Drugs

, Volume 31, Issue 2, pp 131–148 | Cite as

Ocular Sodium Cromoglycate

An Overview of its Therapeutic Efficacy in Allergic Eye Disease
  • Eugene M. Sorkin
  • Alan Ward
Drug Evaluation

Summary

Synopsis

Sodium cromoglycate stabilises mast cell membranes and prevents the release of histamine and other biochemical mediators. When topically applied to the eye before allergen exposure, ocular sodium cromoglycate1 prevents many of the signs and symptoms associated with type I allergic reactions (which includes hayfever, acute allergic and chronic allergic conjunctivitis, and vernal keratoconjunctivitis) and giant papillary conjunctivitis.

Although difficulties exist in evaluating clinical trials in allergic eye disease, both open and controlled studies have shown ocular sodium cromoglycate to be very effective in relieving the subjective symptoms and clinical signs of the above ocular disorders. In addition, ocular sodium cromoglycate may decrease the need for supplementary oral antihistamines and, more importantly, the need for ocular corticosteroids, thus decreasing the incidence of steroid-induced ocular side effects. However, in severe cases and in instances of acute exacerbation of symptoms, the combined ocular application of sodium cromoglycate and corticosteroids may be very effective.

No systemic or severe adverse reactions have been attributed to ocular sodium cromoglycate, which is not surprising since systemic drug absorption from the eye is minimal. However, transient local stinging and burning have been reported.

Thus, although further studies in giant papillary conjunctivitis and comparative studies with corticosteroids in allergic conjunctivitis and vernal keratoconjunctivitis are needed to more clearly define the extent of benefits that may be obtained from ocular sodium cromoglycate, it is clear that the safety and efficacy of the drug in type I allergic eye diseases is such that it should be considered as a first-line agent when drug therapy of these disorders is indicated.

Pharmacodynamic Properties

Since the conjunctiva of the eye contains numerous inflammatory cells responsible for antigen elimination, phagocytosis and immunological memory of the individual, it is susceptible to a number of different types of allergic eye disease. The pharmacological effects of sodium cromoglycate have been ascribed to stabilisation of the mast cell membrane, which prevents the release of histamine and other biochemical mediators after the antigen (or offending allergen) has reacted with antibody at the cell surface. However, once these mediators have been released and symptoms have occurred, sodium cromoglycate is not effective except to prevent a reaction to the next exposure. Sodium cromoglycate has no direct vasoconstrictor, bronchodilator, antihistamine or anti-inflammatory activity.

Pharmacokinetic Studies

Sodium cromoglycate is effective only by topical administration due to its lipid insolubility. Only very low concentrations of sodium cromoglycate are systemically absorbed after ocular administration to man (about 0.03%) or rabbits (up to 0.02%). Sodium cromoglycate has been found to be detectable in aqueous humour of the rabbit eye for up to at least 7. hours but less than 24 hours after topical application. Systemically absorbed drug is excreted unchanged in the bile and urine.

Therapeutic Trials

Of the 4 major types of allergic eye conditions, ocular sodium cromoglycate is effective primarily on those of the IgE-mediated type I (atopic allergy or immediate hypersensitivity reaction) variety. These type I reactions include hay fever conjunctivitis and acute allergic conjunctivitis, which are caused by pollen and non-pollen allergens, respectively. Other type I reactions include chronic allergic conjunctivitis, which is used to describe the perennial form of allergic conjunctivitis, and vernal keratoconjunctivitis (potentially the most severe of the type I reactions). However, giant papillary conjunctivitis, which may be seen in users of contact lenses or associated with other foreign bodies, is unlikely to be mediated directly by IgE although ocular sodium cromoglycate has proven useful.

There are many difficulties in evaluating clinical trials of agents used to treat allergic eye diseases. Trials should be placebo-controlled and performed during the pollen season and be of ‘within-patient’ design. Since ocular sodium cromoglycate is essentially prophylactic, treatment should also ideally be initiated before any allergic symptoms have appeared. Importantly, since there has been no proven simple and reliable objective method of measuring the severity of symptoms of allergic eye diseases, reliance has been placed on patient subjective assessments of changes in the severity of their symptoms, using patient diary cards.

