Cromoglicic acid

Benjamin Clanner-Engelshofen is a freelance writer in the medical department. He studied biochemistry and pharmacy in Munich and Cambridge / Boston (USA) and noticed early on that he particularly enjoyed the interface between medicine and science. That is why he went on to study human medicine.

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The active ingredient cromoglicic acid is one of the so-called mast cell stabilizers and is used against allergic complaints. In contrast to other antiallergic drugs, cromoglicic acid does not help in acute cases, but only as a preventive measure against allergic reactions. So it is taken if you know in advance that you will come into contact with an allergen such as hay fever. Here you can read everything you need to know about cromoglicic acid: effect, application as well as side effects and interactions.

This is how cromoglicic acid works

Allergic reactions are excessive defense reactions of the immune system to actually harmless stimuli (allergens) such as pollen, house dust mites, certain foods or pets. Contact of the allergen with the skin, mucous membrane or conjunctiva of the eyes causes unpleasant symptoms such as redness, swelling and itching.

An allergy arises from the fact that the immune system forms special antibodies on initial contact with the allergen, which precisely match the characteristic surface structures of the allergen and can therefore quickly recognize the "enemy". These antibodies attach to the outside of mast cells - small, motile immune cells. The next time the allergen enters the body, it comes into contact with the antibodies on the mast cells and becomes bound to them. As a result, the mast cell in question releases histamine and other inflammatory substances in a flash. These increase the blood flow in the tissue (reddening and swelling) so that more immune cells can reach the scene. They also ensure that more fluid is formed by the glands of the mucous membranes in order to wash away the allergens (runny nose, watery eyes) and trigger itching so that any larger allergen particles can be removed by scratching.

Mast cell stabilizers such as cromoglicic acid can be used to suppress these allergic reactions. They stabilize the mast cells so that they no longer react so sensitively to allergens with the release of inflammatory messenger substances. This prevents allergy symptoms.

Uptake, degradation and excretion of cromoglicic acid

Since cromoglicic acid only has a local effect and is not absorbed into the body when taken orally, only dosage forms such as eye drops, nasal sprays or inhalation preparations are suitable for the active ingredient. Cromoglicic acid is also only absorbed very slightly via the mucous membranes and is excreted unchanged in the urine and stool.

When is cromoglicic acid used?

Cromoglicic acid is approved for the treatment of:

• allergic conjunctivitis and nasal mucosal inflammation

The treatment is always preventive, as cromoglicic acid is not suitable for acute treatment. The therapy can be used both seasonally (for example in the case of grass or tree pollen allergy) or permanently.

This is how cromoglicic acid is used

When using it, it should be noted that cromoglicic acid only has a relevant effect after about two to three days. Until then, acutely effective antiallergic agents should be used in parallel with the mast cell stabilizer.

Nasal spray

The nasal mucous membranes are treated with cromoglicic acid nasal spray (two percent sodium cromoglicate solution, the water-soluble sodium salt of cromoglicic acid): four times a day, a puff is given into each nostril. If the effect is not sufficient, the dose can be increased to two sprays up to six times a day.

eye drop

To treat watery, irritated eyes, one drop of cromoglicic acid eye drops (two percent sodium cromoglicate solution) is instilled into the conjunctival sac of both eyes four times a day. The dose can be increased to two drops eight times a day if necessary.

Inhalation solution

Cromoglicic acid inhalation solutions as well as aerosols and powder inhalers are available for asthmatic complaints. Aerosol sprays and powder inhalers should be reserved for adult patients, as their use requires a certain amount of coordination. Inhalation solutions that are nebulized through an inhaler and inhaled through a mask are suitable for children.

With direct, deep inhalation, two milligrams of cromoglicic acid are inhaled four times a day. When inhaling via a nebulizer, where you breathe more superficially and less deeply, 20 milligrams per single dose are inhaled four times a day.

What are the side effects of cromoglicic acid?

In some patients, the active ingredient cromoglicic acid causes irritation of the mucous membranes of the nose and mouth, nosebleeds, sneezing, coughing, hoarseness, taste disturbances and tongue swelling. The eye drops can cause burning sensation, a foreign body sensation and reddened eyes.

Other possible side effects are headache, nausea and, rarely, hypersensitivity reactions (itching, shortness of breath, asthma attacks and swelling of the mucous membranes).

What should be considered when using cromoglicic acid?

Direct interactions between cromoglicic acid and other active ingredients are not yet known.

Hands should be washed before using cromoglicic acid eye drops. Contact lens wearers should remove the lenses before use. Dripping in the solution may impair vision for a few minutes. You should wait at least a quarter of an hour before using other eye preparations.

Before using the nasal spray, the nose should be blown if necessary.

When using cromoglicic acid in asthma, the breath force, which is measured by the peak flow meter, should always be monitored in order to be able to notice any deterioration in breathing in good time. To stop treatment with cromoglicic acid, the dosage should be reduced gradually. Abrupt withdrawal could trigger an asthma attack.

During pregnancy and breastfeeding, the doctor will carefully weigh the benefits and risks of using the mast cell stabilizer.

How to get drugs with cromoglicic acid

All medicines that contain only the active ingredient cromoglicic acid do not require a prescription and can be bought in pharmacies without a prescription. This applies both to preparations for direct use on the mucous membranes as eye drops or nasal spray and for inhalation as an aerosol or inhalation solution.

Combination preparations that also contain a prescription-only active ingredient (e.g. for asthma patients) require a prescription.

How long has cromoglicic acid been known?

The mast cell stabilizer cromoglicic acid was discovered through self-experiments by the scientist R. Altounyan in 1965. He examined various plants for their asthma-improving effect and discovered the substance khellin in bishop's herb. Its chemical derivative cromoglicic acid proved to be effective and comparatively few side effects. Today there are numerous approved preparations with the active ingredient cromoglicic acid.

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