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首页> 外文期刊>Allergy & clinical immunology international: official organ of the International Association of Allergology and Clinical Immunology >Update: Ocular Steroids in the Treatment of Allergic Conjunctivitis
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Update: Ocular Steroids in the Treatment of Allergic Conjunctivitis

机译：更新：激素治疗过敏性结膜炎

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摘要

Pharmacological treatment of allergic conjunctivitis consists of agents designed to block various pathways in the immunolglobulin E (IgE) mediated inflammatory cascade. Oral and topical antihistamines target histamine receptors, preventing histamine-mediated symptoms of allergic conjunctivitis, such as itching, watery eyes, and swelling. Antihistamines do not inhibit other inflammatory mediators and have a tendency to induce ocular drying, which limits their use. Although topical mast cell stabilizers block the release of histamine, prostaglandins, and leukotrienes by stabilizing mast cell membranes, they are more useful as prophylaxis because they have no effect on already synthesized inflammatory mediators. Topical multiple action agents with mast cell-stabilizing activity have more diverse inhibitory effects on the inflammatory cascade, and will inhibit preexisting inflammatory mediators and block synthesis of more inflammatory mediators. Due to their ability to block the generation of most inflammatory mediators through inhibition of mast cell phos-pholipase A2, topical corticosteroids represent the most effective treatment approach to persistent and chronic forms of allergic conjunctivitis. However, corticosteroids are less likely to be prescribed due to their increased risk of cataract formation and elevated intraocular pressure (IOP), and the restriction to short-term use. According to current treatment recommendations, allergic conjunctivitis is managed in a stepwise approach. Lubricants are initially recommended for disease prevention. In patients who do not respond, pharmacotherapy is prescribed in the following sequence until acceptable relief of symptoms is achieved: Topical antihistamines, alone or in combination with nonsteroidal antiinflammatory drugs; topical antihistamines combined with vasoconstrictors; and multiple action agents with a short course of corticosteroids.
机译：变应性结膜炎的药理学治疗由旨在阻止免疫球蛋白E（IgE）介导的炎症级联反应中各种途径的药物组成。口服和局部用抗组胺药靶向组胺受体，可防止组胺介导的过敏性结膜炎症状，例如瘙痒，水汪汪的眼睛和肿胀。抗组胺药不会抑制其他炎症介质，并具有诱发眼部干燥的趋势，这限制了它们的使用。尽管局部肥大细胞稳定剂通过稳定肥大细胞膜来阻止组胺，前列腺素和白三烯的释放，但它们作为预防剂更为有用，因为它们对已经合成的炎症介质没有影响。具有肥大细胞稳定活性的局部多种作用剂对炎症级联反应具有更多不同的抑制作用，并且将抑制先前存在的炎症介质并阻止更多炎症介质的合成。由于局部皮质类固醇具有通过抑制肥大细胞磷脂酶A2来阻止大多数炎症介质产生的能力，因此是持久和慢性形式的过敏性结膜炎的最有效治疗方法。然而，由于其增加白内障形成的风险和升高的眼内压（IOP），以及短期使用的限制，因此不太可能开具皮质类固醇的处方。根据目前的治疗建议，过敏性结膜炎可以逐步治疗。最初建议使用润滑剂预防疾病。在无反应的患者中，按以下顺序进行药物治疗，直至症状得到可接受的缓解：局部使用抗组胺药，单独使用或与非甾体抗炎药联合使用;局部用抗组胺药与血管收缩药合用;和多种作用剂以及短疗程的皮质类固醇激素。

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