Mary Barna Bridgeman, PharmD Rupal Patel Mansukhani, PharmD
GR is a 28-year-old man who comes to the pharmacy in April complaining of itchy eyes. He explains that his eyes have been itchy for the past few weeks. He says they have been tearing more than usual as well. GR is not on any medications and has no medical conditions. Upon questioning, he says that he has been affected by seasonal allergies over the past few years. GR owns a lawn cutting company and is outside for most of his day. He has taken loratadine 10 mg in the past, but only when he had systemic symptoms. At this time, he has no other symptoms besides his itchy eyes. What would you recommend for GR?
GR is experiencing allergic conjunctivitis. The treatment goal for allergic conjunctivitis is removal or avoidance of the allergen. Because his job requires him to be outdoors, it would be difficult for GR to avoid the allergen; therefore, symptomatic relief is recommended. It is usually recommended that patients with allergic conjunctivitis be treated first-line with ocular lubricants. If symptoms continue, GR could then switch to an antihistamine/ mast cell stabilizer product. There are currently 2 such products on the market, Zaditor (Novartis) and Alaway (Bausch Lomb). Either can be recommended for use twice daily. If symptoms persist, you can suggest adding loratadine 10 mg as a second regimen.
NJ is a 33-year-old man who comes to the pharmacy complaining of an itchy rash on his leg. He was working in the yard and thinks he came in contact with poison ivy. NJ says that when this has happened in the past, he has always treated it with a topical cream, but he cannot remember its name. He also mentions that his 1-year-old daughter was outside playing while he was doing yard work, and she has a little bit of a rash on her leg as well. He wants to purchase something that would be safe and effective for both of them. What would you recommend?
NJ should be counseled that when he comes in contact with poison ivy, it is important to wash the exposed area with soap and water. The quicker he washes off the exposed area, the less severe his reaction will be. For itching, you can recommend that NJ use a topical hydrocortisone cream, which can provide relief. Nonprescription oral antihistamines can also be prescribed to assist with the itching. However, it is recommended to avoid topical creams that contain antihistamines (diphenhydramine), anesthetics (benzocaine), and antibiotics (neomycin, polymycin). They generally can cause more harm than benefit. NJ’s daughter would not qualify for self-treatment because she is younger than 2 years, so she should be referred to a physician for evaluation. The Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care provides the following parameters for selftreatment in a case such as NJ and his daughter: “Exclusions for self-treatment include less than 2 years of age, dermatitis present >2 weeks, involvement of 20% of the body surface area, presence of numerous bullae, extreme itching, swelling of the body or extremities, swollen eyes or eyelids swollen shut, discomfort in genitalia from itching, signs of infection, failure to self manage after 7 days, low tolerance for pain, or impairment of daily activities.”1
Dr. Mansukhani is a clinical pharmacist in South Plainfield, New Jersey, and clinical assistant professor, Ernest Mario School of Pharmacy, Rutgers University. Dr. Bridgeman is an internal medicine clinical pharmacist in Trenton, New Jersey, and clinical assistant professor, Ernest Mario School of Pharmacy, Rutgers University.
1. Contact dermatitis. In: Krinsky DL, Berardi RR, Ferreri SP, et al, eds. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care. 17th ed. Washington, DC: American Pharmacists Association; 2011:650.