 10.6+/-4.6 months (range, 0.5 to 18.0 months in all 57 patients: 5 to 18 months in the 51 patients without brimonidine allergy and 0.5 to 3.8 months in the six patients who developed brimonidine allergy.
  
  
  CONCLUSIONS
  The incidence of ocular allergy after the use of brimonidine 0.2% topical medication for up to 18 months was 10.5% in patients with a documented history of apraclonidine allergy. Therefore, it is generally safe as well as efficacious to administer brimonidine to patients with an ocular allergy to apraclonidine.
authors.affiliation: Department of Ophthalmology, Kresge Eye Institute, Wayne State University School of Medicine, Detroit, Michigan 48201-1423, USA. dongshin@med.wayne.edu
authors.forename: D H
authors.initials: DH
authors.lastname: Shin
authors.forename: B K
authors.initials: BK
authors.lastname: Glover
authors.forename: S C
authors.initials: SC
authors.lastname: Cha
authors.forename: Y Y
authors.initials: YY
authors.lastname: Kim
authors.forename: C
authors.initials: C
authors.lastname: Kim
authors.forename: K D
authors.initials: KD
authors.lastname: Nguyen
mesh_terms: D000316:Adrenergic alpha-Agonists / Q000009:adverse effects / Q000627:therapeutic use*; D000368:Aged; D000068438:Brimonidine Tartrate; D002908:Chronic Disease; D003000:Clonidine / Q000009:adverse effects / Q000031:analogs & derivatives*; D004342:Drug Hypersensitivity / Q000209:etiology*; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000188:drug therapy*; D005902:Glaucoma, Open-Angle / Q000188:drug therapy*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D011446:Prospective Studies; D011810:Quinoxalines / Q000627:therapeutic use*
chemical_list: D000316:Adrenergic alpha-Agonists; D009883:Ophthalmic Solutions; D011810:Quinoxalines; D000068438:Brimonidine Tartrate; C016986:apraclonidine; D003000:Clonidine