Open studies in allergic conjunctivitis have suggested ocular sodium cromoglycate 2 and 4% solutions are very effective in relieving the ocular signs and symptoms of hay fever conjunctivitis and acute allergic conjunctivitis within 7 days of the initiation of treatment 4 times daily. Moderate-to-excellent control of symptoms after 4 weeks of treatment have been judged to be achieved in as many as 96 and 92% of cases, according to patients and investigators, respectively.

The majority of controlled studies of ocular sodium cromoglycate 2 or 4% drops or ointment formulation in allergic eye diseases have been undertaken in patients with hay fever conjunctivitis. Ocular sodium cromoglycate provides significantly greater subjective symptom relief than placebo and patients have preferred the active drug over placebo in most cases. Ocular sodium cromoglycate also significantly decreases objective signs and the need for supplementary oral antihistamines. Ocular sodium cromoglycate 4% may be more effective than the 2% drops in controlling eye symptoms. The exact nature of the relationship, if any, between serum IgE concentrations and clinical effectiveness of ocular sodium cromoglycate has yet to be established.

The few studies comparing ocular sodium cromoglycate and ophthalmic corticosteroids in the treatment of hay fever conjunctivitis have shown that both drugs are effective in relieving symptoms, although steroids provide greater symptomatic relief, with no difference between the drugs with regard to patient preference. However, further studies involving larger numbers of patients are needed before definitive comparable efficacies can be established, although ocular sodium cromoglycate presents the patient with less risks of side effects with long term use than do ophthalmic corticosteroids.

In a small number of controlled trials in patients with chronic allergic conjunctivitis, ocular sodium cromoglycate has been shown to be significantly more effective than placebo and equivalent to dexamethasone 0.1% ophthalmic solutions. Again, however, more comparative studies of ocular sodium cromoglycate and corticosteroids are needed. Less satisfactory results have been seen in open trials of patients with chronic allergic conjunctivitis owing to the variable chronicity and severity of this disease entity; in these studies, ocular sodium cromoglycate should be given for longer periods (10 to 14 days) before evaluating therapy.

Ocular sodium cromoglycate 2 or 4% has been very effective in alleviating the subjective symptoms and objective signs of vernal keratoconjunctivitis. Open studies have shown that the drug may be effective as monotherapy in many cases. However, in patients with severe clinical symptoms the addition of corticosteroids, vasoconstrictors, antibiotics or mucolytics may be required. Ocular sodium cromoglycate is also significantly more effective than placebo in decreasing the many signs and symptoms of vernal keratoconjunctivitis.

There has been no correlation between the response to ocular sodium cromoglycate drops and serum IgE concentrations in patients with vernal keratoconjunctivitis. Ocular sodium cromoglycate 2% produces effects comparable to those produced by dexamethasone 0.1% ophthalmic solution, and decreases the need for corticosteroids in patients already receiving steroids. It may therefore reduce the incidence of steroid-associated side effects, including cataracts, infections and glaucoma. Ocular sodium cromoglycate and ocular corticosteroids may be used together with good effect in patients with either severe disease or acute symptom exacerbations.

In giant papillary conjunctivitis, ocular sodium cromoglycate 2 and 4% drops have produced symptom improvement reported within 2 to 30 days. However, further clinical studies involving larger numbers of patients are required to fully assess the effects of ocular sodium cromoglycate in this condition.

Side Effects

While no systemic or severe adverse reactions have been attributed to ocular sodium cromoglycate even after as long as 8 months of therapy, transient local stinging and burning have been reported in 13 to 77% of patients receiving the drug. However, these effects regress during continued treatment and may vary greatly according both to the individual and to the disease state. Stinging has been attributed to a preservative, 2-phenyl ethyl alcohol, used in some of the commercial formulations of ocularsodium cromoglycate, and there are indications that the omission of this preservative not only reduces the incidence of this side effect but also increases the efficacy of the drug by avoiding dilution with tears.

