Intal und kontaktallergie

Contact Dermatitis 1985: 12: 18-20

Disodium cromoglycate inhibits allergic patch test reactions
HANS MEFFERT¹, GERD G. WISCHNEWSKY² AND WOLFGANG GÜNTHER¹ ¹ Department of Dermatology (Charité), Humboldt-University, 1040 Berlin, GDR ² Department of Pharmacological Research, VEB Berlin-Chemie, 1199 Berlin, GDR Disodium cromoglycate was applied before patch testing in patients with contact allergy to propipocaine hydrochloride, nickel and formaldehyde. the responses obtained were mitigated to a high degree when compared witth similar effects due to corticoids.
Key words: Disodium cromoglycate - contact dermatitis - inhibition of patch test reaction Accepted for publication August 7, 1984 Disodium cromoglycate (DSCG, Intal®, Lomudal®) is a well-known safe drug used in the prophylaxis of allergic asthma, rhinitis and exercise-induced asthma (1-4). It is also effective in ragweed conjunctivitis and food allergies (5, 6). In animal tests cutaneous anaphylaxis is prevented. (7, 8). Absorption in man is minimal by all routes, because of the poor solubility of the compound. Its prophylacitic action is accepted in IgE-mediated atopic reactions. IgG-induced liberation of mediator substances is not influenced. However, Baur & Thiel (2) discovered an inhibitory effect on the immediate and the delayed response in patients with allergic asthma.
We investigated the influence of DSCG on patch test reactions following the suggestion of Sukanto et al. (9), who demonstrated the suppressive effect of topically applied corticosteroids.

Material and Methods
In 11 patients with proven contact allergy, either to propipocaine hydrochloride (Falicain®, Exofalicain®, Opthafalicain®), nickel or formaldehyde, 4 circular areas (2,6 cm diameter) on healthy back skin were marked by means of a ball-piont pen. They were prepared as follows: 1: DSCG powder (10 mg Intal®) applied to dry skin 2: 40 µl of propanolic DSCG solution (20 mg/ml Intal®) were pipetted on the skin by circulating movements3: propanol (control) 0,4 ml as described in point 24: 40 µl Cerson liquid® (0,02% fluomethasone pivalate, 2,0% salicylic acid, 0,05% benzalkonium bromide in ethanol) as described in point 2 After evaporation of the solvent, the aereas were covered with tape-fixed discs of cellophane. They were removed 24 h later and the prepared areas used for allergen testing: propipocaine hydrochloride 1% aq. (6 cases), formaldehyde 2% aq. (1 case), nickel sulfate 5% aq. (4 cases). Patches were applied using the Finn-chamber technique. Reading was after 24 h exposure. The size of patch test responses was defined by planimetry. The degree of inhibition was evaluated by comparison with the areas prepared with flumethasone pivalate. Differences were calculated according to the Student t-test.
Topical DSCG 4% in propanol diminishes patch test reactions to about 75%, expressed as size of erythema (cm²), compared to flumethasone pivalate, with about 35% inhibition over a wide range of variation. DSCG used as powder (Intal 10 mg per area) does not have any effect (Table 1).
Table 1. Results of application of 0,04 ml corticosteroid or disodium cromoglycate on patch test reactions_______________________________________________________________________ _______________________________________________________________________1 _______________________________________________________________________mean _______________________________________________________________________Statistics (t-test): control/corticosteroid p<0,05; control/disodium cromoglycate solution p<0,001.

Discussion
Although contact dermatitis is considered a delayed-type reaction, we were able to demonstrate that DSCG mitigates allergic patch test reactions, when applied topically. Dissolved in propanol, it may be a useful treatment for contact dermatitis. A DSCG solution could be used transepidermally in disorders in which mast-cell degranulation plays a leading part, such as urticaria pigmentosa (10).
References
1. Cliff A D, Holzel A. Long-term therapy with sodium cromoglycate (Intal, Lomudal or Aarane): effects and side effects. Ann Allergy 1978: 41: 313-318.
2. Baur X, Thiel A. Prophylaxe von Sofort- und Spätreaktionen bei exogen-allergischem Asthma bronchiale. Münch Med Wochenschr 1978: 120: 1269-1273 3. Beach J E, Blair A M J N, Clarke A J, Bonfield C T. Cromolyn sodium toxicity studies in promates. Tox Appl Pharmacol 1981: 57: 367-400 4. Gmuer H, Scherrer M. Schutz vor anstrengungs-induziertem Asthma bronchiale mit Dinatrium-Cromoglycate (DSCG, Cromolyn, Lomudal, Intal) und mit Ketotifen (Zaditen). Schweiz Med Wochenschr 1979: 109: 881-884.
5. Welsh P W, Yunginger J W, Tani D G, Toussaint Jr. N F, Larson L A, Bourne W M, Gleich G J. Topical ocular administration of cromolyn sodium for treatment in seasonal ragweed conjunctivitis. J Allergy & Clin Immunol 1979: 64: 209-215 6. Nizami R M, Lewin P K, Baboo M T. Oral cromolyn therapy in patients with food allergy. Annals of Allergy 1977: 39: 102-108.
7. Butchers P R, Fullarton J R, Skidmore I F, Thompson L E, Vardey C J, Wheeldon A. A comparison of the anti-anaphylactic activities of salbutamol and disodium cromoglycate in the rat, the rat mast cell and in human lung tisuue. Br J Pharmacol 1979: 67: 23-32.
8. Church M K, Gradidge C F. The activity of sodium cromoglycate analogues in human lung in vitro: a comparison with rat passive cutanous anaphylaxis and clinical efficacy. Br J Pharmacol 1980: 70: 307-311.
9. Sukanto H, Nater J P, Bleumink E. Influence of topically applied corticosteroids on patch test reactions. Contact Dermatitis 1981: 7: 180-185.
10. Czarnetzki B M, Behrendt H. Urticaria pigmentosa: clinical picture and response to oral disodium cromoglycate. Br J Dermatol 1981: 105: 563-567.
Department of DermatologyHumboldt UniversityDDR-1040 BerlinSchumannstr. 20/21German Democratic Republic

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