Immunology Review Corner

Immunology Review Corner: Chapter 53 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al.

Prepared by Dr. Thao N. Tran, Puget Sound Allergy, Asthma and Immunology (formerly at Stony Brook University Hospital- SUNY); Dr. Karla Lowe, Walter Reed Medical Center; and Dr. John Norvell, Vanderbilt University.

Chapter 53:  Chromones

1. Which of the following statements concerning cromolyn and nedocromil is true?
a. Cromolyn but not nedocromil is water soluble
b. Both nedocromil and cromolyn are highly fat soluble
c. Both nedocromil and cromolyn are ionized at physiologic pH
d. 75% of an inhaled cromolyn dose is cleared by the lungs within 2 minutes

2. Which of the following statements concerning cromolyn and nedocromil is correct?
a. Both inhibit the release of histamine from human skin mast cells, but fail to inhibit histamine release from mast cells at other anatomic sites
b. Both cromolyn and nedocromil block the activation of human blood eosinophils
c. Cromolyn but not nedocromil has been shown to inhibit the release of prostaglandin D2 from human mast cells
d. Nedocromil and cromolyn have been shown to enhance neutrophil activation, chemotaxis, and mediator release

3. Which of the following statements about cromolyn is correct?
a. Cromolyn fails to inhibit bronchoconstriction induced by irritants such as sulfur dioxide
b. Cromolyn reduces the size of wheals induced in human skin with intradermal histamine
c. Cromolyn can inhibit angiotensin-converting enzyme inhibitor-induced cough in patients receiving enalapril or captopril
d. Cromolyn enhances neurokinin-P release in human skin

4. Single doses of nedocromil and cromolyn have been shown to protect against bronchoconstriction from which of the following stimuli?
a. Sulfur dioxide
b. Histamine
c. Methacholine
d. Direct acting spasmogens

5. For which of the following bronchoconstrictor agents is treatment with cromolyn and nedocromil ineffective (not protective) in the acute situation?
a. Exercise/ cold air
b. Hypertonic saline
c. Substance P
d. Methacholine

6. The anti-inflammatory effects of cromolyn and nedocromil are demonstrated by:
a. Decreased sputum neutrophils with cromolyn treatment when compared with placebo
b. Significant reduction of neutrophils in bronchial biopsy after 12 weeks of treatment with cromolyn
c. Nedocromil reduces the numbers of eosinophils in bronchoalveolar lavage at 48 hours after antigen challenge
d. Biopsy studies revealed that the number of activated macrophages is significantly reduced in the bronchial mucosa after 16 weeks of treatment with nedocromil

7. Which of the following is the recommended starting dose frequency for cromolyn and nedocromil?
a. One time per day
b. Two times per day
c. Three times per day
d. Four times per day

8. Using a spacer can increase the effective delivered dose from nedocromil sodium metered dose inhalers by:
a. Does not increase the delivered dose. A spacer only helps with the overall coordination of the inhalation
b. 2-5%
c. 10-15%
d. 20-50%

9. Nedocromil is more efficacious than cromolyn in which of the following ocular conditions?
a. Vernal keratoconjunctivitis
b. Acute seasonal conjunctivitis
c. Chronic allergic conjunctivitis
d. Bacterial conjunctivitis

Answers
1. c, page 916
2. b, pages 917-918
3. c, page 919
4. a, page 919
5. d, page 919
6. c, page 921
7. d, page 924
8. d, page 924
9. a, page 924