Dosage and Administration

Ocular sodium cromoglycate 2 and 4% drops should be given as 1 to 2 drops in each eye 4 to 6 times daily; the 4% sterile ophthalmic ointment should be applied to the lower eyelid 2 to 3 times daily, taking care to avoid direct contact between the eye and the tube nozzle. Ocular sodium cromoglycate should be stored in a cool place, protected from sunlight and discarded 4 weeks after the container has been opened.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Allansmith MR, Korb DR, Greiner JV, Henriquez AS, Simon MA, et al. Giant papillary conjunctivitis in contact lens wearers. American Journal of Ophthalmology 83: 697–708, 1977PubMedGoogle Scholar
  2. Altounyan REC. Inhibition of experimental asthma by a new compound — disodium cromoglycate (Intal). Acta Allergologica 22: 487–491, 1967Google Scholar
  3. Altounyan REC. Changes in histamine and atropine responsiveness as a guide to diagnosis and evaluation of therapy of obstructive airways disease. In Pepys J & Frankland AW (Eds) Disodium cromoglycate in allergic airways disease, pp. 47–53, Butterworths, London, 1970Google Scholar
  4. Altounyan REC. Review of the clinical activity and modes of action of sodium cromoglycate. In Pepys J & Edwards AM (Eds) The mast cell — its role in health and disease, pp. 199–216, Pitman Medical, London, 1979Google Scholar
  5. Andersson P, Berstrand H. Antigen-induced bronchial anaphylaxis in actively sensitized guinea pigs: effect of long-term treatment with sodium cromoglycate and aminophylline. British Journal of Pharmacology 74: 601–609, 1981PubMedCrossRefGoogle Scholar
  6. Ashton MJ, Clark B, Jones KM, Moss GF, Neale MG, et al. The absorption, metabolism and excretion of disodium cromoglycate in 9 animal species. Toxicology and Applied Pharmacology 26: 319–328, 1973PubMedCrossRefGoogle Scholar
  7. Baryishak YR, Zavaro A, Monselise M, Samra Z, Sompolinsky D. Vernal keratoconjunctivitis in an Israeli group of patients and its treatment with sodium cromoglycate. British Journal of Ophthalmology 66: 118–122, 1982PubMedCrossRefGoogle Scholar
  8. Bec P, Berard P, Bonnet M, Cazillas JM, Chagnon A, et al. Cromoglycate de sodium en collyre dans les conjonctivites allergiques. Etude contrôlée multicentrique à double insu. Revue de la littérature. Journal Français d’Ophthalmologie 5: 727–732, 1982Google Scholar
  9. Bedford GJB. Allergic eye conditions. Update 25: 1797–1803, 1982Google Scholar
  10. Berman BA. Cromolyn: past, present and future. Pediatric Clinics of North America 30: 915–930, 1983PubMedGoogle Scholar
  11. Bernstein IL, Johnson CL, Tse CST. Therapy with cromolyn sodium. Annals of Internal Medicine 89: 228–233, 1978PubMedGoogle Scholar
  12. Blamoutier J. Opticron et conjonctivites allergiques. Étude comparative Opticron et collyre corticoîde. Gazette Médicale de France 87: 2041–2045, 1980Google Scholar
  13. Brogden RN, Speight TM, Avery GS. Sodium cromoglycate (cromolyn sodium): a review of its mode of action, pharmacology, therapeutic efficacy and use. Drugs 7: 164–282, 1974PubMedCrossRefGoogle Scholar
  14. Buckley RJ. Long-term experience with sodium cromoglycate in the management of vernal keratoconjunctivitis. In Pepys J & Edwards AM (Eds) The mast cell: its role in health and disease, pp. 518–523, Pitman Medical, London, 1979Google Scholar
