Article Date: 12/1/2011

Controlling Ocular Itch Associated With Allergic Conjunctivitis

Controlling Ocular Itch Associated With Allergic Conjunctivitis

Broad spectrum of patients — from age 2 to 102 — find success with BEPREVE.

By Andre Le, OD

This Spring, the allergy season in Ft. Worth, Texas, began about a month or two earlier than usual. Patients came into our practice in droves with the typical complaints of ocular itching associated with allergic conjunctivitis.

Treating the Itch Issue

Ocular itching is the number one complaint that brings allergic conjunctivitis patients to me. We see children as young as 2 and 3 years old coming in with moderate to severe ocular itching. Once we diagnose allergic conjunctivitis, we automatically prescribe an antihistamine/mast cell stabilizer. We are very proactive in treating this condition because we want our patients to get relief as quickly as possible. Once I start patients on a regimen, I'll see them in a month, then every other month going forward.

I use BEPREVE® (bepotastine besilate ophthalmic solution) 1.5%, [ISTA Pharmaceuticals, Inc.] in nearly all of my patients because of its proven efficacy and safety profile. Indicated for children as young as 2 years old, BEPREVE fits the broad spectrum of patient age — literally from 2 to 102 — that we see in our practice. In addition to the rapid efficacy against ocular itching that BEPREVE has demonstrated in clinical trials,1 the well-documented comfort of BEPREVE on instillation2 is important to all of our patients — particularly younger patients and their parents.

The most common adverse reaction reported with BEPREVE in clinical studies was a mild taste following instillation in approximately 25% of subjects.

Other adverse reactions occurring in 2% to 5% of the study participants treated with BEPREVE were eye irritation, headache and nasopharyngitis.

H1 Specificity

Many of our contact lens patients have to manage chronic dry eye. It is especially difficult for these patients to stay in their lenses when they get seasonal allergic conjunctivitis as well. Our challenge is to treat the ocular itching without making their dry eye worse. The H1 receptor specificity of BEPREVE means it has low binding affinity for off-target receptors that may cause or exacerbate dry eye.3 This specificity is reflected in its safety profile. In clinical studies, BEPREVE was associated with less dry eye than placebo drops.4 Instilled at least 10 minutes before patients put their lenses in and again after they take them out, BEPREVE helps them continue to wear contacts comfortably during the allergy season.

Whether or not they are contact lens wearers, using drops twice a day, administered in the morning and at night, easily fits most patients' lifestyles and keeps their ocular itch fully under control during waking hours. My patients seem to find BID dosing convenient and easy to remember.

Cost Effectiveness

The 10 mL bottle of BEPREVE is also beneficial to our patients. It's one of the best values, per drop, among available prescription antihistamine/mast cell stabilizers,5 providing 2 months of therapy for a single copay. This is usually sufficient to get patients through peak allergy season — even an extended one.

1. Williams JI, Schooley GL, Gow JA, McNamara TR. BEPREVE™ 1.5% provides clinically meaningful reduction in allergen-induced ocular itching for subjects in an analysis of two phase 3 conjunctival allergen challenge (CAC) clinical trials. J Allergy Clin Immunol. 2010;125(suppl. 1):AB38.
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: 88th Annual Meeting of the American Society of Optometry; November 17-20, 2010; San Francisco, CA.
3. Kato M, Nishida A, Aga Y, et al. Pharmacokinetic and pharmacodynamic evaluation of central effect of the novel antiallergic agent bepotastine besilate. Arzneimittelforschung. 1997;47:1116-1124.
4. Data on file. ISTA Pharmaceuticals®, Inc.
5. Wingard JB, Mah FS. Critical appraisal of bepotastine in the treatment of ocular itching associated with allergic conjunctivitis. Clin Ophthalmol. 2011;5:201-207.

BEPREVE is a histamine H1 receptor antagonist indicated for the treatment of itching associated with allergic conjunctivitis.
Instill one drop into the affected eye(s) twice a day (BID).
• 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.
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.


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

Optometric Management, Issue: December 2011