This invention relates to prevention and/or treatment of oral allergy symptoms, and particularly to the application of preparations to the lips for topical prevention and/or topical treatment of oral allergy symptoms.
Allergic conditions result from release of mediators, including histamine, from sensitized mast cells upon exposure to an allergen.
Individuals with pollen allergy often experience oral itchiness, i.e., irritation of various surfaces within the mouth and throat, upon ingestion of raw fruits and/or raw vegetables, often resulting in these individuals deciding to avoid eating these foods. The condition of oral itchiness, or other allergic symptom, such as irritation and/or swelling, is the result of local activation of mast cells within tissues of the mouth upon exposure to raw fruits and vegetables that cross-react with the pollens to which the individuals are allergic. As defined herein, “oral itchiness” shall also refer to any allergic symptom affecting the throat (pharynx) and/or the voice box (larynx), such a itchiness, irritation, and/or swelling thereof.
Currently, no approved medical treatment is available to alleviate this condition. Patients are advised to avoid raw fruits to which they are sensitive, but this deprives the patient of important nutrients that are found in fruits and vegetables. Avoidance also causes uncomfortable social problems. There are anecdotal reports of relief with allergy immunotherapy (allergy shots), and with use of antihistamines.
Mast cell stabilizers, such as Cromolyn Sodium, are commonly used in treatment of multiple allergic conditions, including asthma, rhinoconjunctivitis, eczema, and pruritus.
Each 5 mL ampule of Gastrocrom™ contains 100 mg Cromolyn Sodium, USP, in purified water. Cromolyn Sodium, USP, is a hygroscopic, white powder having little odor. It may leave a slightly bitter aftertaste. Gastrocrom™ Oral Concentrate is clear, colorless, and sterile. It is intended for “oral” use, i.e., to be swallowed and reach superficially situated mast cells along the gastrointestinal tract, or to be absorbed systemically via the gastrointestinal tract, just as pills, capsules, and tablets are to be swallowed and absorbed systemically.
In particular, users of Gastrocrom™ are instructed to: Squeeze liquid contents of an ampule containing a single dose of Gastrocrom™ into a glass of water. Stir the resulting solution. Drink all of the solution immediately.
Also, Cromolyn Sodium is commonly administered via a power-driven nebulizer, under the brand names: Intal™ and Intal Inhaler™. The nebulizer must have a suitable face mask or mouthpiece. Nebulizers make a liquid into an aerosol that one breathes in through one's mouth, or through one's mouth and nose, into the lungs. However, one is also commonly advised: “Do not take this medicine as a solution by mouth”. One is also advised “If you get a bitter or unpleasant taste in your mouth, gargle or rinse your mouth after you use this medicine.” Patients are also advised: “To relieve dry mouth or throat irritation caused by cromolyn inhalation, rinse your mouth with water, chew gum, or suck sugarless hard candy after each treatment.”
Patients are advised to: “Use cromolyn sodium inhalation on a regular basis for best results. It may be several weeks before you see the effects.” Patients are further advised: “It is very important that you use your cromolyn sodium inhaler properly, so that the medicine gets into your lungs. Your doctor may want you to use a spacer with your inhaler.” Cromolyn oral inhalation will no longer be available in the U.S. after Dec. 31, 2010.
Stated disadvantages include: “Cromoglicic acid requires administration four times daily, and does not provide additive benefit in combination with inhaled corticosteroids.”
It is commonly accepted that Cromolyn Sodium is poorly absorbed topically through mucosal barriers, and is consequently not absorbed well into the oral mucosa. Further, it is also commonly believed that the physicochemical properties including the polarity of the Cromolyn Sodium molecule may also interfere with its absorption and local activity.
In the co-pending patent application “PREPARATIONS FOR TOPICAL PREVENTION AND/OR TREATMENT OF ORAL ALLERGIC SYMPTOMS DUE TO ORAL CONTACT WITH FRUITS AND/OR VEGETABLES”, filed Dec. 30, 2010 application Ser. No. 12/981,726, a topical preparation of at least one of a mast cell stabilizer and/or an antihistamine is disclosed for prevention and/or treatment of oral allergy syndrome, or other allergy-related oral inflammatory processes. For example, the topical administration of Cromolyn Sodium prior to ingestion of raw fruits and raw vegetables may be used to prevent oral allergy symptoms. The topical administration can be performed by use of a solution, a powder, an aerosol, a tablet, a chewable tablet, a gel, a melting strip, a mouth rinse, a mouth swab, or a piece of candy, and may be combined with carrier molecules and/or mucoadhesive molecules to enhance efficacy.