  15. Chin GN. Treatment of vernal keratoconjunctivitis with topical cromolyn sodium. Journal of Pediatric Ophthalmology and Strabismus 15: 326–329, 1978Google Scholar
  16. Collum LMT, Cassidy HP, Benedict-Smith A. Disodium cromoglycate in vernal and allergic kerato-conjunctivitis. Irish Medical Journal 74: 14–18, 1981aPubMedGoogle Scholar
  17. Collum LMT, Logan P, Read BH. Disodium cromoglycate in vernal kerato conjunctivitis. In Molina C (Ed) Proceedings of the Annual Meeting of the European Academy of Allergology and Clinical Immunology, Vol. 2, pp. 748–755, Cleremont-Ferrand, 1981bGoogle Scholar
  18. Cox JSG. Disodium cromoglycate, FPL670 (Intal). A specific inhibitor of reaginic antibody/antigen mechanisms. Nature 216: 1328–1329, 1967PubMedCrossRefGoogle Scholar
  19. Dahan E, Appel R. Vernal keratoconjunctivitis in the black child and its response to therapy. British Journal of Ophthalmology 67: 688–692, 1983PubMedCrossRefGoogle Scholar
  20. Dawson JP. Comparative trial of 2% sodium cromoglycate unit-dose eye drops in seasonal allergic conjunctivitis. In Pepys J & Edwards AM (Eds) The mast cell: its role in health and disease, pp. 506–511, Pitman Medical, London, 1979Google Scholar
  21. Donshik PC, Ballow M, Luistro A, Samartino L. Treatment of contact lens-induced giant papillary conjunctivitis. Contact Lens Association of Ophthalmologists Journal 10: 346–350, 1984Google Scholar
  22. D’Souza MF, Emanuel MB, Gregg J, Charlton J, Goldschmidt J. A method of evaluating therapy for hay fever. A comparison of four treatments. Clinical Allergy 13: 329–335, 1983PubMedCrossRefGoogle Scholar
  23. Easty D, Rice NSC, Jones BR. Disodium cromoglycate (Intal) in the treatment of vernal kerato-conjunctivitis. Transactions of the Ophthalmological Societies of the United Kingdom 91: 491–499, 1971PubMedGoogle Scholar
  24. Easty DL. Sodium cromoglycate eye drops in allergic conjunctivitis. Acta Allergologica (Suppl. 13): 62–67, 1977Google Scholar
  25. El Hennawi M. Clinical trial with 2% sodium cromoglycate (Opticrom) in vernal keratoconjunctivitis. British Journal of Ophthalmology 64: 483–486, 1980PubMedCrossRefGoogle Scholar
  26. El Hennawi M. A comparison between 2% and 4% sodium cromoglycate eye drops in the treatment of vernal keratoconjunctivitis. Current Eye Research 2: 765–768, 1983CrossRefGoogle Scholar
  27. Foglé-Hansson M, Rundcrantz H. DSCG eye drops in allergic rhino-conjunctivitis. Acta Oto-Laryngologica (Suppl. 360): 33–34, 1979Google Scholar
  28. Foreman JC, Mongar JL, Gomperts BD, Garland LG. A possible role for cyclic AMP in the regulation of histamine secretion and the action of cromoglycate. Biochemical Pharmacology 24: 538–540, 1975PubMedCrossRefGoogle Scholar
  29. Foster CS, Duncan J. Randomized clinical trial of topically administered cromolyn sodium for vernal keratoconjunctivitis. American Journal of Ophthalmology 90: 175–181, 1980PubMedGoogle Scholar
  30. Frankland AW, Walker SR. A clinical comparison of topical clobetasone butyrate and sodium cromoglycate in allergic conjunctivitis. Clinical Allergy 11: 473–478, 1981PubMedCrossRefGoogle Scholar
  31. Friday GA, Biglan AW, Hiles DA, Murphey SM, Miller DL, et al. Treatment of ragweed allergic conjunctivitis with cromolyn sodium 4% ophthalmic solution. American Journal of ophthalmology 95: 169–174, 1983PubMedCrossRefGoogle Scholar
