Contact Allergens in Prescription Topical Ophthalmic Medications. Issue 2 (March 2022)

• Record Type: Journal Article
• Authors: Shaver, Rob L.; Warshaw, Erin M.
• Is Part Of: Dermatitis. Volume 33:Issue 2(2022)
• Page Start: 135
• Page End: 143
• Publication Date: 2022-03
• Subjects: Skin -- Inflammation -- Periodicals; Skin -- Diseases -- Periodicals; Dermatology -- Periodicals; Dermatitis, Contact -- Periodicals; Dermatitis, Atopic -- Periodicals; Dermatitis, Occupational -- Periodicals; Drug Eruptions -- Periodicals; 616.51
• DOI: 10.1097/DER.0000000000000751
• Languages: English
• ISSNs: 1710-3568

Abstract

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.