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Intal drops (sodium cromoglycate) relieved symptoms of vernal conjunctivitis in all the 19 patients we studied, reducing the need for steroids although the response varied. Intal was also effective in all 11 patients with acute or subacute seasonal allergic conjunctivitis, but in only 4 of 11 patients with mild chronic conjunctivitis associated with atopy. No side-effects were noted other than mild irritation in some cases.

Since the introduction of sodium cromoglycate, attempts have been made to develop a drug with similar activity when taken orally. M&B 22,948 is an orally absorbed mast cell stabiliser which has previously been shown to block exercise induced asthma in adults. We conducted a trial in which 15 children with asthma each undertook three exercise challenges. They were pretreated with either M&B 22,948 or placebo, given double-blind, in randomly allocated order, prior to the second and third challenges. Our results failed to show a protective effect of M&B 22,948 against exercise induced asthma but the possible reasons for the discrepancy with the previous trial will be discussed.

Patients with Cystic Fibrosis (CF) have an increased incidence of bronchial hyper-reactivity to inhaled methacholine (MCh). There is also an increased skin reactivity to inhaled allergens and an increased incidence of allergic rhinitis. Thus, CF shares some clinical features with asthma and drugs used in asthma may be useful in CF. Sodium cromoglycate (SCG) is efficacious in asthma, blocking some patients against MCh challenge and decreasing bronchial hyper-reactivity. We studied the potential role of SCG in CF by determining if it could block acute bronchoconstriction induced by MCh, and predict CF patients whose bronchial hyper-reactivity and symptoms would lessen with longterm use. Fifteen CF patients known to respond to an MCh challenge were studied. None had clinical asthma, nor had intercurrent infections at the time of the study. Three standard MCh challenges were performed on consecutive days at the same time; two after placebo (distilled water) and one after 2ml 1% SCG, which were given in random order in a double-blind manner. As well as providing a baseline, the two placebo studies provided a measure of the reproducibility of the MCh challenges (variation less than 10%). There were only small changes in FEV1 after placebo and SCG (less than 6%). The mean FEV1 was 65% (range 32-90) and PD20 was calculated from the dose-response curves of cumulative MCh inhaled versus drop in FEV1. Four patients (27%) were completely protected by SCG. We conclude that longterm trials of SCG in CF are indicated to assess predictive ability of MCh challenge blocking for improved symptom scores and decreased MCh sensitivity. SCG may benefit selected CF patients.

A double-blind cross-over study of nebulised sodium cromoglycate (SCG) was carried out on 27 asthmatic pre-school children over a one year period. All subjects had sufficiently severe asthma to have had at least one hospital admission. The active treatment was SCG 20 mg in 2 ml administered by nebuliser 4 times daily. Assessment was made by diary card and clinical examination. Results were analysed in 24 subjects who completed the study. Statistical analysis allowed for treatment order and seasonal effects. Significant results in favour of SCG were obtained for night cough, day activity, percentage of symptom free days and overall asthma severity. During active treatment there was no reduction in hospital admission rate or intravenous drugs used. The wheeze score in the week after an upper respiratory infection was not reduced during SCG treatment. Nebulised SCG is tedious prophylactic treatment for the very young asthmatic child, but worth a trial when other therapies have failed.