  32. Friedlander MH. The ocular immune response. In Friedlander MH (Ed.) Allergy and immunology of the eye, p. 55, Harper & Row, New York, 1979Google Scholar
  33. Greaves MW. The effect of disodium cromoglycate and other inhibitors on in vitro anaphylactic histamine release from guinea pig basophil leucocytes. International Archives of Allergy and Applied Immunology 36: 497–500, 1969PubMedCrossRefGoogle Scholar
  34. Greenbaum J, Cockroft D, Hargreave FE, Dolovich J. Sodium cromoglycate in ragweed-allergic conjunctivitis. Journal of Allergy and Clinical Immunology 59: 437–439, 1977PubMedCrossRefGoogle Scholar
  35. Hechanova Jr MG. A double-blind study comparing sodium cromoglycate eye ointment with placebo in the treatment of chronic allergic conjunctivitis. Clinical Trials Journal 21: 59–66, 1984Google Scholar
  36. Hyvärinen L. Sodium cromoglycate in management of vernal and chronic allergic conjunctivitis. International Ophthalmology 1: 129–133, 1979PubMedCrossRefGoogle Scholar
  37. Inerfield CG. A comparison between two formulations of ‘Opticrom’ eye drops in the treatment of hayfever conjunctivitis. Paper presented at the European Academy of Allergology and Clinical Immunology, Annual Meeting, Portugal, 1982Google Scholar
  38. Inerfield CG, Million R, Singh HS. Cromoglycate eye drops in hay-fever conjunctivitis. A new formulation appears to reduce stinging. Practitioner 228: 543–544, 1984Google Scholar
  39. Kazdan JJ, Crawford JS, Langer H, MacDonald AL. Sodium cromoglycate (Intal) in the treatment of vernal keratoconjunctivitis and allergic conjunctivitis. Canadian Journal of Ophthalmology 11: 300–303, 1976PubMedGoogle Scholar
  40. König P. A review of cromolyn. In Berman BA & MacDonnell KF (Eds) Differential diagnosis and treatment of pediatric allergy, pp. 251–258, Little-Brown, Boston, 1981Google Scholar
  41. Laibson PR. Evaluation of cromolyn sodium in the treatment of vernal conjunctivitis. Journal of the American Academy of Ophthalmology 89: 125, 1982Google Scholar
  42. Lass JH, Foster CS. A double masked randomized study of topical cromolyn vs placebo in vernal keratoconjunctivitis (abstract). Investigative Ophthalmology and Visual Science 20(Suppl. 3): 86, 1981Google Scholar
  43. Lavin N, Rachelefsky MD, Kaplan SA. An action of disodium cromoglycate: inhibition of cyclic 3′, 5′-AMP phosphodiesterase. Journal of Allergy and Clinical Immunology 57: 80–88, 1976PubMedCrossRefGoogle Scholar
  44. Lee VHL, Swarbrick J, Stratford Jr RE, Morimoto KW. Disposition of topically applied sodium cromoglycate in the albino rabbit eye. Journal of Pharmacy and Pharmacology 35: 445–450, 1983aPubMedCrossRefGoogle Scholar
  45. Lee VHL, Swarbrick J, Redell MA, Yang DC. Vehicle influence on ocular disposition of sodium cromoglycate in the albino rabbit. International Journal of Pharmaceutics 16: 163–170, 1983bCrossRefGoogle Scholar
  46. Leiferman KM, Yunginger JW, Larson JB, Gleich GJ. The effect of cromolyn sodium powder as a treatment for ragweed pollinosis. Journal of Allergy and Clinical Immunology 56: 481–490, 1975PubMedCrossRefGoogle Scholar
  47. Leino M, Tuovinen E. Clinical trial of the topical use of disodium cromoglycate in vernal, allergic and chronic conjunctivitis. Acta Ophthalmologica 58: 121–124, 1980PubMedCrossRefGoogle Scholar
