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Dermatitis : contact, atopic, occupational, drug
2022 Mar-Apr 01;33 (2): 135-143.

Contact Allergens in Prescription Topical Ophthalmic Medications.

Rob L Shaver, Erin M Warshaw
Author Information
PMID: 34115664 DOI: 10.1097/DER.0000000000000751

Abstract

BACKGROUND/OBJECTIVE: Both active and inactive ingredients in topical ophthalmic agents may cause allergic contact dermatitis. Here, we examined ingredients in prescription topical ophthalmic medications available in the United States.
METHODS: A comprehensive list of topical ophthalmic medications was generated using AccessPharmacy. Categories included antiglaucoma, antibiotic, antibiotic/corticosteroid, corticosteroid, antiviral, antifungal, mydriatic, and miotic agents. For each formulation, ingredients were investigated using the National Institutes of Health US National Library of Medicine database and/or manufacturer websites. Counts and proportions were calculated for inactive ingredients, including those in the American Contact Dermatitis Society (ACDS) Core 90 Allergen Series.
RESULTS: Two hundred sixty-four unique prescription ophthalmic medications met the inclusion criteria. The most common ACDS Core 90 allergen/cross-reactor inactive ingredient was benzalkonium chloride (68.1%, 180/264), followed by sorbates (11.7%, 31/264), parabens (6.8%, 18/264), sodium metabisulfite (3.8%, 10/264), propylene glycol (3.0%, 8/264), and lanolin (3.0%, 8/264). Approximately 21% (20.8%, 55/264) of products had no ACDS Core 90 allergens/cross-reactor inactive ingredients. The most common ACDS Core 90 allergen/cross-reactor active ingredients were aminoglycoside antibiotics, bacitracin/polymyxin B, and corticosteroids. Important non-ACDS Core 90 allergens included inactive ingredients, such as EDTA 28.0% and thimerosal 2.7%, as well as active ingredients, especially β-blockers.
CONCLUSIONS: Benzalkonium chloride, sodium metabisulfite, propylene glycol, and lanolin were common inactive ingredient allergens. Most ophthalmic categories had low allergen formulations available for patients with contact allergy.

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MeSH Term

Allergens
Dermatitis, Allergic Contact
Drug Hypersensitivity
Humans
Lanolin
Ophthalmology
Patch Tests
Prescriptions
Propylene Glycol
Sulfites
United States

Chemicals

Allergens
Sulfites
sodium metabisulfite
Propylene Glycol
Lanolin
Journal Article
Article has an altmetric score of 2

Word Cloud

Created with Highcharts 10.0.0ingredientsinactiveophthalmicCore90ACDSactivetopicalmedicationscommon8%30%agentscontactprescriptionavailableusingincludedNationalContactallergen/cross-reactoringredientchloride7%sodiummetabisulfitepropyleneglycol8/264lanolinallergensBACKGROUND/OBJECTIVE:maycauseallergicdermatitisexaminedUnitedStatesMETHODS:comprehensivelistgeneratedAccessPharmacyCategoriesantiglaucomaantibioticantibiotic/corticosteroidcorticosteroidantiviralantifungalmydriaticmioticformulationinvestigatedInstitutesHealthUSLibraryMedicinedatabaseand/ormanufacturerwebsitesCountsproportionscalculatedincludingAmericanDermatitisSocietyAllergenSeriesRESULTS:Twohundredsixty-fouruniquemetinclusioncriteriabenzalkonium681%180/264followedsorbates1131/264parabens618/26410/264Approximately21%2055/264productsallergens/cross-reactoraminoglycosideantibioticsbacitracin/polymyxinBcorticosteroidsImportantnon-ACDSEDTA28thimerosal2wellespeciallyβ-blockersCONCLUSIONS:BenzalkoniumcategorieslowallergenformulationspatientsallergyAllergensPrescriptionTopicalOphthalmicMedications

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