Cromoglicate

Intravenous delivery to lungs of antiallergic compounds Sodium cromoglicate (Cromolyn sodium)... 

Rynacrom containing sodium cromoglicate is available as a nasal spray used in allergic rhinitis. 

In allergic rhinitis the first choice treatment is a non sedating antihistamine, per oral or nasal. Local treatment with sodium cromoglicate often works well, sometimes in combination with antihistamines. In severe nasal congestion a local steroid is usually needed to alleviate the symptoms. 

Causes are largely unclear complaints of food intolerances are often made, but clear evidence of specific and consistent adverse effects is hard to obtain (a distinction is drawn here from genuine dietary allergy which responds to avoidance of the offending item, for instance shellfish, and use of oral sodium cromoglicate). The basis of irritable bowel syndrome rests somewhere in the hinterland of perception of dysfunction, and otherwise normal but exaggerated physiological colonic responses. 

Bone mineral density was measured after 7.4 months in 49 asthmatic children, 38 of whom took inhaled beclomethasone, average daily dose 276 micrograms, and 11 sodium cromoglicate, average daily dose 30 mg (121). Children who had used beclomethasone had grown as much as those who used sodium cromoglicate. Trabecular and cortical bone mineral density in the proximal forearm and lumbar spine increased to the same extent in both groups. 

Antihistamines and intranasal corticosteroids are the first-line treatments for allergic rhinitis. Sodium cromoglicate, ipratropium bromide and decongestants, are alternative or add-on treatments. Drug treatment should be selected according to the severity, frequency and duration of symptoms ... 

Mild persistent or moderate-severe intermittent use an oral or intranasal antihistamine, or an intranasal corticosteroid (e.g. beclometasone or fluticasone). Intranasal decongestants and sodium cromoglicate are useful add-on drugs. 

Moderate-severe persistent intranasal corticosteroids are the drug of choice. Antihistamines, intranasal decongestants, and sodium cromoglicate are alternatives if steroids are contraindicated, or can be used as add-on drugs. Ipratropium bromide is useful for people with persistent watery effusion. 

Topical mast cell stabilisers are best used for prophylaxis of allergic eye symptoms. Sodium cromoglicate is effective in most people. Lodoxamide and nedocromil are more expensive, but may be worth trying in people with inadequate response to sodium cromoglicate. Mr JA cannot use eye drops because he wears contact lenses therefore nasal corticosteroids are recommended. 

Q15 Comment on the suitability of the following agents for Chandra at this time (i) pure O2, (ii) a muscarinic agonist drug, (iii) cromoglicate and (iv) low-dose aspirin. 

Treatment of allergic rhinitis includes antihistamines, Hi receptor antagonists, such as axelastine, and corticosteroids, such as beclometasone or budesonide. However, cromoglicate is the first choice for children. 

There is some evidence that children under five years of age obtain benefit from use of nedocromil sodium or sodium cromoglicate. These agents are used only in prophylaxis cromoglicate is not a bronchodilator and cannot be used to treat acute episodes of asthma. Its action is not well understood but the prophylactic effect appears to be partly due to stabilization of mast cells, which reduces release of histamine and other mediators so that hyperactive bronchial muscle is less responsive to environmental triggers. 

Children may benefit from asthma prophylaxis using sodium cromoglicate or nedocromil sodium. 

Sodium cromoglicate is used for prophylaxis in asthma when there appears to be an allergic basis to the condition. Although its mechanism of action is not well understood, it appears to reduce the release of inflammatory agents from mast cells and so is useful in asthma prophylaxis, particularly in children. It is unlikely to be of value in COPD. 

As a powder, e.g. sodium cromoglicate. Particle size and air flow velocity are important. Most particles above 5 micrometres in diameter impact in the upper respiratory areas particles of about 2 micrometres reach the terminal bronchioles a large proportion of particles less than micrometer will be exhaled. Air flow velocity diminishes considerably as the bronchi progressively divide, promoting drug deposition peripherally. 

By preventing the release of histamine from storage cells glucocorticoids and sodium cromoglicate can suppress IgE-induced release from mast cells. Pj-agonists have a similar effect. 

Some patients develop wheeze that regularly follows within a few minutes of exercise. A similar response occurs following the inhalation of cold air since the common mechanism appears to be airway drying. Inhalation of a p -adrenoceptor agonist, sodium cromoglicate (see below) or one of the newer leukotriene receptor antagonists (see below) prior to either challenge prevents broncho-constriction. 

Cromoglicate was introduced in 1968 as the culmination of work carried out by the asthmatic research director of the company (REC Altounyan) on himself. We can admire Dr Altounyan without recommending this as the best way of screening new chemical entities. 

Since it does not antagonise the broncho-constrictor effect of the mediators after they have been released, cromoglicate is not effective at terminating an existing attack, i.e. it prevents broncho-constriction rather than induces bronchodilation. Special formulations are used for allergic rhinitis and allergic conjunctivitis. 

Sodium cromoglicate is effective in extrinsic (allergic) asthma including asthma in children, and in exercise-induced asthma but its use has declined since the efficacy and safety of low dose inhaled corticosteroid have become apparent. 

Nedocromil sodium (Tilade) is structurally unrelated to cromoglicate but has a similar profile of actions and can be used by metered aerosol in place of cromoglicate. 

Anti-inflammatory agents can commence either with sodium cromoglicate or low-dose inhaled gluco-... 

Most antiasthma treatment is therefore aimed either at reducing release of inflammatory cytokines (glucocorticoids and sodium cromoglicate) or at direct bronchodilatation by stimulation of the bronchial [)j-adrenoceptors. 

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