The effect of sodium cromoglycate on analgesic-induced asthmatic reactions

The onset of increased airways obstruction after analgesic ingestion by asthmatics with analgesic idiosyncrasy suggests an immediate type 1 allergic response. The effect of sodium cromoglycate (DSCG) on this response was assessed in nineteen patients with this syndrome. DSCG prevented asthmatic attacks in only three patients, all non-atopic, suggesting that analgesic idiosyncrasy is not an allergic disorder. The effectiveness of DSCG in preventing asthmatic attacks in some patients with analgesic idiosyncrasy would suggest that a trial of this preparation should be undertaken before commencing continuous corticosteroid therapy.     

Effect of disodium cromoglycate on asthmatic reactions to alcoholic beverages

Eleven asthmatic patients with a history of asthma with or without rhinitis following the ingestion of alcoholic drinks were challenged by oral ingestion of the suspected drink, and some with equivalent amounts of ethyl alcohol. Asthma was provoked in six cases, four having falls in the FEV₁ of more than 15%. Three of the latter studied in detail gave immediate asthmatic reactions to the alcoholic beverage, but not to the ethyl alcohol tested by oral ingestion, and in one case by administration through a naso-gastric tube. Pre-treatment by inhalation of disodium cromoglycate inhibited the asthmatic reactions to the alcoholic beverages.     

The effects of inhaled beclomethasone dipropionate (Becotide) and sodium cromoglycate on asthmatic reactions to provocation tests

A comparison was made between the effects of prior inhalation of sodium cromogly-cate or beclomethasone dipropionate on immediate, late and dual asthmatic reactions to provocation challenge tests with a range of allergens. Whereas sodium cromoglycate inhibited immediate and dual asthmatic reactions, beclomethasone dipropionate had no effect on immediate asthmatic reactions, but consistently inhibited late asthmatic reactions.     

The effect of frequent administration of sodium cromoglycate to asthmatic children who previously responded poorly

The effect of an increased frequency of administration of sodium cromoglycate (SCG) was studied in twenty-four asthmatic children who had previously responded poorly to 3–4 capsules per day. Six out of seven children who were assessed clinically alone improved when their dose was raised to 6 capsules daily. When a diary score and bronchodilator consumption were recorded, the more frequent administration of SCG gave significantly better results in eleven of seventeen children. However, only five of the twelve children given peak flow meters to use twice daily at home showed objective improvement. At the beginning of the trial four children were on systemic corticosteroid treatment and two of them were weaned off while on the raised dosage of SCG. The other two were not improved and were treated with a corticosteroid aerosol, beclomethasone diproprionate (Becotide), as were two other SCG failures. There was no clear correlation between the duration of protection given by SCG on exercise testing and the clinical response in this trial. The fact that only four out of twenty-four children who previously did not respond satisfactorily to SCG eventually needed corticosteroids, suggests that the increased frequency of administration may reduce the proportion of children failing to respond to SCG.     

Effect of sodium cromoglycate on histamine inhalation tests

Sixteen adult asthmatic subjects in a clinical steady state were included in the study. On day 1, after baseline assessment of spirometry (FEV1, FEV1/FVC, FEF25-75), they underwent three to four consecutive inhalation tests using twofold increasing doses of histamine to measure the provocative concentration causing a fall in FEV1 of 20% (PC20). Baseline FEV1 was back to +/- 5% of the initial assessment before each histamine inhalation test (HIT). On days 2, 3, and 4, after baseline spirometry which confirmed that FEV1 was within 10% of initial day 1 assessment, placebo-lactose (P) or 40 mg of sodium cromoglycate (SCG) were nebulized in a double-blind randomized 4.3.1. two-treatment crossover study design. Ten minutes later, spirometry was repeated and followed by an HIT. Baseline spirometry was not significantly different on each day or after P and SCG. There was no statistical difference between the geometric means of the three or four PC20's done on day 1, indicating that there is no tachyphylaxis induced by repeated HIT. There was no statistical difference between mean PC20 after P (0.52 +/- 3.3 (SD) mg/ml), after SCG (0.50 +/- 3.2), and of the three to four HIT done on day 1 (0.40 +/- 3.6). We conclude that in asthmatic subjects SCG has no acute bronchodilator effect and does not alter the response to inhaled histamine.     