  48. Lindsay-Miller ACM. Group comparative trial of 2% sodium cromoglycate (Opticrom) with placebo in the treatment of seasonal allergic conjunctivitis. Clinical Allergy 9: 271–275, 1979PubMedCrossRefGoogle Scholar
  49. Matter M, Rahi AHS, Buckley RJ. Sodium cromoglycate in the treatment of contact lens-associated giant papillary conjunctivitis. Proceedings of the 7th Congress of the European Society of Ophthalmology (Helsinki), pp. 383–384, 1985Google Scholar
  50. Mazurek N, Berger G, Pecht I. A binding site on mast cells and basophils for the anti-allergic drug cromolyn. Nature 286: 722–723, 1980PubMedCrossRefGoogle Scholar
  51. McCarthy D, Telang SM, Mellor P, Midha RN, Upton N, et al. Recurrent allergic conjunctivitis. An assessment of 2% sodium cromoglycate eye drops. A multicentre general practitioner study. Practitioner 222: 854–856, 1979Google Scholar
  52. Meisler DM, Berzins UJ, Krachmer JH, Stock EL. Cromolyn treatment of giant papillary conjunctivitis. Archives of Ophthalmology 100: 1608–1610, 1982PubMedCrossRefGoogle Scholar
  53. Meisler DM, Krachmer JH, Goeken JA. An immunopathologic study of giant papillary conjunctivitis associated with an ocular prosthesis. American Journal of Ophthalmology 92: 368–371, 1981PubMedGoogle Scholar
  54. Moss GF, Jones KM, Ritchie JT, Cox JSG. Plasma levels and urinary excretion of disodium cromoglycate after inhalation by human volunteers. Toxicology and Applied Pharmacology 20: 147–156, 1971PubMedCrossRefGoogle Scholar
  55. Nizami RM. Treatment of ragweed allergic conjunctivitis with 2% cromolyn solution in unit doses. Annals of Allergy 47: 5–7, 1981PubMedGoogle Scholar
  56. Orr TSC, Cox JSG. Disodium cromoglycate, an inhibitor of mast cell degranulation and histamine release induced by phospholipase A. Nature 224: 197–198, 1969CrossRefGoogle Scholar
  57. Ostler HB. Acute chemotic reaction to cromolyn. Archives of Ophthalmology 100: 412–413, 1982aPubMedCrossRefGoogle Scholar
  58. Ostler HB. Alpha1-antitrypsin and ocular sensitivity to cromoglycate. Lancet 2: 1287, 1982bPubMedCrossRefGoogle Scholar
  59. Ostler HB, Martin RG, Dawson CR. The use of disodium cromoglycate in the treatment of atopic ocular disease. In Leopold JH & Burns RD (Eds) Symposium on ocular therapy, pp. 99–108, John Wiley & Sons Inc., New York, 1977Google Scholar
  60. Pepys J, Hargreave FE, Chan M, McCarthy DS. Inhibitory effects of disodium cromoglycate on allergen-inhalation tests. Lancet 2: 134–137, 1968PubMedCrossRefGoogle Scholar
  61. Portellinha W, Beifort Jr R, Molinari H, Paula Silva VL, de Paiva ER. Cromoglicato dissódico e corticóide tópico nas conjunctivites atópicas crónicas e primaveris. Arquivos Brasileiros Oftalmologia 41: 105–108, 1978Google Scholar
  62. Roy AC, Warren BT. Inhibition of cAMP phosphodiesterase by disodium cromoglycate. Biochemical Pharmacology 23: 917–920, 1974PubMedCrossRefGoogle Scholar
  63. Sakuraba H, Hirano Y, Takahashi N. Clinical trial of topical disodium cromoglycate (DSCG) in allergic conjunctivitis. Folia Ophthalmologica Japonica 31: 1743–1749, 1980Google Scholar
  64. Sasaki Y, Koshibu A, Uyama M. A long-term study of disodium cromoglycate (Intal) eye drops in treatment of vernal conjunctivitis. Folia Ophthalmologica Japonica 33: 411–415, 1982Google Scholar
