Frank Perlman

Clinical effects of epinephrine by inhalation; a survey.

Abstract 1.1. A clinical study and information gained from a questionnaire indicates that epinephrine used in a concentrated form by oral inhalation usually offers symptomatic relief of asthma. This relief in most cases diminishes with continued use of the method, and more frequent and intensive administration becomes necessary. Serious harm results from excessive use. 2.2. An attempt has been made to describe the clinical and pathological changes which we have observed in our practice from excessive spraying. This includes a consideration of 48 private patients who have died following prolonged employment of this method of self-medication. 3.3. Our survey of 2,236 asthmatics in our practice in the past ten years gives the following mortality figures. Among 648 users of the oral epinephrine spray, 48, or 7.4 per cent, have terminated fatally. Among 1,588 supposed nonusers of this form of medication, 22, or 1.4 per cent, have died. Since the mortality in users was over five times as great as in nonusers, we believe that injudicious use of this form of medicinal relief has contributed materially to death from asthma in our series.

Induction of both reaginic and blocking antibodies with a low molecular weight fraction of timothy pollen extract

Abstract In preliminary studies to evaluate the potential of the nonprecipitating antigen D for treatment of timothy-sensitive patients, a group of 8 nonallergic individuals was given a series of intracutaneous injections of antigen D at weekly intervals for 4 weeks. Each of the persons had no clinical history of allergy and gave negative skin reactions to antigen D, crude pollen extract (WST), and allergens A and B of timothy pollen. Four weeks after the last injection of antigen D, 6 of the 8 volunteers gave positive skin reactions when skin tested with various timothy allergens. Passive transfer studies with sera obtained from these volunteers not only showed significant blocking antibody titers but also varying amounts of reaginic antibody titers up to 1/25. The successful induction of homocytotropic antibodies in rhesus monkeys by repeated intracutaneous injections with antigen D was demonstrated by both direct skin reactions and histamine release from passively sensitized monkey lung fragments. The homocytotropic antibodies produced in both man and rhesus monkeys are heat labile, persist at sensitized sites for at least 48 hours, and can be passively transferred by sera.

Dimethylsulfoxide as a penetrant carrier of allergens through intact human skin

Abstract The penetrant-carrier capacity of dimethylsulfoxide (DMSO) through intact human skin was studied with allergens of varying molecular sizes and compositions. Results showed that only with DMSO 90 per cent and penicillin could positive Prausnitz-Kustner (P-K) reactions be produced. Larger sized allergens in DMSO applied directly over sensitized sites failed to penetrate sufficiently to produce positive P-K reactions. Removal of stratum corneum permitted the production of positive P-K reactions with allergens of all molecular sizes and in simple buffered saline.

Isolation of a Reaginic Antibody Fraction with Properties of γG-Globulin.∗

Summary 1. Serum from untreated timothy sensitive patient (E.F.) was fractionated by Sephadex G-200 gel-filtration and DEAE-cellulose ion-exchange chromatography, and resulted in the isolation of a single fraction with reagin activity. 2. The isolated reagin possesses chromatographic and immunochemi-cal characteristics of γG-globulin.

Arthropods in respiratory tract allergy. Their relationship to allergens in house dust.

The role of insects and other arthropods as inhalant allergens gained our attention when the incident of positive skin test reaction was found to approach that for pollens, feathers, and even house dust. In the course of routine testing of a large number of patients with respiratory tract allergy (hay fever and asthma), over 40 per cent showed significant skin test reactions. Likewise, the reaginic antibodies were distinct for each of these allergens. These positive reactions shinved no correlation with the reactions to conveTitioiial altergenic extracts. Correlation of positive skin tests to arthnipods uilh the pn>ductiori of clinical disorders remains unclear. Specific ttiological diagnosis is made by inference while the specific hyposensitization must rely of such inference. Benefit from treatment of otherwise refractory cases adds weight to the importance fif arthropods as inhalant allergens.

Stability and behavior of reaginic antibodies: effects of freezing, thawing, and lyophilizing on skin-sensitizing activity of reaginic sera.

Abstract This is one in a series of studies on the behavior and stability of reaginic antibodies subjected to various physical, chemical, and thermal influences. Observations were made on the effect of freezing, thawing, and storing, in the lyophilized state, sera of various ages from a few hours to more than four years. These observations provided a basis for acceptance of the reliability of our entire serum banks used in the successive studies. Both human volunteers and lower primates were employed as recipients for the passive transfer studies. The sera used contain reaginic antibodies for a variety of allergens. Those containing reagin for penicillin were most valuable for quantitation, since challenge at a remote site permitted the presumption of delivery of equal quantities of allergens to all the sensitized sites, thus eliminating the element of trauma and error of measurement, faults inherent in the direct challenge. Results indicate that lyophilization as well as storage of serum at subfreezing temperature preserved the reaginic antibodies equally well for a number of years (perhaps better with lyophilized serum). Repeated freezing and thawing, and even allowing the serum to stand in liquid state for hours to several days, did not significantly alter the reaginic titer, as measured by passive transfer test on the monkey. These results will make more acceptable our succeeding studies and permit our expanding our serum banks for long-range immunological studies with reaginic antibodies.

Effects of beta-propiolactone (betaprone) on reaginic (skin-sensitizing) antibodies☆

Abstract The measurement of reaginic antibodies by transfer to nonallergic human beings has the potential risk of transferring the hepatitis virus. Since beta-propiolactone (BPL) is an effective virucidal agent in 0.40 per cent concentration and is rapidly denatured to harmless end products, its value in treating such reaginic serum was studied particularly as it may affect these labile antibodies. Despite the fact that this agent acts on various functional groups associated with proteins, the reduction in reagin titers of various sera directed against a number of allergens was slight. Only the reagin directed against penicillin was apparently completely destroyed. Experiments used nonallergic human beings and subhuman primates with the use of varying dilutions of BPL (from 0.2 per cent to 1.0 per cent) and serial dilutions of sera. The virucidal agent was added in some instances to each serum dilution and in other experiments only to the concentrated sera. The slight drop in the reagin titer was comparable in the various experiments. In vitro experiments with rabbit precipitating antibodies against several antigens showed no significant change in precipitating antibody titer after exposure to BPL. BPL (0.4 per cent), after incubation with serum, produced a minimal irritative effect in several subjects chiefly in the form of a small papule which did not interfere with the passivetransfer reaction.