Nedocromil sodium is more potent than sodium cromoglycate against AMP-induced bronchoconstriction in atopic asthmatic subjects

Nedocromil sodium is a new chemical entity which shows similar properties to sodium cromoglycate (SCG) and in addition exhibits a preferential activity in stabilizing mucosal mast cells. We have compared the effect of inhalation of nebulized placebo, SCG and nedocromil sodium on the bronchoconstrictor response to inhaled adenosine monophosphate (AMP) in eight atopic asthmatic subjects aged 25 yr (range 21-32 yr). The geometric mean provocation doses of AMP required to produce a 20% decrease in FEV1 (PD20FEV1) and a 40% decrease in Vmax30 (PD40 Vmax30) following placebo were 4.9 (0.3-14.2) and 1.8 (0.1-8.4) mumol respectively. Prior inhalation of both SCG and nedocromil sodium significantly inhibited the bronchoconstrictor response to AMP with PD20FEV1s of 36.6 (4.0-132.7) and 134 (12.4-560), and PD40 Vmax30 values of 20.5 (1.4-110) and 101.6 (5-560) mumol respectively (P less than 0.001). Nedocromil sodium was 3.9 (FEV1) and 8.0 (Vmax30) times more potent than SCG (P less than 0.001). In conclusion, both drugs inhibit the bronchoconstrictor response to inhaled AMP, and nedocromil is at least 4-8 times more potent than SCG.     

Bronchial hyperreactivity after treatment with sodium cromoglycate in atopic asthmatic patients not exposed to relevant allergens

The bronchial hyperreactivity, measured as the responsiveness to histamine, was studied in 14 atopic patients before, during, and after 4 wk of treatment with sodium cromoglycate (SCG) and placebo in a double-blind, randomized, crossover study. The patients were not exposed to relevant allergens during the study. The variations in provocation concentrations corresponding to 20% decrease in FEV1 (PC20) were small during both placebo and active drug treatment. After SCG treatment, PC20 increased (less responsiveness) in nine of the 14 patients, especially in those with low PC20 values. The difference between placebo and active drug treatment was not statistically significant. Although SCG has a mediator-inhibiting effect, this study gave no support for the assumption that inhibition of mediator release leads to a reduction of the bronchial hyperreactivity in atopic asthmatic subjects who are not exposed to relevant allergens.     

The effect of orally administered sodium cromoglycate on allergic reactions caused by food allergens

In five patients who exhibited allergic reactions, four with asthma and one with angioneurotic oedema, to orally administered soybean flour, the protective effect of orally administered sodium cromoglycate has been investigated. Protection from reactions in soybean provocation tests has been achieved with doses ranging from 400 mg to 600 mg given four times daily.     

A prospective study of respiratory infection in asthmatic patients treated with beclomethasone dipropionate and sodium cromoglycate

A prospective study of forty adult asthmatic patients attending two chest clinics in the City of Liverpool was undertaken. All patients had reversible airways obstruction and were under treatment with either beclomethasone dipropionate or sodium cromoglycate. Satisfactory symptomatic control was achieved in both groups of patients on a subjective basis, but there was a statistically significant (P <0.001) reduction in the number of admissions to hospital in the treatment year compared to the preceding 12 months in the beclomethasone aerosol group. No increased incidence of lower respiratory tract infections or non-specific sore throats was found in either group studied. No cases of clinical oral Candida infection occurred in the beclomethasone aerosol treated patients. It is concluded that beclomethasone dipropionate in aerosol form is not only a safe and effective method for symptomatic control of adult bronchial asthma but is also economically worthwhile as a means of reducing hospital admissions in this vulnerable group of patients.     

Morphological changes of basophils in immunological reactions—effect of sodium cromoglycate

The morphological changes in blood basophils, from patients with bronchial asthma, were studied in vitro during immunological reactions, with particular reference to interaction with anti-IgE. Anti-human IgE results in an absolute reduction in basophil numbers in buffy coat preparations as well as basophil cytoplasmic degranulation. An increase in the numbers of pear-shaped (A-form) basophils is also observed. Sodium cromoglycate impairs all these anti-IgE induced basophil changes, providing further insight into the mechanism of action of this compound in bronchial asthma.     