  65. Sayegh F, Samerra’e S, Khateeb M. Clinical trial of topical disodium chromoglycate in vernal keratoconjunctivitis. Ophthalmologica 177: 208–213, 1978PubMedCrossRefGoogle Scholar
  66. Shrewsbury RP, Swarbrick J, Newton KS. Influence of ophthalmic formulation on sodium cromoglycate disposition in the albino rabbit eye. Journal of Pharmacy and Pharmacology 37: 614–617, 1985PubMedCrossRefGoogle Scholar
  67. Simon-Licht IF, Dieges PH. A double-blind clinical trial with cromoglycate eye drops in patients with atopic conjunctivitis. Annals of Allergy 49: 220–224, 1982PubMedGoogle Scholar
  68. Swarbrick J, Shrewsbury RP. The prolonged retention of sodium cromoglycate in the rabbit eye. Journal of Pharmacy and Pharmacology 36: 121–122, 1984PubMedCrossRefGoogle Scholar
  69. Tabbara KF, Arafat NT. Cromolyn effects on vernal keratoconjunctivitis in children. Archives of Ophthalmology 95: 2184–2188, 1977PubMedCrossRefGoogle Scholar
  70. Takalo E, Ojantakanen L. Report of a double-blind group comparative trial of sodium cromoglycate 4% eye ointment in the treatment of seasonal allergic conjunctivitis. Presented at the 7th Congress of the European Society of Ophthalmology, Helsinki, May 21–25, 1984Google Scholar
  71. Tani DG, Welsh PW, Bourne WM, Yunginger JW, Gleich GJ. Cromolyn sodium treatment of seasonal ragweed conjunctivitis. Investigative Ophthalmology and Visual Science (Suppl.): 227, 1978Google Scholar
  72. Theoharides TC, Sieghart W, Greengard P, Douglas WW. Antiallergic drug cromolyn may inhibit histamine secretion by regulating phosphorylation of a mast cell protein. Science 207: 80–82, 1980PubMedCrossRefGoogle Scholar
  73. Vakil DV, Ayiomamitis A, Nizami RM. Treatment of seasonal conjunctivitis: comparison of 2% and 4% sodium cromoglycate ophthalmic solutions. Canadian Journal of Ophthalmology 19: 207–211, 1984PubMedGoogle Scholar
  74. Van Bijsterveld OP. A double-blind crossover study comparing sodium cromoglycate eye drops with placebo in the treatment of chronic conjunctivitis. Acta Ophthalmologica 62: 479–484, 1984PubMedCrossRefGoogle Scholar
  75. Van Bijsterveld OP, Van de Reijt ML. Treatment of seasonal atopic conjunctivitis. Acta Therapeutica 7: 235–241, 1981Google Scholar
  76. Walker SR, Evans ME, Richards AJ, Paterson JW. The fate of (l4C) disodium cromoglycate in man. Journal of Pharmacy and Pharmacology 24: 525–531, 1972PubMedCrossRefGoogle Scholar
  77. Welsh PW, Yunginger JW, Kern EB, Gleich GJ. Preseasonal IgE ragweed antibody level as a predictor of response to therapy of ragweed hay fever with intranasal cromolyn sodium solution. Journal of Allergy and Clinical Immunology 60: 104–109, 1977PubMedCrossRefGoogle Scholar
  78. Welsh PW, Yunginger JW, Tani DG, Toussaint Jr NF, Larson LA, et al. Topical ocular administration of cromolyn sodium for treatment in seasonal ragweed conjunctivitis. Journal of Allergy and Clinical Immunology 64: 209–215, 1979PubMedCrossRefGoogle Scholar
  79. Zani G, Rigamonti MT, Schwarz Piria C. L’uso del D.S.C.G. nel trattamento delle congiuntiviti stagionali. Minerva Pediatrica 29: 1679–1682, 1977PubMedGoogle Scholar

Copyright information

© ADIS Press Limited 1986

Authors and Affiliations

  • Eugene M. Sorkin
    • 1
  • Alan Ward
    • 1
  1. 1.ADIS Drug Information ServicesMairangi Bay, Auckland 10New Zealand

Personalised recommendations