Is nasal cromolyn (sodium cromoglicate) effective for treating enteritis?

Nasal Cromolyn Sulfate Is Not Effective for Enteritis

Nasal cromolyn sulfate is not indicated or effective for the treatment of enteritis as it works locally in the nasal passages and has minimal systemic absorption. 1

Mechanism of Action and Limitations

• Cromolyn sodium works by inhibiting the degranulation of sensitized mast cells, thereby preventing the release of mediators of the allergic response and inflammation 1, 2
• When administered nasally, cromolyn sodium must be applied topically and directly to the nasal mucosa to be effective, as it does not pass the cell membrane, is virtually not metabolized, and does not exert significant systemic action 3
• Due to minimal systemic absorption, nasal cromolyn would not reach the intestinal mucosa in sufficient concentrations to treat enteritis 3

Approved Indications for Nasal Cromolyn

• Nasal cromolyn sodium is specifically approved for topical intranasal treatment of seasonal and perennial allergic rhinitis 1
• It is effective in preventing and treating allergic rhinitis symptoms when applied directly to the nasal mucosa 1
• Nasal cromolyn is particularly effective for episodic rhinitis, such as before anticipated allergen exposure 1
• There is no evidence that intranasal cromolyn will benefit patients with vasomotor rhinitis, NARES (non-allergic rhinitis with eosinophilia syndrome), or nasal polyposis 1

Alternative Routes for Enteritis Treatment

• While nasal cromolyn is ineffective for enteritis, oral cromolyn sodium has been studied for food-related allergic responses that can affect the gastrointestinal tract 4
• Oral cromolyn (not nasal) has shown efficacy in preventing immediate and late nasal responses to ingested food allergens when administered systemically 4

Safety Profile of Cromolyn

• Nasal cromolyn sodium has an excellent safety profile with minimal side effects, which are usually mild and local (including sneezing and nasal stinging or burning) 1
• Unlike intranasal corticosteroids, nasal septal perforations and nasal crusting have not been reported with nasal cromolyn sodium 1
• The strong safety profile makes cromolyn suitable for very young children and during pregnancy 1

Practical Considerations

• For nasal allergic conditions, cromolyn should be started early in an allergy season with effects normally noted within 4-7 days of initiation 1
• Severe or perennial allergic rhinitis cases may require 2 weeks or more for maximum effect 1
• Proper contact with the nasal mucosa is essential for efficacy; in patients with nasal congestion, vasoconstrictors or saline lavages may be indicated before cromolyn use 3
• In controlled studies, nasal cromolyn has been shown to be effective compared to placebo for allergic rhinitis but is generally less effective than intranasal corticosteroids 1, 5, 6

Conclusion for Clinical Practice

• For enteritis treatment, alternative medications that can reach the intestinal mucosa in therapeutic concentrations should be considered instead of nasal cromolyn sulfate 3
• If mast cell stabilization is desired for intestinal symptoms, oral formulations of cromolyn would be more appropriate than nasal administration 4