Comparative effects of inhaled salbutamol, sodium cromoglycate, and beclomethasone dipropionate on allergen-induced early asthmatic responses, late asthmatic responses, and increased bronchial responsiveness to histamine

Single-dose salbutamol (200 micrograms), beclomethasone dipropionate (200 micrograms), and sodium cromoglycate (SCG) (10 mg) administered by inhalation 10 minutes before allergen challenge were examined with regard to inhibition of allergen-induced early (EAR) and late (LAR) asthmatic responses and allergen-induced increase in bronchial responsiveness to inhaled histamine. Ten atopic subjects with asthma participated in a blinded, crossover, placebo-controlled trial. The EAR was inhibited by salbutamol and SCG but not by beclomethasone dipropionate or placebo (p less than 0.01). The LAR (p less than 0.01) and the allergen-induced increased bronchial responsiveness to histamine 7 hours (p less than 0.01) and 30 hours (p less than 0.05 and p less than 0.01 for various comparisons) were inhibited by SCG and beclomethasone diproprionate but not by salbutamol or placebo. The allergen-induced LAR and associated increased responsiveness are now believed to be more important clinically than the EAR. The clinical relevance of these results is to stress the importance of the prophylactic nonbronchodilator drugs (SCG and steroids) and the potential inadequacy of bronchodilators used alone in the treatment of both perennial and seasonal allergic asthma.     

Effect of nedocromil sodium on the late asthmatic reaction to bronchial antigen challenge

The effect of inhaled nedocromil sodium (4 mg by pressurized aerosol) on the dual asthmatic reaction to bronchial antigen challenge was studied in eight patients with asthma. The following prechallenge/postchallenge treatment combinations were administered: nedocromil sodium/placebo, nedocromil sodium/nedocromil sodium, placebo/nedocromil sodium, and placebo/placebo. Each patient received three treatment combinations assigned with a balanced incomplete block design. Nedocromil sodium administered before antigen challenge was significantly more effective than placebo in blocking both the early (p less than 0.001) and late (p less than 0.01) fall in FEV1. Postchallenge administration of nedocromil sodium tended to delay the onset of late asthmatic reaction but did not provide significant protection compared to placebo. These results demonstrated that nedocromil sodium prevents both phases of the dual asthmatic reaction to bronchial antigen provocation when it is inhaled before challenge. Further investigation is necessary to elicit a definite answer to whether nedocromil sodium administered after bronchial challenge has an effect on late asthmatic reaction.     

Dual asthmatic reactions to inhaled Dermatophagoides pteronyssinus: reproducibility and antagonism by cromolyn sodium

Twenty-four asthmatic patients sensitized to Dermatophagoides pteronyssinus were challenged with a standardized extract of this allergen. All the patients selected on the basis of skin tests and RAST, had an early asthmatic reaction (EAR). Seventeen of them also had a late asthmatic reaction (LAR). Eleven patients were rechallenged in order to study the reproducibility of both EAR and LAR. Six patients were also challenged after cromolyn sodium premedication Results show that (1) reproducibility of both EAR and LAR is satisfactory (coefficient of variation = 14%), (2) patients with reproducible EAR also have reproducible LAR, and (3) a single dose of cromolyn given before challenge can prevent EAR and markedly attenuate LAR.     

Prophylaxis of adverse reactions to foods. A double-blind study of oral sodium cromoglycate for the prophylaxis of adverse reactions to foods and additives

Twenty-four adult patients with adverse reactions to foods and food additives took part in a double-blind crossover study to compare the efficacy of oral sodium cromoglycate, 1600 mg daily, with placebo. Duration of treatment was eight weeks. There were statistically significant differences (p less than 0.01) in favor of active treatment as assessed by patients' diary card scores during the last week of treatment. Few side effects were observed. Oral sodium cromoglycate appears to be both effective and well tolerated in the treatment of food allergies, particularly when used in conjunction with a maintenance elimination diet.