Post-Intravitreal injection pain reduction using topical NSAIDS: A comparative study.

PURPOSE: To compare the efficacy of two different topical non-steroidal anti-inflammatory drugs (NSAIDs) drops with versus without conservatives after intravitreal injections (IVIs). DESIGN: Prospective, randomized, placebo-controlled, single-blinded comparative study. PARTICIPANTS AND METHOD: A total of 308 eyes of 252 patients receiving an IVI of anti-vascular endothelial growth factor (anti-VEGF) were randomly assigned to receive either a single drop of nepafenac 0.1%, preservative-free diclofenac 0.1%, or artificial tears (control group) immediately after IVI. Primary outcome measure was pain scores immediately, six hours and twenty-four hours post- injection. RESULTS: 166 patients received one topical drop of NSAIDS, of which 90 in the diclofenac group and 76 in the nepafenac group. Additional 86 patients were included in the control group. Mean reported pain score was significantly lower at six hours after IVI in the preservative-free diclofenac group (17.1 ± 23.0) than in the nepafenac group (26.2 ± 31.9) and the control group (27.5 ± 29.2) (p = 0.03). At twenty-four hours post-injection there was no statistically significant difference between the groups. Patients reported less pain compared to previous IVIs and none referred to urgent health care, but these findings were not statistically significant. CONCLUSIONS: The use of topical preservative-free NSAIDs may be superior to preservative- containing NSAIDs in pain relief after IVIs and may be considered as part of the treatment protocol of this population.

Clinical history in suspected cases of immediate allergy to beta-lactam.

BACKGROUND: Mislabeling patients as allergic to beta lactams poses an increased risk of morbidity, healthcare costs, and even mortality. This study aimed to define the accuracy of medical history, taken by a specialist, in diagnosing immediate reaction to beta lactams. METHODS: All patients labeled as allergic to beta lactam were interviewed by a specialist in allergy and clinical immunology and defined as suspected of having a history of immediate or non-immediate reaction. When indicated, skin tests to major and minor determinants and oral graded challenge to the culprit drug were performed. RESULTS: A total of 909 patients were evaluated. A total of 798 (87.7%) were labeled as allergic to penicillin. In 108 (11.9%) cases, the allergist suspected an immediate reaction based on clinical history. Skin test or challenge proven diagnosis of IgE-mediated allergy to beta lactam were significantly more prevalent in the group with an allergist's suspicion of an immediate allergy (23.1% vs. 5%, p < 0.01). The sensitivity and negative predictive values of an anamnesis of immediate reaction were high (0.9 and 0.95, respectively), but the specificity and positive predictive value were low (0.37 and 0.23, respectively). CONCLUSION: Medical history taken by an allergist can exclude immediate hypersensitivity reaction, but it is not specific enough to confirm the diagnosis. Skin testing and graded challenge in suspected cases of immediate hypersensitivity reaction are indicated.