((A-262)) (A-262) A Case of Periocular/Palpebral Allergic Reaction due to Bepotastine Besilate Ophthalmic solution

Background: The topical Ophthalmic eye solution Bepotastine Besilate (1.5%w/v) is a second-generation H1-antihistamine used to treat allergic conjunctivitis. It works by blocking eosinophil migration towards the inflamed region and stabilizing the mast cell. Initially, the oral dosage form of bepotastine was used to treat Allergic Rhinitis and urticaria but later topical formulation got approved for ophthalmic treatment for allergic conjunctivitis in 2009 by the USFDA. In our case, we are reporting an allergic reaction caused by the topical antihistamine solution Bepotastine Besilate which was prescribed for allergic conjunctivitis.

Objectives: This case report aims to describe the adverse drug reaction of Periocular/Palpebral Allergic Reaction due to Bepotastine Besilate Ophthalmic solution.

Methods: An elderly Male Patient of 61 yrs age came to Ophthalmology OPD with the chief complaint of swelling around the periorbital area along with itching and excoriation of the skin, conjunctival congestion along with mucoid discharge for the past 1 day. He is a known case of allergic conjunctivitis and has been on and off treatment for the same for the last 3 months.Upon examination the patient is suspected to have allergic reaction due to drug and is immediately asked to stop the medication

Results: In the follow-up after four days, the patient’s Itching, swelling, and redness surrounding the eye disappeared and photophobia was reduced. The causality assessment was carried out using the WHO-UMC Causality method and Naranjo causality assessment. Both evaluations showed probable cause for the adverse reaction. The Hartwigs Severity Assessment scale assessed the severity demonstrating moderate severity from the obtained data.

Conclusions: Although Bepolastin Besilate is prescribed as an anti-allergic medication, in our case, it acts as a causative factor for ocular allergy. Such cases are rarely seen in the ophthalmology OPD. Early recognition of such adverse reactions to the medication and management by withholding the drug and giving symptomatic treatment can stop further ADR