Diretrizes brasileiras sobre o monitoramento e tratamento da conjuntivite alérgica pediátrica

Ronconi, Cristiana Soares; Issaho, Dayane C.; Ejzenbaum, Fabio; Hopker, Luisa Moreira; Solé, Dirceu; Chong Neto, Herberto J.; Moreira, Ana Tereza R.; Tabuse, Marcia Keiko; Santos, Myrna S.; Rossetto, Julia Dutra

Cristiana Soares Ronconi

Ophthalmology and Visual Science Department, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

https://orcid.org/0000-0001-9923-7662

Dayane C. Issaho

Ophthalmology Department, Hospital de Olhos do Paraná, Curitiba, PR, Brazil.

Fabio Ejzenbaum

Ophthalmology Department, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.

https://orcid.org/0000-0002-8802-5610

Luisa Moreira Hopker

Ophthalmology Department, Hospital de Olhos do Paraná, Curitiba, PR, Brazil.

https://orcid.org/0000-0001-6875-9820

Dirceu Solé

Pediatrics Department, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

Herberto J. Chong Neto

Pediatrics Department, Universidade Federal do Paraná, Curitiba, PR, Brazil.

Ana Tereza R. Moreira

Department of Ophthalmology and Otorhinolaryngology, Universidade Federal do Paraná, Curitiba, PR, Brazil.

https://orcid.org/0000-0001-5105-0663

Marcia Keiko Tabuse

Ophthalmology and Visual Science Department, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

Myrna S. Santos

Ophthalmology and Visual Science Department, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

https://orcid.org/0000-0002-7733-694X

Julia Dutra Rossetto Corresponding author: Julia D. Rossetto. E-mail: julia_rossetto@hotmail.com

Ophthalmology and Visual Science Department, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

Pediatric Ophthalmology Department, Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.

https://orcid.org/0000-0001-9620-6609

Corresponding author: Julia D. Rossetto. E-mail: julia_rossetto@hotmail.com

Disclosure of potential conflicts of interest: None of the authors have any potential conflicts of interest to disclose.

Classification	Mechanism of action	Side effects	Topical ophthalmic agents generic name	Dosage
Artificial tears	Dilution and removal of antigens from the eye surface	Chronic use can lead to chemical conjunctivitis due to preservative exposure	Cellulose derivative	With preservatives: 1 drop up to 6 times daily Preservative free: unlimited use
Topical decongestants	Vasoconstriction via stimulation of alpha-adenoreceptors	Chemical conjunctivitis, follicular reaction, rebound hyperemia, pupillary dilation; contraindicated in patients with narrow-angle glaucoma	Emedastine, ephedrine, naphazoline, pheniramine	1 or 2 drops up to 4 times daily
Topical antihistamines	Relatively selective histamine receptor antagonist	Ocular burning, headache, bitter taste	Azelastine, levocabastine	1 or 2 drops up to 4 times daily
Mast cell stabilizers	Mast cell degranulation blockage, stabilizing the cell and preventing the release of histamine and related mediators	Ocular burning, stinging and itching sensations	Sodium chromoglycate, lodoxamide tromethamine, nedocromil	1 or 2 drops twice up to 4 times daily
Multiple-action agents	Selective H1-receptor antagonists and mast cell stabilizers	Itching, irritation, burning, stinging sensations, eye redness	Olopatadine, alcaftadine, ketotifen	1 drop once daily 1 drop up to 3 times daily
NSAIDs	Cyclooxygenase and prostaglandins blockage	Ocular burning, stinging, and itching sensations	Ketorolac tromethamine, diclofenac, nevanac	1 drop up to 6 times daily
Corticosteroids	Interfere with intracellular protein synthesis and cause blockage of phospholipase A2, the enzyme responsible for the formation of arachidonic acid	Intraocular pressure increase, cataracts	Loteprednol, prednisolone, fluormetolone, dexametasone	2/2 hs-4/4 hs for 3-4 weeks Taper when using for more than 7 days
Immunosuppressors	Anti-inflammatory/immunomodulatory activity by inhibiting the activation of NF-kB, a nuclear factor involved in regulation of immune and proinflammatory cytokine genes	Eye burning, headache, foreign body sensation, conjunctival hyperemia	Cyclosporin	1%-2%: 2-4 times daily 0.05%: 2-4 times daily
Immunosuppressors			Tacrolimus	Ointment 0.02%-0.03% Drops 0.03%-0.1% 2-4 times daily

Symptoms	Controlled (all criteria below)	Uncontrolled (at least 1 of the following)
Itchiness	No symptoms or symptoms	Any intensity if present >2 days/week
Tearing	No symptoms or symptoms	<2 days/week
Visual discomfort
Visual Analog Scale	<5	≥5
Hyperemia (Efron scale)	0-1	2-4

Classification	Mild	Intermittent moderate	Perennial moderate	Severe	Vision-threatening conditions
Nonpharmacologic measures	x	x	x	x	x
Artificial tears	x	x	x	x	x
Topical decongestants	x	x	x	x	x
NSAIDs	x
Selective H1-receptor antagonists and mast cell stabilizers	x	x	x	x	x
Mild corticosteroids		x	x
Cyclosporin			x
Corticosteroids		Only if corneal involvement	Only if corneal involvement	x	x
Tacrolimus				x	x
Supratarsal corticosteroids					x
Papillae excision					x
Ulcer debridement					x
Immunotherapy			x*	x*	x*
Monoclonal antibodies				x**	x**
Oral antihistamines/antileukotrienes		x	x	x	x
Nasal corticosteroids		x***	x***	x***	x***

[1] Corresponding author: Julia D. Rossetto. E-mail: julia_rossetto@hotmail.com

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Diretrizes brasileiras sobre o monitoramento e tratamento da conjuntivite alérgica pediátrica

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