Douglas E. Johnstone

Melon and banana sensitivity coincident with ragweed pollinosis

Abstract Because of a suspected relationship between ragweed pollinosis and melon or banana sensitivity, 2,067 consecutive patients in an allergy practice were queried with regard to symptoms from melon or banana ingestion. Of 1,447 patients with pollinosis, 90 complained of oral pruritus, which was by far the most common symptom caused by these fruits. No melon- or banana-induced oral pruritus occurred in any of 620 allergic patients who did not have pollinosis. Melon- or banana-sensitive patients as a group showed the following characteristics: (1) All were sensitive to ragweed or grass pollen clinically and by skin test. (2) Most showed a much higher degree of skin test sensitivity to ragweed than a control group of patients with ragweed pollinosis who were not melon or banana sensitive. (3) The prevalence of asthma was much higher in the melon- and banana-sensitive group (78 per cent) than that in the control group (47 per cent). Immunologic studies with rabbit antisera showed no common antigens by Ouchterlony gel diffusion between ragweed, melon, and banana or between timothy, melon, and banana, although common antigens were found between all of the melons, (watermelon, cantaloupe, and honeydew). Passive cutaneous anaphylaxis in guinea pigs demonstrated a strong cross-reaction between ragweed antigen and cantaloupe antibody, suggesting common antigenic determinants as an explanation for the melon sensitivity-ragweed pollinosis syndrome. Possible alternative causes of this relationship are discussed.

Alpha-1 antitrypsin in childhood asthma.

Alpha-1 antitrypsin (AAT) phenotypes and serum levels were studied in two childhood perennial asthmatic populations. The first was an ambulatory, mostly mild nonsteroid-dependent group living in Rochester, N.Y. The second was a more severe mostly steroid-dependent group residing at an asthma residential treatment center in Denver, Colo. The prevalences of alpha-1 antitrypsin protease inhibitor (Pi) tyes were the same for bothe groups and similar to prevalences in a random population. Alpha-1 antitrypsin serum levels were significantly elevated for the mild nonsteroid-dependent group when compared to the more severe steroid-dependent group. The steroid-dependent group had serum levels similar to a group of nonasthmatic control children. These findings indicate that there is not a strong association of alpha-1 antitrypsin Pi variants such as Pi MZ or Pi MS with more severe asthma. Elevated serum levels in the milk perennial asthmatic group may be the result of chronic inflammatory processes. Normal levels in the sterioid-dependent group may be the result of corticosteroid control of inflammation associated with asthma.

Leukocyte histamine release in Hymenoptera-allergic patients: Correlation with skin test reactivity and changes following hyposensitization therapy

Abstract We have studied 46 Hymenoptera-allergic patients and 11 nonallergic controls by grading the severity of their sting reaction, determining their skin test reactivity, and performing human leukocyte histamine release with a commercial mixed stinging insect extract. A significant correlation was found between increasing severity of sting reaction and increasing skin test reactivity (p

The case for hyposensitization: its rationale and justification.

If physicians who give primary medical care to children will become familiar with the appropriate applications of hyposensitization therapy, huge prophylactic, as well as therapeutic, rewards will ensue.

A study on boric acid absorption in infants from the use of baby powders

T HAT boric acid may be toxic when absorbed into the t~lood stream in suftleiently large quantities througk misuse of the pure chernieal is a fact well known to most physicians. 1-~ Unfortunately, there has arisen, however, a wholly baseless misconception with respect to tile safety of various commercially marketed baby powders containing amounts of boric acid varying from 3 to 5 per cent. The assumption appears to be that because such powders contain small amounts, albeit in a chemically different form, of a substance capable of proving toxic under conditions of misuse, the combined product must of necessity be toxic, in spite of the fact that millions of cans of baby powder containing boric acid or its salts hav.e been marketed for some fifty yea.rs without a single substantiated instance of toxicity. In the light of these observations, the work to be reported was underiaken under very closely controlled chemical and clinical conditions to explore the many factors involved in the use of borated baby powder.

Prophylaxis of allergic disease in the newborn infant.

T HE published criticisms2, 8; I13 I2 of our work,G, lo on the prophylaxis of allergic disease in the newborn child and in early infancy have, naturally, been of great interest to us. They are very welcome, principally because they will be of assistance in future studies. At the moment, the discussion of these criticisms gives us the opportunity of putting into print some sidelights on our work which, while of considerable significance, we did not think of sufficient importance to include in our original publications. These studies were begun about twenty years ago when one of us (J. G.) was greatly impressed by the suffering of infants with severe eczema, the anguish such an infant could cause in a family, and the consequent reluctance of the parents of such a child, particularly when the first-born, in view of the commonly accepted knowledge of the hereditary nature of allergic disease, to have more children. It was felt that one of the best contributions one could make as a pediatrician was to study what might be done in the way of prophylaxis of allergic disease in the newborn or young infants. It seemed possible that many of the allergic disturbances in this age group were due to cow’s milk, which, as was later pointed out,3 is not a natural food for newborn human infants, as is the common opinion, but was designed by nature for feeding calves. About the time this interest was developed, Hill and Stuartg had reported on a commercially available soybean milk” devised by them with which considerable success was experienced in the feeding of infants with eczema. Whether or not one could feed newborn infants from birth on soybean milk was not well established, as this had been done only in the case of one infant by Tso,l” a Chinese physician. The reasons for starting a newborn infant on soybean milk in an attempt to prevent the development of allergic disease in the newborn child5 were explained to a number of pregnant mothers who had had the most bitter experiences with atopic dermatitis in their infants in the past. With great reluctance, some consented to this experiment. The success of the procedures advocated was such tha.t, within a few years, there was no difficulty in persuading the mothers of potentially allergic infants to start their newborn babies on a cow’s milk substitute, and eventually we saw many new patients because of this method of feeding. It was soon obvious that controlled studies should be made, despite our clinical impression of the favorable results. It also seemed perfectly evident that sibling controls, rather than alternate cases, would be best for this purpose.

