Because anaphylactic reactions can also induce Takotsubo syndrome, we have proposed the measurement of anaphylactic inflammatory mediators such as histamine, tryptase, chymase, leukotrienes, thromboxane, and platelet-activating factors as well as the use of corticosteroids or
mast cell stabilizers for the prevention of this condition (59).
It is known that
mast cell stabilizers from synthesized compounds or natural products are commonly used clinically to prevent allergic reactions.
Other in vitro and in vivo studies using
mast cell stabilizers or mast cell-depleting agents have shown controversial results.
Multidrug therapy, such as H-1 and H-2 receptor antagonists,
mast cell stabilizers, and leukotriene receptor antagonists are used in varying combinations to achieve control.
The pharmacologic agents that are available as ophthalmic solutions, used in the treatment of allergic conjunctivitis belong to diverse classes: (1) Antihistamines - which block H1 receptors, e.g., levocabastine, azelastine, emedastine, bepotastine, and alcaftadine; (2)
Mast cell stabilizers - which increase the calcium influx to the mast cell and prevent changes in the membrane permeability resulting in the stability of membrane decreasing degranulation of mast cells, [6] e.g.
He was on regular H1 antagonist and
mast cell stabilizers was started with 300 mg omalizumab on monthly basis, Urticaria activity score started improving after second month.
Out of 100 patients 25 patients were treated with antihistamines and nasal decongestants, 25 patients treated with antihistamines, nasal decongestants and corticosteroid spray, 25 patients treated with antihistamines, nasal decongestants and
mast cell stabilizers and other 25 patients treated with specific immunotherapy and avoidance of specific allergen.
A / Topical antihistamines and topical
mast cell stabilizers appear to reduce conjunctival injection and itching effectively.
Interestingly, the main findings of the present study showed that hydroxytyrosol and oleuropein, at non-cytotoxic concentrations, inhibit [beta]-hexosaminidase release from peritoneal mast cells stimulated by different triggers, acting thus as
mast cell stabilizers. Other in vitro studies have shown that several dietary polyphenols inhibit the activation of mast cells (Middleton et al., 2000; Singh et al., 2011).
Combination
mast cell stabilizers and antihistamines are the most recently developed drugs available for topical ophthalmic treatment of allergic conjunctivitis.
The anti-inflammatory abilities of certain herbs can work on the same inflammation pathways as many of the currently recommended pharmaceutical treatment options for EoE, such as corticosteroids,
mast cell stabilizers and leukotriene inhibitors.
(32,34) Good eyelid margin hygiene should also reduce the recurrence of the condition, but recurrent and stubborn inflammatory episodes may also need topical corticosteroid treatment (eg, prednisolone 0.5% QDS for a few days) to generally quieten the eye, reduce lacrimation and photophobia as well as reduce further development of corneal infiltrates (27,30,35) As an inflammatory condition, some limbitis cases may respond to topical
mast cell stabilizers (eg, regular use of sodium cromoglicate over one month).