Using the teachings of the co-pending patent application entitled “PREPARATIONS FOR TOPICAL PREVENTION AND/OR TREATMENT OF ORAL ALLERGIC SYMPTOMS DUE TO ORAL CONTACT WITH FRUITS AND/OR VEGETABLES”, filed Dec. 30, 2010, application Ser. No. 12/981,726, a number of patents afflicted with oral allergy syndrome were treated with Cromolyn Sodium mouth rinse. These patients experienced much relief of their oral allergy and throat allergy symptoms. However, some individuals still experienced lip itchiness, of both the internal and external lip surfaces. Thus, it seems that sometimes mouth rinsing of Cromolyn Sodium fails to deliver sufficient Cromolyn Sodium to the mast cells of the lip.
A general aspect of the invention is a method for the treatment and/or prevention of oral allergic symptoms of the lips due to oral contact with a food allergen. The method includes topically administering to the lips of an effective amount of at least one of: a mast cell stabilizer; an antihistamine; and a leukotriene inhibitor.
In some embodiments, the mast cell stabilizer also has anti-histamine properties.
In some embodiments, to extend contact time of the at least one of the mast cell stabilizer and the antihistamine with the lip, at least one of the mast cell stabilizer and the antihistamine is mixed with at least one of: an oily carrier and mucoadhesive material.
In some embodiments, the mast cell stabilizer is Cromolyn Sodium.
In some embodiments, the mast antihistamine is levocetirizine.
In some embodiments, the leukotriene inhibitor is montelukast.
In some embodiments, the mast cell stabilizer is mixed with a carrier molecule so as to enhance local absorption.
In some embodiments, an effective amount of at least one of a mast cell stabilizer and an antihistamine is applied by at least one of: a lip swab, a lipstick, a lip roller, a lip brush, a sponge, a tube, a jar.
Another general aspect of the invention is the use of a mast cell stabilizer in the manufacture of a medicament for the topical treatment and/or topical prevention of oral allergic symptoms of the lips.
Another general aspect of the invention is the use of an antihistamine in the manufacture of a medicament for the topical treatment and/or topical prevention of oral allergic symptoms of the lips.
Another general aspect of the invention is the use of a leukotriene inhibitor in the manufacture of a medicament for the topical treatment and/or topical prevention of oral allergic symptoms of the lips.
Another general aspect of the invention is a pharmaceutical formulation for use in the prevention and/or treatment of oral allergic symptoms of the lips of a person. The pharmaceutical preparation includes an effective amount of at least one of: a mast cell stabilizer and an antihistamine, the effective amount being effective for treatment and/or prevention of oral allergic symptoms of the lips of a person.
In some embodiments, the mast cell stabilizer is selected from: Cromolyn Sodium, Cromoglicate (cromolyn), Nedocromil, Pemirolast potassium, Nedocromil sodium, Lodoxamide tromethamine, Bepotastine besilate, Epinastein HCl, Azelastine HCl, Olopatadine HCl, Ketotifen fumarate.
In some embodiments, the antihistamine is selected from: first generation antihistamines, second generation antihistamines, third generation antihistamines.
In some embodiments, thje oral allergic symptoms of the lips of the person are due to the consumption of at least one of: a piece of raw fruit, a piece of raw vegetable, a nut, fish, shellfish, dairy, baked goods, eggs, soy, wheat, corn.
In some embodiments, the pharmaceutical formulation further includes a delivery medium including at least one of: a thickening agent, a viscous agent, a wetting agent, an adhesive agent, a flavored solution, a taste-masking compound, a lip-gloss color base.
In some embodiments, the pharmaceutical formulation is delivered to oral mucosa of the lips of the person as one of: a liquid, a liposome suspension, a gel, a butter, a wax-like solid.
