Cromolyn sodium: A potential therapy for uremic pruritus?

Abstract

Uremic pruritus occurs in up to 50% of patients undergoing chronic hemodialysis. The pathogenesis of this disabling condition is unknown but likely involves multiple pathways involving the peripheral and central nervous system as well as local chemical and inflammatory mediators. Therapy has involved modification of the dialysis procedure, topical medications such as emollients, physical treatments such as ultraviolet light, and several oral medications such as antihistamines, activated charcoal, and gabapentin. Unfortunately, most of these therapies have not been subjected to rigorous clinical trials and clinical success has been variable. Two patients with disabling uremic pruritus refractory to multiple interventions are reported, who showed significant improvement in pruritus severity as assessed by a visual analog scale when they were treated with the mast cell stabilizer cromolyn sodium. Cessation of cromolyn resulted in return of pruritus, which improved with rechallenge with the medication. Cromolyn sodium may offer an alternative therapy for patients with refractory uremic pruritus, and should be subjected to a randomized placebo-controlled trial.

The effect of the omega-3 supplement on uremic pruritus in hemodialysis patients; a double-blind randomized controlled clinical trial

“…In our study, omega-3 administration decreased degree and duration and disability and direction of pruritus significantly in chronic hemodialysis patients without any side-effects or complications. Considering this finding, omega-3 supplement therapy could be encouraged in uremic pruritus (20)(21)(22)(23)(24)(25)(26)(27).…”

Chronic kidney disease-associated pruritus: impact on quality of life and current management challenges

“…Cromolyn sodium was found to improve pruritus in a case study of 2 HD patients. 81 In a subsequent RCT of 60 HD patients, twice daily cromolyn sodium cream 4% significantly reduced pruritus severity compared to placebo over 4 weeks. 82 In a double-blind, RCT of 40 HD patients, zinc sulfate, a medication shown to prevent histamine release from mast cells, 83 given for 2 months led to a significant improvement in CKD-aP compared to placebo.…”

Treatments of uremic pruritus: A systematic review

“…According to our exclusion criteria and after reading the articles in details, finally 41 articles remained. (Aperis, Paliouras, Zervos, Arvanitis, & Alivanis, 2010;Gunal et al, 2004;Huseyin et al, 2010;Manenti et al, 2005;Marquez et al, 2012;Naini et al, 2007;Rayner, Baharani, Smith, Suresh, & Dasgupta, 2012;Razeghi et al, 2009;Shavit, Grenader, Lifschitz, & Slotki, 2013;Solak et al, 2012;Yue et al, 2015), antihistamines (Marquez et al, 2012), antiemetic (Ashmore, Jones, Newstead, Daly, & Chrystyn, 2000;Deshpande, 2004;Murphy, Reaich, Pai, & Finn, 2003;Yue et al, 2015), opioid agonist (Kumagai et al, 2012;Wikstrom et al, 2005), opioid antagonist (Pauli-Magnus, Klumpp, Alscher, Kuhlmann, & Mettang, 2000), immunosuppressants (Birgani, Khalili, & Zamani, 2011;Duque, Yosipovitch, Fleischer, Willard, & Freedman, 2005;Ghorbani, Feily, Khalili, & Dormanesh, 2011;Kuypers, Claes, Evenepoel, Maes, & Vanrenterghem, 2004;Pauli-Magnus, Klumpp, et al, 2000), mast cell stabilizer (Birgani et al, 2011;Feily et al, 2012;Rosner, 2006;Vessal, Sagheb, Shilian, Jafari, & Samani, 2010), antidepressants (Shakiba et al, 2012;Pakfetrat, Malekmakan, Hashemi, & Tadayon, 2017;Pour-Reza-Gholi et al, 2007), leukotriene receptor antagonist , hemorrheologic agent (Mettang, Krumme, Bohler, & Roeckel, 2007), and oils (Szepietowski, 2005;…”

“…For this reason, antipruritic effect of mast cell stabilizer (Cromolyn Na) was assessed in some studies. All the aforementioned studies revealed that cromolyn sodium either topical or systematic is an effective drug in relieving UP (Birgani et al, ; Feily et al, ; Rosner, ; Vessal et al, ). Montelukast and pentoxyfilline are the other drugs reported to have an antipruritic effect in UP, though there was only one study that evaluated these drugs (Mettang et al, ; Nasrollahi et al, ).…”

“…All four studies on the effect of Cromolyn Na revealed reduction in pruritus score (Birgani et al, 2011;Feily et al, 2012;Rosner, 2006;Vessal et al, 2010).…”