This article was originally published in a sponsored newsletter.

Recently, I became acutely reminded of the importance of consistency in my prescribing and conversations with patients. A patient came in to see me for her annual comprehensive eye health evaluation. She doesn’t wear contact lenses or glasses, and she is good about maintaining her eye health, both in her daily life and coming into the office for annual check-ups. When she arrived at the office this time, we did our normal pre-evaluation testing and history. I greeted her as I always do: “Mrs. A, thank you so much for coming in today! It is great to see you. Tell me how you are doing and what your goals are for today.”

What she said made me wish I had been more proactive with her in the past. She told me she had been taking cetirizine for the last four years for allergies. She said she has had allergies off and on and thought it would be better to stay on this OTC medication long-term to prevent sinus infections (I’m not sure who told her this, but it’s an essential piece of her history). She went on to report that, although she had been under the care of an ENT a couple of years ago, she decided to forgo all allergy testing and maintain symptom relief with what seemed like a simple routine. Eight months before this visit, she decided to stop taking this OTC medication and see whether she still needed it. A week later, she began experiencing the onset of intense itching and a rash all over her body that was so severe it kept her up at night. As she sat in the chair talking to me, she struggled to keep from scratching and said the situation had become so bad that she was miserable most of the day and night. Her eyes were involved as well. She had returned to the care of an ENT to try to mitigate the symptoms, but they had not been able to resolve the issue for her.

This condition is undeniably something that we should be aware of and be able to speak about with patients, but upon researching the available literature, I found only one retrospective study from 2019.1 From what we know so far, it is most common in patients who have been on cetirizine for a long period of time and is more common in females.

Looking back at what I might have done for this patient, I could have:

1. Investigated more complete details about her timeline of medication use, OTC and otherwise.
2. Prescribed ocular hygiene as a preventive measure to help her avoid the need for oral medications.
3. Utilized non-oral OTC treatments, such as anti-allergy lid wipes, to alleviate symptoms of ocular allergies.
4. Educated her about the risks and benefits that OTC oral allergy medications have on ocular health.

It is easy to become complacent and it can be a challenge to elicit a good history. However, when a patient like this is in my chair suffering as much as she is, I am reminded of why I love what I do and what a difference we can make when we stay vigilant. This may be a rare adverse event and I may never see another case of it, but, as they say, it isn’t rare when it’s in your chair. What a reminder to thoroughly educate every patient and prescribe what is best for them in every encounter we have.

Reference(s):

1. Chung AH, Grenade LL, Harinstein LM. Pruritus after discontinuation of cetirizine. Ther Adv Drug Saf. 2019 Jul;10:10:2042098619859996. doi:10.1177/2042098619859996

APRIL JASPER, OD, FAAO graduated from Nova Southeastern University College of Optometry with highest honors in 1995. She is the owner of Advanced Eyecare Specialists in West Palm Beach, FL. Dr. Jasper completed her residency in primary care, ocular disease and contact lenses in Boston, MA where she also held a position as adjunct professor at NEWENCO. Dr. Jasper has served her patients and colleagues as president of the Florida Optometric Association 2016 to 2017. She continues to share her knowledge and expertise around the world authoring numerous publications, lecturing and as chief editor of Optometric Management magazine.