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Multiple action agents and the eye: do they really stabilize mast cells?

Lambiase, Alessandro; Micera, Alessandra; Bonini, Stefano

Current Opinion in Allergy and Clinical Immunology: October 2009 - Volume 9 - Issue 5 - p 454–465
doi: 10.1097/ACI.0b013e3283303ebb
Eye allergy: Edited by Leonard Bielory and Stefano Bonini
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Purpose of review Multiple action drugs, such as azelastine, epinastine, ketotifen and olopatadine, have recently been suggested to combine antihistaminic effect, mast cell stabilization and anti-inflammatory action. This pharmaceutical class is, therefore, rapidly becoming the first choice for prevention and treatment for allergic conjunctivitis.

Recent findings Increasing in-vitro studies have been performed to investigate the mast-cell-stabilizing effect of multiple action drugs. Most of the study results agree that these drugs are able to inhibit histamine and several neoformed mediators, including cytokines and arachidonic acid-derived products, from mast cells. However, the mechanisms of action have not yet fully been elucidated. Most of the results from clinical trials as well as the in-vivo experimental studies, including the conjunctival provocation model, support the evidence of a stabilizing effect of these drugs.

Summary Evidence of a different inhibitory effect of multiple action compounds on the pro-inflammatory mediators released from the mast cells suggests the possibility to target different phases of the allergic reaction, leading to a potential improvement in the management of allergic patients.

aCIR Laboratory of Ophthalmology, University Campus Bio-Medico, Italy

bIRCCS-G.B. Bietti Eye Foundation, Rome, Italy

Correspondence to Stefano Bonini, MD, Full Professor, Department of Ophthalmology, University Campus Bio-Medico, Via Alvaro del Portillo 21, Rome 00128, Italy Tel: +39 06225419185; fax: +39 0622541456; e-mail: s.bonini@unicampus.it

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