Gustavus A. Peters

Evaluation of IgE tests in an allergy practice

Abstract We measured serum IgE in 264 patients seen in the course of an allergy practice during the summer of 1970. IgE values were elevated in 21 per cent of patients who had idiopathic asthma and 10 per cent of patients who had idiopathic rhinitis. The elevated IgE was of no immediate clinical help in this idiopathic group because we were unable to detect hidden allergenic factors on further review of the history and skin tests. The finding of such an elevation, however, will prompt us to a continuing search for an allergic etiology or other condition associated with elevation of IgE. In patients who had hypersensitivity to stinging insects, IgE was elevated in 9 of 29 (31 per cent), and in patients with asthma and aspirin intolerance it was elevated in one of 5. Results in small numbers of patients with several other conditions including cold urticaria, chronic urticaria, and drug allergy are also presented.

Urinary excretion of histamine in patients having asthma and hay fever: observations on changes produced by administration of cortisone.

Abstract Children excreted normal amounts of free and conjugated histamine in the urine in the intervals between attacks of allergy. During acute attacks, the excretion of free histamine tended to be decreased, suggesting that free histamine may be retained in the body. The administration of adrenocortical hormones to five patients having acute attacks of allergy resulted in an increased elimination of free histamine in the urine; in two of the patients who had severe attacks, this elimination was abnormally great. The effect of these hormones on conjugated histamine was variable.

The effect of premedication with chlorpheniramine on reactions to methylglucamine iodipamide

Abstract In 1,830 cholangiographic examinations in which methylglucamine iodipamide was given at the Mayo Clinic, premedication with chlorpheniramine, in doses of 6 to 10 mg. given intramuscularly 5 minutes prior to intravenous injection of the contrast medium, reduced the incidence of reactions to 6 per cent from the rate of 24 per cent in 854 such examinations without antihistaminic premedication. Methylglucamine iodipamide can and does produce toxic and anaphylactoid reactions as well as hypotension if given too rapidly. Studies of blood concentrations of histamine in 10 cases failed to substantiate the idea that methylglucamine iodipamide may be a histamine releaser, except in one case in which a reaction occurred. There the concentration of histamine increased to twice as much as that found before the injection. Adding epinephrine (in two tested quantities) to the chlorpheniramine for injection seemed not to enhance the effects of chlorpheniramine, but rather added annoying side effects. Premedication with an antihistaminic drug, though definitely helpful, does not appear to be the complete answer to the prevention of reactions following injection of contrast medium for cholangiography, but we do recommend its use for lessening these reactions.

Fatal necrotizing angiitis associated with hypersensitivity to pencillin O and iodides

Abstract A case of fatal necrotizing angiitis is thought to have resulted from the administration of penicillin O to a patient known to be sensitive to penicillin G. The patient also had an iodide allergy and hence it cannot be stated definitely that this did not have a place in the production of the necrotizing angiitis. Several of us who saw the patient thought that the penicillin O was probably more important than the iodides in the final outcome of the case. Postmortem findings were typical of allergic angiitis described by Zeek, while some features were characteristic of the allergic granulomatous type described by Churg and Strauss. Skin reactions to penicillin G and O and procaine were all negative. The patient died despite cortisone therapy; the dosage level may have been inadequate. This case, as well as others which have been described in the literature, especially those of Gruber and Rich, shows that drug allergy is important in the pathogenesis of some of the so-called cases of periarteritis nodosa.

Acute Anaphylactic Reactions and Aspirin Allergy

The subject of anaphylaxis immediately brings to mind penicillin, and for good reasons. Still, any of a long list of diagnostic and therapeutic agents and foods can be the cause of this life-threatening event. Every physician and even some patients should be prepared to deal with this emergency. For some asthmatic patients, even taking aspirin can precipitate a severe attack of asthma. In particular, the combination of asthma and nasal polyps should raise suspicion of this type of aspirin allergy.