Douglas C. Heiner

Studies on iron metabolism. V. Further observations on cow's milk-induced gastrointestinal bleeding in infants with iron-deficiency anemia.

By means of a sensitive radioisotopic, technique and alternating periods of controlled diet, 17 of 34 infants with iron-deficiency anemia were shown to have abnormal occult gastrointestinal blood loss which was induced by whole cows milk (WCM), commonly associated with hypoproteinemia, and was ameliorated or, stopped by substitution of soya or proprietary milk formulas for the cows milk feeding. In eight subjects the WCM-induced bleeding did not diminish despite iron therapy so long as WCM was ingested. Limited studies directly implicated bovine serum protein as a probable inciting agent and also demonstrated a correlation between the amount of milk ingested and the degree of bleeding. Follow-up studies on four of the subjects with previous WCM-induced bleeding suggest that the phenomenon may be transient, occurring in infancy, and likely related to development of gastrointestinal immunity. The relative incidence of such WCM-related hemorrhage has not been established, but in our over-all experience it appears to occur in approximately half of young children with iron-deficiency anemia who are ingesting a quart or more of homogenized-pasteurized cows milk daily.

Virus-specific IgE and IgG4 antibodies in serum of children infected with respiratory syncytial virus

Rose Hong Dang Bui, M.D., Giuseppe A. Molinaro, M.D., James D. Kettering, Ph.D., Douglas C. Heiner, M.D., Ph.D., David T. Imagawa, Ph.D.,, and Joseph W. St, Geme, Jr., M.D. From the Departments of Pediatrics, Pathology, and Microbiology, Loma Linda University School of Medicine, Loma Linda, California, and the Departments of Pediatrics, Microbiology, and Immunology, Harbor-UCLA Medical Center, UCLA School of Medicine, Torrance, California

Studies on iron metabolism

Summary A preliminary study of a group of infantswith iron deficiency anemia has revealed evidence of occult gastrointestinal bleeding, precipitins to cows milk, and the passage of serum proteins into gastric juice. These findings are strong evidence of gastrointestinal dysfunction. Guaiac-positive stools were found in 40per cent of the iron-deficient infants tested. Precipitins to cows milk were found in 75 to 80 per cent of the iron-deficient subjects who were taking this food prior to diagnosis. This is regarded as an abnormal finding. Serum proteins in the fasting gastric juice were demonstrated in 12/13 of anemic subjects and in 2/12 of control subjects by means of agar diffusion techniques. Semiquantitative estimates of serum albumin, and gamma globulin in the gastric juice suggest a pathologic loss of these proteins in at least some anemic subjects. These findings suggest the existence of at least 2 forms of iron deficiency anemia in infants; two forms, that is, which are etiologically distinct. The first of these has been termed “primary iron deficiency”; the second is believed to depend on primary sensitization to cows milk. Mechanisms have been proposed to explain the possible interrelationships of the causative factors in each group.

Immunoglobulins and other proteins in commercial preparations of gamma globulin

The use of pooled gamma globulin in the treatment of congenital and acquired agammaglobulinemias and of a few dysgammaglobulinemias, and in the prophylaxis of certain infections, is widely accepted. In addition to this, gamma globulin is often prescribed by practicing physicians for patients with repeated infections or with chronic allergic disorders, even though its value in these circumstances is not established. Because of the importance of gamma globulin and its widespread use, it was felt that the immunoglobulin composition of various commercial gamma globulin preparations should be ascertained. In this paper, several of the differences which exist among individual commercial gamma globulin preparations are documented and discussed.

Prevalence of Avocado Allergy among Atopic Patients

A 41-year-old woman with known food allergy to avocado was treated for anaphylaxis after eating a meal containing avocado. This prompted a study to determine the prevalence of avocado induced symptoms and skin reactivity in a group of atopic patients. One hundred consecutive atopic patients with allergic rhinitis undergoing skin testing before initiation of immunotherapy were also prick skin tested to avocado. Patients with symptoms upon avocado ingestion were also assessed for specific serum IgE antibodies to avocado. Of the 100 atopic patients not selected for avocado sensitivity, 21 had positive prick skin tests to avocado. Eight of the 21 avocado skin test positive patients reported that symptoms repeatedly followed the ingestion of avocado; two reported systemic reactions, but six noted oral symptoms only. Serum IgE antibodies to avocado were elevated in seven of the eight patients reporting symptoms after eating avocado. Seven of the eight patients also reported oral symptoms following cantaloupe ingestion. Four reported similar symptoms upon eating banana. Avocado-induced symptoms occurred in 8% of 100 consecutive atopic allergic rhinitis patients unselected for avocado reactivity. Oral, and less frequently systemic, allergy symptoms appear to be more common among the atopic population than previously appreciated.

Delayed Immunologic Food Reactions

Delayed onset reactions to ingested foods may be difficult to recognize, especially if days or weeks elapse before symptoms appear. More than one immunologic mechanism may be involved and it is often difficult to assess the relative importance of each. Because immunologic responses occur in many healthy subjects who readily tolerate a specific food, little importance can be ascribed to a particular immunologic test unless it is shown that at least 95% of normals with similar exposure do not have such a response. Each food contains multiple antigens and allergic individuals differ considerably both in their immune responses and in the clinical manifestations they display. Because of this, the recognition and management of delayed food reactions is complex and requires an awareness of documented food-related disorders. It is a fruitful area for future research.

Somatic and Psychiatric Aspects of Childhood Allergies.

This monograph presents many points of view concerning the pathogenesis of allergic disorders in children, summarizes evidence for the importance of emotional as well as immunologic factors, and cites the thoughts of leading workers in psychiatry and allergy who have a special interest in children. It contains common sense ideas and suggestions of value in the management of children who have allergic disorders. Expressed divergences of opinion, however, underscore the complexity of the mechanisms which are operative in allergy, and indicate a need for refinements in methods of diagnosis and in the objective assessment of therapy. A minor criticism is that although advances in descriptive and theoretical aspects of allergy are stressed, there is little space devoted to current research in basic immunology as it relates to allergy, and not enough is said about the vast area of ignorance which remains. The great need for fresh investigative approaches and for