A cheaper preparation of disodium cromoglycate in the treatment of allergic rhinitis.

A CHEAPER PREPARATION OF DISODIUM CROMOGLYCATE IN THE TREATMENT OF ALLERGIC RHINITIS From Major N K Cooper FRCS(Ed), DLO, RAMC Sir, The clinical symptoms of allergic rhinitis are brought on in predisposed individuals during the pollen season by the release of histamine from mast cells in the nasal mucosal,2 following the combination of antigen with antibody at the surface of these cells• This process of histamine release may, however, be reduced or abolished by treatment with disodium cromoglycate, as has been demonstrated by isotope studies and electron microscopl utilizing preparations of excised human nasal mucosa. Clinically, the increased sensitivity displayed by the nasal mucosa of sufferers from allergic rhinitis towards released histamine can also be minimised by treatment with topical disodium cromoglycate at or before the time of allergen exposure. With this in mind, twelve patients presenting at the ENT Outpatients Department at BMH Rinteln between June and September 1987 with symptoms and signs of allergic rhinitis were selected for study. Six patients were treated with Vividrin Nasenspray (Dr Mann Pharma, Berlin) and the other six with Rynacrom Nasal Spray (Fisons plc) during these months. The limited number of Vividrin samples available restricted the size of the study. In West Germany during the months of this study, the most severely allergogenic plant pollens, such as those from species of ryegrass, meadowgrass and mugwort (Artemesia vulgaris), are at the peak of their production and distribution into the atmosphere . Only four out of twelve patients had undergone previous allergy testing, and in each of these four patients a positive reaction to grass poliens had been elicited. In the other eight patients the history and findings alone were the criteria for their inclusion in the study. The patients ranged in age from 10 to 48 years, and consisted of eight males and four females. Each patient was instructed in the use of their respective nasal spray, and after nose blowing each patient was seen to use the spray correctly before leaving the clinic. The dosages were 0.5ml (lOmg) of either preparation four times daily. The clinical outcome of this study was that after six weeks of treatment 11 of the 12 patients reported a 50% or greater subjective improvement in their symptoms of allergic rhinitis, and all 11 patients wished to continue using their treatment for the rest of the pollen season. No side effects from treatment were reported. The remaining patient demonstrated little improvement on disodium cromoglycate treatment and eventually required cautery of his inferior turbinates and submucosal resection of his nasal septum. • Symptomatic relief of allergic rhinitis has important implications for military personnel suffering from this complaint in the field. During military operations which necessitate absolute silence, particularly at night, repeated sneezing, coughing or hawking provide an easy. sound target upon which the enemy can localise their fire. The danger thus engendered to the soldier with such uncontrolled symptoms, and to his companions, has been documented in innumerable operational reports dating from the earliest records of warfare, and present. day training in infantry tactics mandates platoon commanders to eliminate this hazards. This study demonstrates that these potentially dangerous symptoms can be successfully controlled under West German conditions by the use of two identical preparations of topical disodium cromoglycate • solution, only one of which Rynacrom is currently allotted a NATO stock number for re-ordering purposes. The second preparation Vividrin is not only supplied in a smaller spray (14mls as compared with 26mls) which may be more convenient for use in the • field, but is also over 40% per unit volume cheaper than Rynacrom at existing currency exchange rates• I therefore suggest that the cheaper version should be made available to replace the more costly one. A saving of several thousand pounds sterling per year could be made if all the Rynacrom Nasal Spray dispensed at • BAOR medical facilities, currently in excess of 1,100 units per annum , were to be replaced with locally purchased Vividrin Nasenspray. Further savings could also be made through local purchase of topical disodium cromoglycate solution for ophthalmic use . •