Article Date: 8/1/2011

Even Allergies are Bigger in Texas

Even Allergies are Bigger in Texas

BEPREVE® provides rapid relief for severe ocular itch associated with allergic conjunctivitis.

By Derek N. Cunningham, OD, FAAO

Spring in Austin, Texas is not the harbinger of seasonal allergies but actually the midpoint in terms of ocular allergy misery. The Texas allergy season lasts longer and we actually get hit hardest early in the year, from January to March. Many pollen-producing plants and trees are around longer than up north and several live year round. Our biggest nemesis is Mountain Cedar pollen, an allergen so potent for some patients that it produces flu-like symptoms.

Thanks to cedar pollen, the population base for allergies is quite broad for a short period of time. Patients arrive in droves after what, for many, has been a frustrating effort to find relief for their Texas-sized ocular itching. They've come to us for a powerful solution to make their eyes comfortable fast. This is particularly true for contact lens patients for whom the allergy season poses additional challenges.

Texas Pollen Meets its Match

We've used BEPREVE® (bepotastine besilate ophthalmic solution) 1.5%, [ISTA Pharmaceuticals, Inc.] since its launch.

With BEPREVE, the relief our patients experience is very rapid, usually within minutes. Even patients with the most severe ocular itching—folks who are really unhappy when they walk in the door—can obtain complete relief with BEPREVE. In clinical trials, 68% of eyes that had been rated as suffering from severe itching achieved complete relief (no itch) just 3 minutes after a single drop was instilled.1 Our experience in practice has been similar. The magnitude of this therapeutic effect is underscored by the placebo comparison. Only 3% of placebo-treated eyes went from severe to zero itch in that time frame.1

In addition to speedy relief from ocular itching, many patients in clinical trials found BEPREVE to be very comfortable. The severity of allergies we encounter means it's important for us to prescribe a powerful therapy. For patients wanting fast relief, comfort upon instillation is also important. Fortunately, BEPREVE provides the efficacy they're looking for with the comfort they demand. A different placebo comparison from the clinical trials provides confirmation of our experience: BEPREVE was as comfortable on instillation and at 5 minutes post-dosing as the placebo drop in these studies.2

BID Dosing for the Texas Allergen Challenge

Because of the pollen counts and immense quantity of allergens in the air, you really can't get away from ocular itching in this region of the country. Typical patients start having trouble at the end of the day and certainly by the next morning. We've been able to provide excellent control of ocular itch associated with allergic conjunctivitis with the twice-daily dosing of BEPREVE. Contact lens wearers like putting a drop in before they insert their lenses in the morning and then instilling another drop after they've removed their lenses at bedtime. It's a regimen that's easy to remember, fits patients' lifestyles and usually lines up well with their lens care regimens. We recommend that patients with red eyes refrain from wearing their lenses. For those who are able to wear lenses, we tell them to take their lenses out prior to using BEPREVE and to wait 10 minutes before putting their lenses back in. With BEPREVE, we find that patients enjoy consistent, reliable control of itchy eyes.

Allergen Effects on Contact Lens Wear

As optometrists in a large eyecare network, many patients are referred to us because of contact lens intolerance. We know itching associated with allergic conjunctivitis may contribute to this problem.

We always caution patients to refrain from wearing their lenses if they have an irritated eye and to schedule an office visit so we can properly evaluate the cause. If we suspect allergy, we also tell patients that contact lenses may trap allergens and can worsen the comorbidities related to allergy. If they want the most relief, we advise them to discontinue contact lens wear, even if they can tolerate it, and use the recommended topical anti-allergy medicine, along with preservative-free artificial tears to wash out the allergen while symptoms persist.

If the patient's lifestyle dictates that they must wear contact lenses, we warn them that they may not get sufficient relief of ocular itch associated with allergic conjunctivitis. We also make sure they know to remove their lenses before using BEPREVE.

We counsel our lens wearers to take as many of these additional steps as possible to reduce the impact of Texas allergies:

• Decrease lens wear time
• Replace lenses more frequently
• Use daily disposable lenses
• Avoid the allergen (which often means staying indoors as much as possible)
• Monitor pollen counts (when counts are up, remove lenses for a day or two)
• Use cold compresses (these are great during acute phases of allergic reactions, but they're not practical for the long haul)

In Texas, one thing that is definitely oversized is our allergy season.

We've found that BEPREVE is an excellent way to help our patients get the fast relief from itching associated with allergic conjunctivitis and the comfort they're seeking during this difficult time.

Indications and Usage

BEPREVE is a histamine H1 receptor antagonist indicated for the treatment of itching associated with allergic conjunctivitis.

Dosage and Administration

Instill one drop into the affected eye(s) twice a day (BID).

Warnings and Precautions

• To minimize the risk of contamination, do not touch dropper tip to any surface. Keep bottle tightly closed when not in use.
• Patients should be advised not to wear a contact lens if their eye is red
• BEPREVE should not be used to treat contact lens-related irritation.
• Patients should remove contact lenses prior to instillation of BEPREVE. Lenses may be reinserted after 10 minutes following administration of BEPREVE.

Adverse Reactions

The most common adverse reaction occurring in approximately 25% of patients was a mild taste following instillation. Other adverse reactions which occurred in 2-5% of subjects were eye irritation, headache, and nasopharyngitis.



1. Clark JC, Williams JI, Gow JA, Abelson MB, McNamara TR, for the Bepotastine Besilate Ophthalmic Solutions Clinical Study Group. Bepotastine besilate ophthalmic solution 1.5% rapidly eliminates ocular itching in more severly allergic subjects in the conjunctival allergen challenge model of allergic conjunctivitis. Poster presented at the 24th Annual Eastern Allergy Conference. Palm Beach, FL: May 6-9, 2010.
2. Williams JI, Ackerman SL, Dao JT, Reddy TA, McNamara TR, Gow JA. The ocular comfort of bepotastine besilate ophthalmic solution 1.5% in a safety clinical trial. Poster presented at the 88th Annual Meeting of the American Academy of Optometry. San Francisco, CA: November 17-20, 2010.

Dr. Cunningham is a paid consultant of ISTA Pharmaceuticals, Inc.

Optometric Management, Issue: August 2011