Effectiveness of nonpharmacologic treatments for acute seasonal allergic conjunctivitis.
OBJECTIVE
To investigate whether artificial tears and cold compress alone or in combination provide a treatment benefit and whether they were as effective as or could enhance topical antiallergic medication.


METHODS
Randomized, masked clinical trial.


METHODS
Eighteen subjects (mean age, 29.5±11.0 years) allergic to grass pollen.


METHODS
Controlled exposure to grass pollen using an environmental chamber to stimulate an ocular allergic reaction followed by application of artificial tears (ATs), 5 minutes of cold compress (CC), ATs combined with CC, or no treatment applied at each separate visit in random order. A subset of 11 subjects also had epinastine hydrochloride (EH) applied alone and combined with CC in random order or instillation of a volume-matched saline control.


METHODS
Bulbar conjunctival hyperemia, ocular surface temperature, and ocular symptoms repeated before and every 10 minutes after treatment for 1 hour.


RESULTS
Bulbar conjunctival hyperemia and ocular symptoms decreased and temperature recovered to baseline faster with nonpharmaceutical treatments compared with no treatment (P <0.05). Artificial tears combined with CC reduced hyperemia more than other treatments (P <0.05). The treatment effect of EH was enhanced by combining it with a CC (P <0.001). Cold compress combined with ATs or EH lowered the antigen-raised ocular surface temperature to less than the pre-exposure baseline. Artificial tear instillation alone or CC combined with ATs or EH significantly reduced the temperature (P <0.05). Cold compress combined with ATs or EH had a similar cooling effect (P >0.05). At all measurement intervals, symptoms were reduced for both EH and EH combined with CC than CC or ATs alone or in combination (P <0.014).


CONCLUSIONS
After controlled exposure to grass pollen, CC and AT treatment showed a therapeutic effect on the signs and symptoms of allergic conjunctivitis. A CC enhanced the use of EH alone and was the only treatment to reduce symptoms to baseline within 1 hour of antigenic challenge. Signs of allergic conjunctivitis generally were reduced most by a combination of a CC in combination with ATs or EH.
Ophthalmic Research Group, Life and Health Sciences, Aston University, Birmingham, United Kingdom.
Paramdeep S
PS
Bilkhu
Ophthalmic Research Group, Life and Health Sciences, Aston University, Birmingham, United Kingdom. Electronic address: j.s.w.wolffsohn@aston.ac.uk.
James S
JS
Wolffsohn
Ophthalmic Research Group, Life and Health Sciences, Aston University, Birmingham, United Kingdom.
Shehzad A
SA
Naroo
National Pollen and Aerobiological Research Unit, University of Worcester, Worcester, United Kingdom.
Louise
L
Robertson
National Pollen and Aerobiological Research Unit, University of Worcester, Worcester, United Kingdom.
Roy
R
Kennedy
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000485:Allergens / Q000009:adverse effects; D003131:Combined Modality Therapy; D003228:Conjunctiva / Q000098:blood supply; D003233:Conjunctivitis, Allergic / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D017679:Cryotherapy; D003984:Dibenzazepines / Q000008:administration & dosage; D004311:Double-Blind Method; D005260:Female; D006634:Histamine H1 Antagonists / Q000008:administration & dosage; D006801:Humans; D006940:Hyperemia / Q000139:chemically induced / Q000188:drug therapy; D007093:Imidazoles / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions / Q000008:administration & dosage*; D011058:Pollen / Q000009:adverse effects; D012621:Seasons; D012882:Skin Tests; D016896:Treatment Outcome; D055815:Young Adult
D000485:Allergens; D003984:Dibenzazepines; D006634:Histamine H1 Antagonists; D007093:Imidazoles; D009883:Ophthalmic Solutions; C053090:epinastine