Use of soybean milk as an aid in prophylaxis of allergic disease in children.

T HE purpose of this study was to determine whether the incidence of atopic dermatitis (eczema) and other major allergies, as well as their allergic sequelae in potentially allergic infants might be influenced by completely withholding cow’s milk from their diets from birth until the age of six to nine months. By a potentially allergic infant is meant an infant who has one or more allergic parents or siblings. A previous publication1 has discussed the underlying reasoning for, and demonstrated the feasibility of, raising infants in this manner. Ninety-one infants comprised the experimental group. They were all either offsprings or siblings of one or more individuals with one or more major allergies, that is, asthma, pollinosis (rose or hay fever), atopic dermatitis (eczema), or perennial allergic rhinitis (P.:1.R.). Cow’s milk was deliberately withheld from each infant from birth. Each was fed a commercially available soybean formula.” Table I indicates the age at which these infants were changed from soybean milk to cow’s milk. Table 11 shows the length of the follow-up of this group which was continued until the t,irne of this writing. The histories of sixty-five siblings of those in the experimental group were also reviewed. In addition, a second control group was chosen as follows : From reviewing the histories of 4,710 allergic individuals in 1,215 families, 175 children with approsimatelp the same allergic family history were selected. Those in the sibling group, as well as those in the nonre!ated control group, were considered as suffering from a major allergy only if their allergic symptoms occurred !J!-/ or before the age Of onset of their counterparts in the experimental group. For each group the following data were sought: (1) the total incidence of major allergic diseases, (2) the incidence of at,opic dermatitis. (3) the incidence of other allergies to cow’s milk (colic, diarrhea, etc.), and (4) the allergic sequelae of atopic dermatitis and other allergies due to cow’s milk. Table III summarizes the comparative data obtained from the three groups of infants studied. Major allergy occurred in 14 per cent of the experimental group, in 64 per cent of the siblin g controls, and in 52 per cent of the unrelated control group. The chances that these findings are due merely to coincidence is less than one in one hundred (Chi square equals sixteen). The differences in

Attempts to produce localized Shwartzman reaction in seven species of animals.

Conclusions 1. The localized Shwartzman reaction was produced in 62% of 265 New Zealand albino rabbits, using 3 different toxins (a meningococcal agar washings toxin, a partially purified “polysaccharide toxin” prepared from a culture of Serratia marcescens, and a crude Serratia marcescens agar washing toxin). Using these same toxins, localized Shwartzman reactions could not be induced in 15 Macacca mulatta monkeys, 20 mongrel dogs, 16 guinea pigs, 15 Wistar albino rats, 16 small swine (Hormel “Minipigs”), and 4 Toggenburg goats. 2. One post-partum lactating female goat developed a typical “generalized Shwartzman reaction” (i.e. renal cortical hemorrhagic necrosis).

A study of the influence of experimentally induced hypothyroidism on antibody production and decay rates

The effect of hypothyroidism induced by intravenous injections of I/sup 131/ on antibody production, the anamnestic response, and on antibody decay rate, compared to normal animals, was studied in 63 rabbits. After initial antigenic stimulation, normal animals reached a higher peak titer on an average of 5 days earlier than hypothyroid animals. Antibody half-life in these animals, as measured by time for antibody concentration to fall 50% from peak titer, was 11.4 days in normal compared to 21.3 days in hypothyroid animals. Following a second antigenic stimulation, normal rabbits reached a peak titer in an average of 6.4 days compared to 15 days for hypothyroid animals. The half-life for both groups was measured by determining the rate of disappearance of passively infused antibody. The half-life, thus measured, in normals was 2.4 plus or minus 0.2 days and was 8.8 plus or minus 1.9 days for hypothyroid animals. The time required for serum-tissue equilibration of infused antibody in normals was 1.0 plus or minus 0.00 days compared to 2.3 plus or minus 1.5 days in hypothyroid animals. (auth)

Tamm-Horsfall glycoproteinuria: An early index of human renal allograft rejection

Urinary glycoprotein of Tamm and Horsfall (T & H) is a renal substance found in the ascending limb of the loop of Henle and the distal convoluted tubule. Excretion can be measured by 0.58 M NaCl precipitation. Normal excretion = (1.7–2.1 mg/hr/1.73 sq. m. body surface area). Increased excretion occurs with dichromate-induced renal tubular damage in rats. This observation suggested that monitoring T & H excretion might provide an early index of kidney damage in human allograft rejection. Eight patients (4 males, 4 females. Age 9–49 years) were studied during the first 37–120 days post-transplantation. Seven rejection episodes in 5 patients were diagnosed clinically. In each instance T & H excretion exceeded 25 mg/24 hours (½ upper limit of normal adult excretion = normal excretion of one kidney) prior to the onset of clinical rejection. The interval between onset of increased excretion and clinical rejection was between 4 and 14 days (mean = 9 days). Peak excretion rates up to 110 mg/24 hours occurred. High excretion rates in chronic rejection (1 patient) and in glomerulonephritis of the transplanted kidney (1 patient) were also observed. In these instances T & H was primarily in the form of insoluble urinary casts. Since anti-rejection measures are likely to be more effective when the diagnosis of a rejection episode is early, T & H measurement has a practical clinical value.