Cromoglicic acid

Cromolyn was discovered in 1965 by Roger Altounyan, a pharmacologist who had asthma. Altounyan was investigating certain plants and herbs which have bronchodilating properties. One such plant was khella (Ammi visnaga) which had been used as a muscle relaxant since ancient times in Egypt. Altounyan deliberately inhaled derivatives of the active ingredient khellin to determine if they could block his asthma attacks. After several years of trial, he isolated an effective and safe asthma-preventing compound called cromolyn sodium. ==Preparations==

Cromoglicic acid is available in multiple forms: • as a nasal spray (Rynacrom (UK), Lomusol (France), Nasalcrom (the only over-the-counter form, US), Prevalin (non-direct version, NL)) to treat allergic rhinitis. • in a nebulizer solution for aerosol administration to treat asthma. • as an inhaler (Intal, Fisons Pharmaceuticals, UK) for preventive management of asthma. The maker of Intal, King Pharmaceuticals, has discontinued manufacturing the inhaled form, cromolyn sodium inhalation aerosol, due to issues involving CFC-free propellant. As stocks are depleted, this inhaler preparation will no longer be available to patients. In the EU it is manufactured without CFCs by Sanofi, although it must be imported from Canada or Mexico for USA residents. • as eye drops (Opticrom and Optrex Allergy (UK), Crolom, Cromolyn (Canada)) for allergic conjunctivitis • in an oral form (Gastrocrom, Nalcrom) to treat mastocytosis, mast cell activation syndrome, dermatographic urticaria and ulcerative colitis. Another oral product, Intercron (sodium cromoglicate in distilled water, from Zambon France), is used for food allergies. ==Mechanism of action==

"Cromolyn works because it prevents the release of mediators that would normally attract inflammatory cells and because it stabilizes the inflammatory cells. MCT mast cells found in the mucosa are stabilised." Nedocromil is another mast cell stabilizer that also works in controlling asthma. The underlying mechanism of action is not fully understood; for while cromoglicate stabilizes mast cells, this mechanism is probably not why it works in asthma. Pharmaceutical companies have produced 20 related compounds that are equally or more potent at stabilising mast cells and none of them have shown any anti-asthmatic effect. It is known to somewhat inhibit chloride channels (37%±7%) and thus may inhibit the: • exaggerated neuronal reflexes triggered by stimulation of irritant receptors on sensory nerve endings (such as exercise-induced asthma) • release of preformed cytokines from several type of inflammatory cells (T cells, eosinophils) in allergen-induced asthma Note: Another chemical (NPPB: 5-nitro-2(3-phenyl) propylamino-benzoic acid) was shown, in the same study, to be a more effective chloride channel blocker. Finally it may act by inhibiting calcium influx. Cromoglicate is classified as a chromone. Cromolyn is also being tested as a drug to treat insulin-induced lipoatrophy and Alzheimer's disease in combination with Ibuprofen. Cromolyn is also known to bind S100P protein and disrupt the interaction with RAGE. ==Synthesis==