It's that time again, folks.

Not just warmer weather, but allergy season! This could be the reason your dry eye disease (DED) patient who was stable a few months back is now presenting complaining of a flare up of DED symptoms. (See “Conjunctival Papillae Often Points to Allergy,” right.) Symptoms for both ocular allergies and DED overlap, and allergies can exacerbate DED, so it’s important to identify when this affects our patient. 

Ideally, knowing what these patients may be allergic to is the most direct way to help decrease exposure, subsequent allergic reaction, and employ the best treatment. The optometrist’s options for definitively determining one or more allergens are referral to an allergy specialist for allergy testing, or, depending on one’s state and scope of practice, in-office skin prick allergy testing. Optometrists have access to two FDA-approved in-office skin prick allergy-testing platforms. What’s more, recognizing the presence of allergy in a DED patient can guide appropriate treatment. 

In-office platforms
The FDA-approved in-office allergy testing platforms usable by eye care professionals are AllerFocus (Bruder Healthcare) and DoctoRx’s Allergy Formula Ocular Allergy Diagnostic System (OADS) (Bausch + Lomb). Both are administered via a plastic, skin-prick applicator and reimbursable by many medical insurance plans. These can benefit your patients, set your practice apart, and potentially boost additional income.

AllerFocus allergy testing tech-nology can reveal 78 common environmental allergens, such as grasses and animal dander, with one positive and negative control within 15 minutes. (See https://bruder.com/pro/allerfocus/.) 

DoctoRx’s Allergy Formula OADS can reveal 58 allergens specific to each region of the country, including eye-specific allergens, grasses, and dust mites, using one negative and positive control within 10 minutes to 15 minutes. (See https://www.bausch.com/products/diagnostics/)

Guiding appropriate treatment
In determining whether a DED patient also has environmental allergies, the OD can decide to adjust the course of action regarding treatment. An example: If a patient is allergic to dust mites, I may suggest they use a hypoallergenic pillow and mattress covers, wash their bed linens more often using high heat, and change their house filters more often. Education of the patient can be aided by utilizing the informational handouts regarding specific allergens provided by the testing platform manufacturers.

Don’t forget
Oral antihistamines have a drying effect, worsening DED, especially if they contain a decongestant. Therefore, ask your patient how often they are utilizing OTC antihistamines and what symptoms occur when not taken. For example, if they are taking a systemic medication but only have ocular allergy symptoms, then only an ocular antihistamine/mast cell stabilizer is needed. If they have systemic symptoms, discuss options: non-decongestant containing medications, taking only when needed vs. daily, or prescribing montelukast, which has less of a drying effect. 

Overcoming the overlap
With allergy season here, it’s essential to consider the intersection of allergies with DED. The overlap in symptoms and the potential exacerbation of DED by allergies and allergy medication underscore the importance of accurate diagnosis and personalized treatment. OM

Reference

1. Chigbu, D.I.; Karbach, N.J.; Abu, S.L.; Hehar, N.K. Cytokines in Allergic Conjunctivitis: Unraveling Their Pathophysiological Roles. Life (Basel). 2024 ;14(3):350. doi: 10.3390/life14030350. 

Cecelia Koetting, OD, FAAO is a clinical instructor at the University of Colorado School of Medicine. She is a fellow of the American Academy of Optometry, diplomate of the American Board of Optometry, an active American Optometric Association member, and she consults for multiple companies. Email her at Dr.CeceliaKoetting@gmail.com