Another general aspect of the invention is an applicator device for treatment of oral allergy symptoms of the lips. The applicator device includes: a solution of at least one of: a mast cell stabilizer, a leukotriene inhibitor, and an antihistamine; a container for containing the solution; and a transfer device, cooperative with the container, for transferring the solution to the lips of a person experiencing oral allergy symptoms.
In some embodiments, the transfer device is one of: a brush, a sponge, a roller ball, a hole sized to enhance capillary action, a nozzle.
Another general aspect of the invention is an applicator device for treatment of oral allergy symptoms of the lips. The applicator device includes: a lipstick incorporating at least one of: a mast cell stabilizer, a leukotriene inhibitor, and an antihistamine; and a lipstick dispenser for dispensing the lipstick.
The invention will be more fully understood from the following detailed description, in conjunction with the following figures, wherein:
Activation of mucosal mast cells in the oral cavity upon ingestion of raw fruits and/or raw vegetables may result in oral itchiness, that often precludes affected individuals from consuming raw fruits and vegetables. This may significantly adversely affect the allergic individual's quality of life, due to both personal and social implications, and it may compromise self-esteem especially in the pediatric age group, and may further raise nutritional concerns.
According to the invention, blocking the release of histamine and other mediators from the mast cells by mast cell stabilizers, such as Cromolyn Sodium, may enhance the ability of affected individuals to consume raw fruits and raw vegetables that otherwise would trigger an allergic reaction.
The proposed invention consists of introduction of a mast cell stabilizer, such as Cromolyn Sodium, prior to ingestion of fruits and vegetables, either through swallowing, e.g. as tablets, as capsules, or as a liquid or topical application, such as in the form of melting tabs, aerosol, oral wash, swabs, candy, or lollypop. Topical application of the mast cell stabilizer before consuming a food allergen, such as raw fruit or raw vegetable, will PREVENT or usefully minimize the uncomfortable oral allergic reaction, such as itching, swelling, etc.
Antihistamine (either first generation, or second generation) can be added to the topical formulation of the mast cell stabilizer, or it can replace it.
For example, to overcome its poor mucous-membrane absorption, Cromolyn Sodium may be mixed in a viscous solution as well as with mucoadhesive materials, such as cyclodextrins, chytosan , alginate, glycerine, propylene glycol so as to extend contact time between Cromolyn Sodium and the oral mucosa and increase the residence time of cromolyn on top of the mucosa by forming a coating over this membrane. Alternatively, or in combination with the foregoing, or Cromolyn Sodium may be mixed with drug absorption enhancers (e.g. EDTA, or Cyclodextrine or a surfactant—e.g polyoxyethelene 9-lauryl esther, Tween 60, poly acrylic acid, or bile acids—sodium cholate, sodium glycocholate, lauryl sulfate) or with carrier molecule which increase drug absorption, such as the carrier molecule, sodium N-(8 [2-hydroxybenzoyl]amino)caprylate, referred to as “SNAC”, to enhance its local and systemic absorption, and thereby maximize its effect.
Take the preparation of the invention five to fifteen minutes before eating a raw fruit that is expected to cause an oral allergy reaction. Take a test amount of the fruit to verify that no symptoms are experienced, i.e., that the oral allergic reaction has in fact been prevented.
An example of a safe and effective formulation is to combine 100 mg of Cromolyn Sodium, in 5 cc water (e.g. Gastrocrom™) with 100 mg of glycerin to create an oral solution. The glycerine helps the patient keep it in the mouth.
Alternatively, instead of glycerin alginate can be used as a 1% to 10% solution in water (e.g. 1 mg alginate/100 ml water)
Glycerol can also be used, usually in the 5-20% concentration range, and propylene glycol 1-10% can be used also. All are GRAS.
A flavoring and/or sweetener can be added to make the preparation more palatable.
Or, the mast cell stabilizer can be formulated as part of a mouth rinse, having generally the same surfactant properties as Anti-Plaque mouth rinse to help the preparation dwell longer in mouth.
Cromolyn Sodium must be taken into and topically applied to the oral mucosa so as to create a four-hour effectiveness window. Nevertheless, the preparation of the invention can be effective even when taken just a few minutes before eating fruit.
