The effect of sodium cromoglycate in preventing aspirin induced bronchospasm

Abstract

Seventeen patients with aspirin-induced asthma were studied, the majority being intolerant to more than one analgesic. In addition to asthma, eleven patients had sinusitis and eight had nasal polyps. Serum IgE levels were normal with a mean of 295 iu/ml. However, some patients had positive cutaneous and PK tests against inhalants and non-analgesic drugs.Spirometry showed the bronchial obstruction to be mild. However, all patients were hyper-reactive to acetylcholine. Oral provocation tests with aspirin alone and also with the prior administration of sodium cromoglycate (SCG) by inhalation were performed and the results assessed by spirometry and clinical examination.The results suggest that the obstruction is probably due to oedema of the bronchial mucosa together with pulmonary congestion rather than a simple spasm of the bronchi.SCG was found to prevent significantly the ventilatory obstruction induced by aspirin.It is suggested that non-immunological factors are responsible for the asthma and that SCG may have an effect on the altered receptors protecting them from the action of aspirin on kinins.

Analgesics, allergy and asthma.

“…In aspirin-sensitive asthmatics, aspirin challenge results in a significant increase in plasma histamine (Stevenson, Arroyave, Bhat & Tan, 1976). Furthermore, aspirin-induced bronchoconstriction can be diminished or even prevented by drugs which either stabilize the mast-cell membranes (Basomba, Romar, Villamanzo & Campos, 1976) or block HI-histamine receptors (Szczeklik & Serwoniska, 1979). Second, inhibition of cyclo-oxygenase might lead to diversion of arachidonic acid metabolism towards lipoxygenase products, which in turn augment the release of histamine and anaphylactic mediators (Adcock, Garland, Moncada & Salmon, 1978).…”

Hypersensitivity to Aspirin and Other Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

“…The evidence for mast cells involvement rests on the finding of histamine, tryptase in serum and bronchial secretions and of PGD2 and its mast cell-specific metabolites in urine following oral or intravenous aspirin challenge in aspirin-hypersensitive patients [76][77][78][79]. Such reactions are also effectively prevented by mast cells inhibitors such as disodium cromoglycate and nedocromil [80,81].…”

Benefit/Risk Ratio of Aspirin

“…Stevenson et aJ38found an increase in plasma histamine after aspirin challenge, while Wasserman et aJ39 reported normal levels of blood histamine. Bosomba et al 40 reported that prior administration of sodium cromolyn prevented aspirin-induced bronchospasm. Cromolyn has been known also to prevent the degranulation and release of histamine and slow-reacting substance of anaphylaxis (SRS-A) caused by compound 48/80, a potent histamine liberator.…”