My apologies for a long post, but this is very exciting stuff for
me. I believe that I'm destined to become a Nasalcrom junkie!

After a disappointing fourth IPL treatment I decided to once again
renew my search for relief/cures. One part of my regimen that was
working exceptionally well for me was taking a daily Loratidine
(Clarinex, Alavert et al), as it siginificantly reduced, though did
not eliminate, certain types of flushing. I got to wondering if
there was anything else I could do to help this along, so I took
another look through the Rosacea Support Highlights
(http://rosacea.ii.net/toc.html) under Treatments | Antihistimines.
I found a post from 1999 that talked about Nasalcrom and decided to
give it a try, in addition to my daily Loratidine. The result is a
VERY signficant reduction in the visibility of the
telangiectasia/redness on my nose - in less than 24 hours! In
addition, I am breathing much easier through my nose after suffering
from swollen nasal passages since at least my early teens.

I was a bit concerned about taking two daily antihistamines, but it
appears as this is OK, as the label states "If desired, you can use
this product with other medicines, including other allergy
medicines. "

Here is the post that I found (from Jennifer & Dr. Nase in 1999):

-----

Jennifer's question -
I have been hearing a lot lately about a nasal spray called Nasalcrom
(active ingredient: cromolyn sodium), which is apparently the only
thing that can actually prevent, rather than merely suppress, hay
fever symptoms. Do you know anything about the effect of Nasalcrom on
rosacea?

-----

Dr. Nase's reply -
Im glad you asked about Nasalcrom ----- Yes, Yes, Yes, Yes!!!!!!!!!!!!

You have stumbled onto something here. Let me explain. We are now
learning that part of the problem with rosacea skin and vessels may
be due to altered function and reactivity of mast cells. Mast cells
are located in facial skin and are in close proximity to blood
vessels. Mast cells are also in great abundance in the nasal
passages. When activated, these mast cells open up (degranulation)
and release substances that cause the nearby vessels to open up
(increased blood flow) and leak (swelling). Mast cells release
histamine, cytokines, prostaglandins and inflammatory enzymes that
can cause intense bouts of inflammation. It has been speculated that
these mast cells are hyperactive or hypersensitive to stimuli such
that they release these inflammatory substances quite often and in
great concentration. These mast cells have been shown to release
these substances in response to:

1. Heat
2. Sun
3. Friction across facial skin
4. Increased nerve activity
5. Immune response
6. General irritation
7. Spontaneously

The reason why antihistamines sometimes help alleviate the redness,
flushing, burning and itching associated with rosacea is because it
blocks the actions of mast cell released histamine on blood vessels.
But, if you remember from the list above, mast cells release many
other potent inflammatory substances.

So the goal should be to stop the mast cell from releasing any of its
contents. This can be done by stabilizing the cell membrane of mast
cells -- with certain drugs. The active ingredient in nasalcrom
(cromolyn sodium) is one such drug -- but it takes some time to
stabilize the membrane of mast cells within your nasal cavity (so be
patient). So yes, I highly recommend it.

Some other interesting news:

1. Some of the allergy/immunology specialists that I gathered
information from said that after treating a handful of patients for
allergies (with oral medication that stabilizes mast cell membrane
throughout the body), some of their patients who also had rosacea
noticed an improvement in their redness and flushing by up to 70-90%.
After they stopped the treatment however, the symptoms reappeared.

2. Some physicians are now using topical cromolyn sodium (in a
hydrophilic base) to treat severe inflammatory skin conditions. Drs.
Moore and Sorensen from LSU Medical Center are reporting good to
excellent success with this treatment lotion. It is exciting to
speculate that this may be a potential weapon against rosacea in the
near future -- I am in contact with these physicians and will relay
any more news.

----

I did some searching to try to see if there is topical cromolyn
sodium available OTC, but didn't come up with anything. I did find
posts from the docs at LSU describing a double-blind, placebo-
controlled study (the patients had atopic dermatitis) using "cromolyn
sodium inhalation solution mixed into a water-based emollient cream
to a final concentration of 0.21%" (which they termed sodium
cromoglycate). Their conclusion: "Treatment with topical cromolyn in
a hydrophilic emollient vehicle has a significant anti-inflammatory
effect on moderate-to-severe atopic dermatitis. We have now
incorporated this treatment into our clinical practice." (see
http://allergy.edoc.com/1998_archives/pdf/nov_98/452.pdf for full
text)

A search through the Mayo Clinic website revealed that there are
other forms of cromolyn sodium/sodium cromoglycate (eyedrops,
inhaled, tablet forms), all of which are prescription meds. Has
anyone tried the ophthalmic form (Crolom) for occular rosacea?

I hope this helps someone. Needless to say, it has me very excited!

Steve Malone
Boise, ID