Cecil Collins-Williams

In vivo and in vitro correlates of food allergy

Sera of 86 patients clinically sensitive to foods were tested by passive sensitization of human and/or monkey lung (127 tests) and the radioallergosorbent test (RAST) (72 tests), using whole-food antigens; the results were compared with skin (prick) testing. Results of the prick test correlated with history in 76% of cases; lung sensitization correlated with history in 37% and with prick test in 57%; and RAST correlated with history in 54% and prick test in 72%. It is concluded that a very large percentage of adverse reactions to foods are IgE-mediated. The prick test is of use in diagnosis, particularly when combined with RAST; the lung sensitization test is technically impractical and not a reliable indicator. The best diagnostic method is careful history with food challenge and withdrawal and rechallenge; the latter is safe except in patients with a history of violent reaction.

Diagnosis of food allergy by the radioallergosorbent test

The radioallergosorbent test (RAST) was positive in 52.5% of 200 sera representing 200 food hypersensitivities from 108 patients with a history of definite immediate-type reactions to foods. Corresponding prick test was performed for 170 of the sera. The latter test was positive in 70%, the RAST was positive in 52%, and iether prick test or RAST was positive in 74%. It is concluded that the RAST is positive less frequently than the prick test in the diagnosis of immediate-type food allergy in clinically sensitive patients, but that the performance of both tests increases slightly the possibility of confirming the diagnosis. However, the RAST is useful for further evaluating positive prick tests with foods that do not correlate with clinical hypersensitivity.

Clinical Spectrum of Adverse Reactions to Tartrazine

Tartrazine, a common additive in foods and drugs, often causes adverse reactions such as recurrent urticaria, angioedema, and asthma and is frequently implicated in hyperkinesis. This paper summarizes the recent literature on the subject and outlines a practical approach for the practicing physician to diagnose and treat these patients in an optimal manner.

Clinical and physiological assessment of asthmatic children treated with beclomethasone dipropionate

Forty-two perennial asthmatic children were selected for a 12-wk study using beclomethasone dipropionate. The groups included 21 steroid-dependent children (Group I) and 21 patients (Group II) whose disease was of sufficient severity that corticosteroid therapy was contemplated. All children received the drug in a dose of 100 mug 4 times daily. During the study, oral prednisone was withdrawn from the steroid-dependent children while other therapy was essentially unchanged. Group II children underwent a double-blind trial, receiving beclomethasone for 6 wk and placebo for 6 wk. Objective assessment of adrenal and pulmonary function was obtained at regular intervals. For the latter, total lung capacity and its subdivisions, airways resistance, maximum expiratory flow volume, and oxygen tension, were measured in both groups. In Group II static elastic recoil was measured also. For most tests the results were statistically significant. In both groups, 18 of 21 patients demonstrated an excellent clinical response, no evidence of adrenal suppression, and improvement in pulmonary function. Forty of 42 patients were followed for another 12 wk, and 19 of each group did well. After 20-24 wk of therapy, 16% of patients harbored monilia in their oropharynx, and 1 patient had clinical monilial stomatitis. Within the limits of the time of the study, beclomethasone dipropionate appeared to provide adequate clinical control in many chronic, severe, steroid-dependent and nonsteroid-dependent asthmatic children.

Antihistamines in Asthma

Reports in the literature have suggested that antihistamines are contraindicated in asthma because they dry the secretions in the upper and lower respiratory tracts. However, the consensus is that this is not the case. There may be a subset of asthmatics who report wheezing and a feeling of tightness in the chest after taking antihistamines but most of those who have severe perennial allergic rhinitis do not have adverse reactions and indeed benefit considerably from antihistamines.

Asthma: Current Concepts

Concepts of the pathophysiology and therapeutic management of asthma must take into account more than the appearance and disappearance of the wheeze. The outstanding pathologic finding in the asthmatic lung is the presence of viscid plugs in the bronchi and bronchioles; other features include edema of the bronchial mucosa and submucosa, shedding of superficial columnar epithelial cells into the bronchial lumen, dilatation of submucosal capillaries, mast cell degranulation, infiltration by eosinophils, and marked thickening of the basement membrane.

Serum Protein Studies in Intractable Asthma A Preliminary Report

Asthma is an extremely common disease occurring in 0.58% of the population2 and usually starting in childhood. It is, therefore, comparable in incidence to peptic ulcer (0.63%) and almost comparable to neoplasm (0.83%). With adequate treatment approximately 88% of children do well.4 Of the remaining 12%, some do poorly because of failure to follow directions or because of complicating illnesses such as fibrosis of the lung or cystic fibrosis of the pancreas. A small group, however, may be described as intractable. For the purpose of this paper, intractable asthma is defined as asthma which does not respond to treatment in a two-year period in patients who have had adequate investigation and adequate treatment.