Cromolyn/sodium cromoglycate/DSCG


Disodium cromoglycate or cromolyn, available since 1973 is an antiasthmatic/ antiallergic drug acting as a mast cell stabilizer.
 
Incidence
About 20 cases reported in the literature.
 
One death (bronchospasm).
 
Clinical manifestations
Anaphylactic shock: 3 cases published.
 
Bronchospasm: one death reported.
 
Rhinitis, conjunctivitis, urticaria.
 
Differentiate from dermatitis, myositis, gastroenteritis (2% of patients) and cough, dry mouth, pharyngeal irritation, mild transient bronchospasm (attributed to local irritant effects of the powder on hyperreactive airways).
 
Diagnostic methods
Cutaneous testing.
 
Skin prick-tests (10 mg/ ml): positive in a few patients.
 
Intradermal skin tests (10 mg/ ml): positive with syndromic reaction in one case.
 
Specific IgE (RAST) by spontaneous binding of DSCG to human serum albumin (one case).
 
Conjunctival challenge test (20 mg/ ml).
 
Bronchial challenge (20 mg/capsule).
 
Mechanisms
IgE-mediated hypersensitivity (positive skin tests, passive transfer, specific IgE).
 
DSCG is a weak hapten (only hydrogen bonds can be found between drug and host cells or tissue).
 
Management
Avoidance.
 
Allergic sensitization may disappear with the time.

References

  1. Ibanez M.D, Laso M.T, Martinez-San Irineo M, Alonso E, "Anaphylaxis to disodium cromoglycate (see comments)", Ann. Allergy. Asthma. Immunol., 1996; 77 (3): 185-6
  2. Shearer W.T, "Anaphylaxis to disodium cromoglycate (editorial)", Ann. Allergy. Asthma. Immunol., 1996; 77 (3): 165
  3. Mansfield L.E, "Disappearance of allergic reaction to cromolyn (cromoglycate) by avoidance and then reintroduction", J. Asthma., 1991; 28 (6): 447-50
  4. Wass U, Plaschke P, Bjorkander J, Belin L, "Assay of specific IgE antibodies to disodium cromoglycate in serum from a patient with an immediate hypersensitivity reaction", J. Allergy. Clin. Immunol, 1988; 81 (4): 750-7

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.