Cromolyn Sodium is poorly absorbed through mucosal barriers unless it is attached to a carrier molecule. Topical application of Cromolyn Sodium when attached to a carrier molecule is enhanced in effectiveness.
However, the polarity of the Cromolyn Sodium molecule may also interfere with its local and/or topical activity, and thus to maximize its effect, it may be embedded in a viscous solution, or it can be mixed with mucoadhesive.
Another benefit of the preparation of the invention is that swallowing this preparation is NOT needed, thereby reducing the amount of drug to which a patient would be exposed.
When using an anti-histamine either alone or in combination with a mast cell stabilizer, the anti-histamine should work fast, and be less sedating. The mast cell stabilizer selected should be the most effective mast cell inhibitor, i.e., a mast cell inhibitor of known efficacy in a variety of allergic conditions, with an excellent safety record, with minimal unpleasant taste. Also possibly combine with a taste masker, such as a flavor and/or a sweetener.
Suiteable Mast Cells Stabilizers Include:
The medications that are listed below are listed as Mast cell stabilizers for the eye.
Those that are also antihistamines are marked: “also an antihistamine.” These all can be used as mast cell stabilizers in preparations of the invention:
Below are medications that are listed only as antihistamines:
The preparation can be applied topically as a mouthwash that includes glycerin.
It must stay in the mouth for a short while (15 to 90 seconds), long enough to be in contact with the oral mucosa and form a temporary coating on its surface. It will begin its effects within a short time after contact with the mucosa, about one to fifteen minutes.
The oral preparation can be used ad-hoc before ingestion of an allergenic food, or preventively, one to four times a day.
The preparation of the invention can also be applied topically as a mouth spray, or by a liposomal emulsion. A liposomal emulsion formulation easily enters the oral mucosa, thereby providing enhanced effectiveness. Much like human cells, liposomes encapsulate the active ingredients of the preparation within a lipid bilayer, thus enabling them to penetrate readily into the mucosa of the mouth.
Oral allergy can also occur upon consumption of raw nuts.
The pharynx and larynx can be involved with swelling and or itching.
The invention can also be used for prevention and/or treatment of minor local allergic reaction within the mouth to any food, such as cake that includes eggs and/or milk and/or soy and/or fish and/or shell-fish.
Oral allergy predominantly occurs when the fruits and vegetables are raw.
Topical antihistamines such as diphenhydramine (Benadryl) work well as an antihistamine incorporated into the preparation of the invention.
Local anesthetics for topical use such as benzocaine (currently used as a topical cream Lanacaine™ or Pramocaine™), can also advantageously be included in the preparation of the invention to further decrease discomfort due to oral allergy symptoms.
Counterirritants, such as mint oil, menthol, or camphor—can be advantageously included in preparations of the invention, alone, or in combination with other active ingredients therein, such as Cromolyn Sodium.
Flavoring compounds and/or taste-masking compounds can also be advantageously included in the preparation of the invention. Even a preparation of Cromolyn Sodium, water, and a flavoring compound (e.g., Strawberry, Cherry, Lemon, Mint) can be used as an effective mouth rinse or mouth wash for preventing and/or treating oral allergy symptoms. Also, a preparation of Cromolyn Sodium and a flavor masking compound to mask any unpleasant taste of the Cromolyn Sodium can be used as an effective mouth rinse or mouth wash for preventing and/or treating oral allergy symptoms.
Cromolyn Sodium: This drug has been approved by the U.S. Food & Drug Administration (FDA) for sale by prescription, and after decades of use, has an excellent safety record. Cromolyn Sodium in nasal form (NasalCrom™) is presently sold OTC in the USA. Cromolyn Sodium has been used for decades in treatment of multiple allergic conditions including asthma, but not yet for the prevention and/or treatment of oral allergy symptoms, including Oral Allergy Syndrome. Oral allergy symptoms include the oral itchiness associated with ingestion of raw fruits, such as raw apples, and raw vegetables, such as raw carrots. Side effects of Cromolyn Sodium are considered very uncommon and when swallowed, may include headache; GI upset; itchiness; irritability; rash; and muscle pain. Since the preparation of the invention provides oral exposure without swallowing the drug, side effects are expected to be even less common.
