Bret Ratner

Management of hay fever in children, with special emphasis on immunization (desensitization)

Summary 1. Hay fever is concerned with the acquisition of pollen sensitivity and may be related to the amount of exposure to particular pollens. 2. The diagnosis of hay fever should be made early so that proper treatment can be instituted in order to avoid the development of the more serious asthma. 3. The importance of nasal eosinophilia is emphasized in differentiating hay fever from infectious rhinitis. 4. Specific allergenic sensitivity must be determined in order to arrive at an adequate program for specific therapy. 5. Specific therapy must include all the positive reacting pollens. 6. Supportive therapy and adjuvant measures are discussed. 7. The perennial method of treatment is the one of choice. 8. Small dosage therapy is advocated. 9. In order to achieve a satisfactory immunologic resistance to the sensitizing pollens, treatment must be continued over a number of years. 10. The immunization procedure, if conscientiously and comprehensively pursued, is effective in reducing or actually preventing the symptomatology of hay fever, and has the noteworthy added virtue of preventing pollen asthma.

Pediatrics in General Practice

For general practitioners, in whose practice is included a major proportion of the medical management of infants and children, and for the specializing pediatrician as well, Postgraduate Medicine presents this special regular department devoted to brief discussions by recognized authorities on their preferred methods of the treatment and management of diseases and problems of infancy and childhood.

GENERAL DISCUSSION. II

I want to thank the Chairman for asking me to join in the discussion of this monograph. My first impulse would be to voice my agreement with many of the viewpoints expressed here, and to terminate my remarks a t that point. This author has, for many years, held to the view that real progress in clinical allergy would be made largely in the domain of animal experimentation. For my own part, I have probably learned more about human allergy from our studies in the guinea pig on experimental asthma, sensitization in utero, and passage of proteins through various living membranes than could have been arrived a t from studies in the clinic. It is well, therefore, a t a conference on the subject of histamine to emphasize the importance of the immunologic basis of the hypersensitive phenomenon and bring again to our attention the three fundamental criteria of allergy: (1) the dependency upon substances known to be antigenic; (2) specificity; and (3) participation of antibodies. Bearing these three facets in mind, namely antigenicity, specificity, and antibody participation, I might here project the problem from the lower animal to the clinic. We know that allergy is an ever present battle against the invasion into the body of foreign substances inhaled, ingested, or injected. The amelioration of allergy is based on the ability of the body to produce enough antibodies so that they may eventually reach the circulation and act as blocking or neutralizing bodies. To this end the body must continually manufacture immunizing agents. There is no single drug or substance which I can envisage as being capable of dispelling this specific antigen-antibody mechanism which is so inherent a part of the animal economy. The hereditary atopic theory, which sought to separate human allergy from anaphylaxis in the lower animal, has been rudely brought to a halt by the observations that the atopic reagins (Prausnitz-Kustner antibodies) are found not only in the spontaneous allergies of asthma, hay fever, and urticaria occurring in man, but have also been found in the artificially induced serum sickness, Ascaris sensitivity, insulin sensitivity, and certain drug sensitivities, some physical allergies, as well as in hypersensitive states in the lower animal. Animal work emphasizes anew that it is the study of the many ways and means that antigens have of invading the body and producing interreactions with tissue antibodies which offer the greatest hope for good and lasting results. Such studies entail a search for all offending substances, their elimination or reduction, and a definite program for building up tolerance. The control of environmental excesses, highly antigenic food excesses, promiscuous and thoughtless use of sera and drugs, and control of diseases which tend to