Abe J. Sosman

Food-dependent exercise-induced anaphylaxis

This article describes four cases of exercise-induced anaphylaxis occurring only in temporal relationship to the ingestion of food. One individual developed anaphylaxis if exercise followed the ingestion of any food within 2 hr. Three other individuals had symptoms only if celery was ingested in relation to exercise. Skin reactivity to fresh celery extracts was demonstrated in all three individuals. The episodes were prevented by avoidance of food ingestion in relation to exercise. This syndrome appears to be a variant of exercised-induced anaphylaxis.

Hypersensitivity to Wood Dust

Abstract Respiratory disease resulting from prolonged exposure to wood dusts may be due to a hypersensitivity reaction in addition to the nonspecific toxic or irritant effects of the inhaled materials. In four patients the hypersensitivity response was manifested by two clinical patterns, one characterized by immediate onset and rapid reversibility of asthmatic symptoms, and the other by a more delayed onset and more gradual reversibility. In this disease the clinical history and challenge with the suspected offending dust proved to be of greater diagnostic importance than skin testing.

Interstitial Lung Disease Due to Contamination of Forced Air Systems

Eight patients had hypersensitivity pneumonitis due to contaminated home or office forced-air heating or air-conditioning systems. We studied their clinical and laboratory features, and the results indicated that this disease may occur as an acute or insidious form differing in type and intensity of respiratory and systemic symptoms. Thermophilic actinomycetes contaminatinf the forced air systems were identified as the sensitizing agents in most cases. Precipitating antibodies to the organisms could be shown in the serums of the patients and the antigen identified by immunofluorescent studies in the three lung biopsies examined by this method. Inhalation challenge studies with the cultured organism or other materials obtained from the forced air systems reproduced the clinical syndrome in the four patients tested. Avoidance of the contaminated system, and the use of corticosteroids in more severe cases,seems to be appropriate therapy for patients with this disease.

Immunologic studies of pigeon breeder's disease

Abstract Immunological reactions of patients with pigeon breeders disease were studied during a symptomatic and an asymptomatic phase of the illness. The decrease in severity and recovery from the illness were accompained by a decrease in the intensity of skin reactivity and diminution in titer of γG-antibodies to various pigeon antigens.

Metabolic changes in exercise-induced asthma

Five patients with a history of post‐exercise bronchoconstriction and eleven control subjects were exposed to gradually increasing work loads on a bicyle ergometer. The asthmatic patients showed higher blood lactic acid levels at all work loads than the control subjects. In contrast to findings in the controls, the plasma free fatty acid in the asthmatics failed to ‘rebound’ following the cessation of exercise; and in two out of three patients plasma FFA did not rise after epinephrine injection. In addition, the asthmatic patients consumed less oxygen during the exercise than the controls.

SUMMARIES OF RESEARCH REPORTS

At the Research Workshop, the first paper :* was presented by Donald P. Schlueter, M.D. His coinvestigators were Drs. Jordan N. Fink and George P. Hensley, all members of The Medical College of Wisconsin. Dr. Schlueter described two paper mill workers with the clinical manifestations and laboratory findings consistent with the chronic form of hypersensitivity pneumonitis, which is also known as extrinsic allergic alveolitis. At the onset of their illness, these two patients experienced recurrent acute and sub-acute episodes of cough, dyspnea and fever, which resolved spontaneously within hours to days when they were away from the environment related to their occupation of bark stripping and chipping of logs in the production of wood pulp. Failure to recognize the early stages of this hypersensitivity pulmonary disease led to their continued exposure and the development of an advanced form of pulmonary disease, which resembled idiopathic pulmonary fibrosis. Chest x-rays showed bilateral nodular infiltrations. The abnormal pulmonary function tests demonstrated a primary restrictive type impairment with a diffusion defect. A lung biopsy also showed an interstitial granulomatous pneumonitis consistent with the diagnosis of a hypersensitivity pneumonitis. An environmental survey of their work area at the mill revealed the presence of a variety of common soil molds, which included Alternaria, Homeodendrum, Rhizopus and other varieties of contaminating molds. By means of immunodiffusion testing of the patients’ sera, precipitating antibodies were demonstrated against several of these mold antigens, with the highest titer directed against an extract of Alternaria. Both of these patients had advanced and irreversible pulmonary disease when they were first seen by these investigators. Challenge by inhalation exposure with an extract of Alternaria was attempted. Both patients developed pulmonary and systemic reactions within six hours following challenge with the alternaria antigen. It is well recognized that hypersensitivity pneumonitis may be the result of either the inhalation of a variety of fungal spores, or the dust derived from material heavily contaminated by fungi. This report is the first to describe this entity resulting from the inhalation of the common soil mold, Alternuria. Although other molds were identified within the occupational dust, the patients demonstrated lower titers of precipitating antibody to several of these molds. Unfortunately the investigators were unable to rechallenge these two paper mill