What are the most commonly used cell stabilizers, such as cromolyn (cromolyn sodium) and corticosteroids like prednisone, for treating allergic reactions?

From the Guidelines

The most effective cell stabilizers for treating allergic reactions include mast cell stabilizers like cromolyn sodium and corticosteroids such as prednisone and fluticasone, with cromolyn sodium being administered as a nasal spray or inhaler and corticosteroids being used orally or through inhalation. These medications work through different mechanisms, with mast cell stabilizers preventing the release of inflammatory mediators like histamine by stabilizing mast cell membranes, while corticosteroids reduce inflammation by suppressing multiple inflammatory pathways 1.

Key Medications and Their Uses

• Cromolyn sodium is typically administered as a nasal spray (5.2 mg per spray, 1-2 sprays per nostril 3-4 times daily) or inhaler (20 mg per puff, 2-4 puffs 4 times daily) for allergic rhinitis and asthma.
• Oral corticosteroids like prednisone are used for acute allergic reactions, with a common regimen being 40-60 mg daily for 3-5 days, then tapering down.
• Inhaled corticosteroids like fluticasone are used at 88-440 mcg twice daily for maintenance therapy.

Mechanisms and Side Effects

• Mast cell stabilizers have fewer side effects but work more slowly and are better for prevention.
• Corticosteroids act more quickly and powerfully but carry more potential side effects with long-term use, including immunosuppression, weight gain, and bone density loss 1.
• The choice between these medications depends on the severity of the allergic reaction, the patient's medical history, and the potential for side effects.

Recent Guidelines and Recommendations

• According to recent guidelines, cromolyn sodium and nedocromil sodium are effective in stabilizing mast cells and can be used as alternative therapy for mild persistent asthma 1.
• Corticosteroids, particularly inhaled corticosteroids, are the most consistently effective long-term control medication for persistent asthma and are recommended for use in combination with other medications for moderate to severe asthma.

From the FDA Drug Label

Cromolyn sodium acts by inhibiting the release of histamine and leukotrienes (SRS-A) from the mast cell. Pharmacologic Category: Mast cell stabilizer Therapeutic Category: Antiallergic

The most commonly used cell stabilizers mentioned are cromolyn sodium, which is a mast cell stabilizer.

• Cromolyn sodium is used for treating allergic reactions by inhibiting the release of histamine and leukotrienes from mast cells.
• Prednisone is a corticosteroid that can be used to treat allergic reactions, but it is not specifically classified as a cell stabilizer in the provided drug labels 2, 2, 3.

From the Research

Cell Stabilizers

• Mast cell stabilizers are a class of drugs that prevent the release of allergic mediators from mast cells, thereby reducing the symptoms of allergic reactions 4, 5, 6, 7, 8.
• Examples of cell stabilizers include:
  • Cromolyn sodium (cromolyn) 4, 5, 6, 7, 8
  • Corticosteroids, such as prednisone 4
  • Disodium cromoglycate 5, 6, 8
  • Sodium nedocromil 5
  • Dexamethasone 5

Mechanism of Action

• Cell stabilizers work by inhibiting the degranulation of sensitized mast cells, thereby blocking the release of inflammatory and allergic mediators 4, 5, 6, 7, 8.
• They may also stimulate the release of anti-inflammatory proteins, such as Annexin A1, which can help to reduce the symptoms of allergic reactions 5.

Clinical Use

• Cell stabilizers are used to prevent and treat allergic reactions, including allergic rhinitis, conjunctivitis, asthma, and vernal keratoconjunctivitis 4, 5, 6, 7, 8.
• They are often used prophylactically to prevent symptoms from occurring, and can be administered intranasally, orally, or topically 7.
• Cell stabilizers have an excellent safety record and are well tolerated, with minimal adverse effects and no significant drug interactions 7, 8.