Cromolyn Sodium is a generic drug name for a mast cell stabilizer, and is sold under trade names that include: Gastrocrom™, Opticrom™, Crolom™, Nasalcrom™ and Intal™.
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A textured plastic ball can be used, such as a hollow polypropylene ball. The texture of the ball enhances the ability of the ball to roll over the surface of the lip and transfer the active ingredient 102 to the lips.
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In case a patient exhibits symptoms of oral allergy after coming into contact or after ingesting a food allergen, it is not too late to apply the active ingredient 102. In fact, when the active ingredient is applied, symptoms are relieved promptly, i.e., within seconds. Thus, the active ingredient 102 can be use both as a preventive modality and as a treatment modality for oral allergies involving the oral mucosa and lips. After the application of the active ingredient 102 to the lips, the cap 104 is screwed back on to the body 100 so that the device remains clean and ready to be reused.
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Lipstick 1300 has an inner thread that is screwed onto applicator screw 1302 that is connected to handle 1304. The applicator screw 1302 together with the handle 1304 are free to rotate about their natural axis relative to body 1306 without disengaging from body 1306. The lipstick 1302 can move up and down within the body 1300, when moved by the applicator screw 1302, but is mechanically constrained so as to not rotate along its axis. Cap 1308 has a snug fit to body 1306 so that a reasonably mild force is required to slide the cap 1308 off body 1306. The required force should be low enough to enable easy removal, yet sufficient to hold the cap 1308 in place and prevent unintentional removal during casual handling, such as placing the lipstick in or removing the lipstick from a pocket, or storing the lipstick in a purse. It is also possible to introduce a slight thread to the outer surface of the body 1306 and a matching thread to the corresponding inner surface of the cap 1308 so that removal of the cap 1308 would require a slight twist.
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Active ingredient(s) can also be applied to the lips as a lotion, a cream, an ointment, or a gel. In each case, one of average skill in the art would know how to formulate each so as to deliver an effective amount per dose. Effective amount depends on the active ingredient(s) used. For example, in the case of Cromolyn Sodium an effective amount is 0.1 ml of a solution of 100 mg of Cromolyn Sodium per 5 ml of water. In the case of antihistamines, e.g., levocitirizine, an effective amount is 0.1 ml of a solution of 0.5 mg levocitirizine per 1 ml water. In the case of leukotriene inhibitors, e.g., montelukast (e.g., Singulair™), an effective amount is 0.1 ml of a solution of 1 mg montelukast per 1 ml water.
Active ingredients can also be applied to the lips in the form of a lip gloss that imparts gloss and/or color to the lips.
Some formulations of the active ingredients can have a taste that is objectionable or unpleasant to some people. For example, some people experience a slightly bitter taste after administration of Cromolyn Sodium. Unpleasant tastes of medications can be masked or blocked. Thus, it may be advantageous to add to some active ingredients and/or a delivery medium a taste-masking or taste-blocking compound.
Some formulations of the active ingredients benefit from the addition of coloring agents that enhance the subjective and/or aesthetic experience of the patient.
Other modifications and implementations will occur to those skilled in the art without departing from the spirit and the scope of the invention as claimed. Accordingly, the above description is not intended to limit the invention, except as indicated in the following claims.
This application is a divisional application of U.S. application Ser. No. 13/026,972, filed Feb. 14, 2011 and entitled “APPLICATION TO THE LIPS OF PREPARATIONS FOR TOPICAL PREVENTION AND/OR TREATMENT OF ALLERGIC SYMPTOMS DUE TO ORAL CONTACT WITH FOODS,” which is hereby incorporated herein by this reference in its entirety; which is a continuation-in-part (CIP) of U.S. application Ser. No. 12/981,726, filed Dec. 30, 2010 and entitled “PREPARATIONS FOR TOPICAL PREVENTION AND/OR TREATMENT OF ORAL ALLERGIC SYMPTOMS DUE TO ORAL CONTACT WITH FRUITS AND/OR VEGETABLES,” which is hereby incorporated herein by this reference in its entirety.
Number | Date | Country | |
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Parent | 13026972 | Feb 2011 | US |
Child | 13365040 | US |
Number | Date | Country | |
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Parent | 12981726 | Dec 2010 | US |
Child | 13026972 | US |