Jerome Glaser

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.

The incidence of subsequent ragweed pollinosis in symptom-free persons having positive reactions to ragweed pollen extract.

Abstract 1.1. Sixty-eight allergic patients were followed for from two to twenty-four years. They had not had ragweed pollinosis initially, but had had positive skin test reactions to ragweed pollen. The purpose of the study was to discover what becomes of such patients with regard to the development of ragweed pollinosis. 2.2. Of the total number of patients, 53 per cent developed ragweed pollinosis, and 47 per cent did not. 3.3. Of the persons developing pollinosis, 88 per cent did so within ten years of the skin tests, and 64 per cent did so within five years of the skin tests. 4.4. The corollary to this is that those who have not developed pollinosis ten years after skin tests are highly unlikely to do so thereafter. 5.5. Of the thirty-two patients who did not develop pollinosis, approximately 25 per cent were observed for twenty-one to twenty-five years, 27 per cent for sixteen to twenty years, 24 per cent for eleven to fifteen years, 10 per cent for six to ten years, and 15 per cent for zero to five years. These figures are affected by the length of time the patients were followed, and must be interpreted accordingly. 6.6. There was no evident relationship between sex or type of skin test (scratch or intradermal) and the development of ragweed pollinosis. 7.7. Of the patients in this study who were 16 years of age or over at the time of skin testing 75 per cent did not develop ragweed pollinosis and 25 per cent did develop ragweed pollinosis. 8.8. Of the patients in this study who were 16 years of age or under at the time of skin testing, 37 per cent did not develop ragweed pollinosis and 63 per cent did develop ragweed pollinosis. 9.9. In view of the foregoing findings, the practice of giving injections of ragweed pollen as a prophylactic measure along with periodic injections of other allergens to patients who have a positive skin test but who do not have ragweed pollinosis appears justified, since there is no evidence to prove that such prophylactic measures are harmful.

A study of the reactions of human polymorphonuclear leukocytes to various allergens

Abstract 1.1. Use of the serum-leukocyte-antigen test described by Black clearly revealed sensitivity in only one (4 per cent) of twenty-four patient sensitivities, while four patient sensitivities (17 per cent) were completely missed by the test. 2.2. In approximately 70 per cent of the test results, definite interpretation could not be made. 3.3. There was close agreement by independent observers on only two-thirds of the test preparations. 4.4. Some of the control slides showed an inactivity of leukocytes which was not understood. 5.5. The test is time consuming and not suitable for routine use by the practicing allergist. Its validity is seriously questioned.

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

The use of strained meats as the protein basis for milk substitutes in the treatment of milk allergy

Abstract 1.1. The use of specially strained meat as a protein basis for milk substitutes in the manner described by Rowe is discussed. 2.2. Three case reports, illustrative of the successful use of such substitutes, are presented.

Effect of treatment on skin and mucous membrane sensitivity and on reagins in hay fever

Abstract 1.1. In a series of 98 cases of pollen sensitive individuals a systematic study was made before and after specific treatment, of the skin reactions in 93, of the mucous membrane reactions in 85, and of the reagin content of the serum in 8, in order to determine whether changes in skin or mucous membrane sensitivity or in circulating reagins could be used as a therapeutic index. 2.2. The skin sensitivity was reduced but not abolished following treatment in over half the cases studied. But not all the patients benefited showed reduced skin sensitivity, and in some unimproved cases there was a lowered cutaneous reactivity. Therefore the skin cannot be used as a therapeutic index. 3.3. Studies of mucous membrane sensitivity showed that following treatment there was always a reduction in those patients who were benefited. In general, the greatest improvement was noted in the cases requiring concentrated extracts to produce symptoms of hay fever, although a few patients were benefited who reacted to relatively high dilutions of pollen extract. Conversely, one patient requiring a highly concentrated extract to produce hay fever symptoms was not benefited by treatment. In one patient not benefited by treatment there was a measurable increase in mucous membrane sensitivity. The mucous membrane of the nose can then in general be used as a therapeutic index in hay fever. 4.4. There was no consistent correlation between the changes in the skin and mucous membranes following a course of treatment. 5.5. A quantitative estimation of the reagin content of the serum showed a marked increase following treatment in 5 of the 8 cases studied. These 5 patients were benefited by treatment. Two of the patients showing no demonstrable change in the reagin content of their serum were also benefited by treatment. The skin sensitizing substances cannot therefore be used as a therapeutic index.

The use of bovine antitoxin for the prophylaxis of tetanus

Abstract 1.1. Bovine tetanus antitoxin has been used with safety in selected persons known to give severe anaphylactic reactions to horse serum. 2.2. The only indication for the use of equine tetanus antitoxin occurs in those cases where the person is known to be, or can be demonstrated to be, sensitive to the bovine but not to the equine preparation. Thus far no such cases have been reported. 3.3. Persons undergoing an allergic study should be tested routinely with equine and bovine sera. This should be done by the scratch method only to avoid as far as possible the sensitizing of the patient to the serum. If the patient is sensitive to both sera, he should be immunized by means of tetanus toxoid, the precautions suggested by Cooke and his associates 5 being carefully observed.

The allergic child in camp

N IMPORTANT consideration in the treatment of any chronic disease, and this is especially true in childhood, is the attempt to prevent the patient from deveIoping a sense of invalidism. The more a child can enjoy activities common to other children of his age, the happier and healthier he will be. Camps especially for diabetic children are highly successiul and have contributed to our knowledge of diabetes in childhood. Camps especially for children suffering from allergic disease have not as yet been established, but with the advances which allergy is now making as a specialty, it is perhaps time to consider the desirability of organizing such camps. Meantime all pediatricians and allergists every summer are confronted with the problem of what to do about their young patients who wish to go to camp. So far as I can determ!ne, this problem has not been dealt with previously in the literature and it is with the hope of stimulating interest in this field that this communication is made. One of the primary considerations for such a camp is that there should be a resident physician in attendance. Previous experience in treating allergic children is highly desirable as a qualification for the camp physician but cannot be insisted upon at this time. Many camps, especially with the present shortage of physicians, employ a nurse for routine care of the campers and depend upon a physician in a neighboring town in case of necessity. This is not advisable in the camp to which an allergic child is to be sent. Not all allergic children, because of the nature and severity of their illness, should be permitted to go to camp, even if the parents are willing. Which child should or should not go is in every case an individual problem to be decided by con: sn]tation between the parents and the pediatric allergist or the parents, the allergist, and the pediatrician. A child on a highly restricted diet should not be sent to camp because the difficulties inherent in carrying out such diets are accentuated by the increased appetite usually associated with camp life and activities. Even if the food allergy is associated with the ingestion of easily avoidable foods such as nuts or berries, the responsibility for avoiding these cannot be assumed by the camp management. In the case of a very cooperative child, it is a reasonable risk; otherwise not. Before going to camp, any child, and particularly the allergic child, should have a thorough physical examination by a pediatrician. Many parents resent having their children examined when the child feels well but most do not resent having a well child thoroughly examined once a year. It is highly advantageous for the pediatrician to educate the parents of his camp age children to utilize the camp examination as the childs yearly physical examination. An important part of this examination is a check on whether or not the child has the prophylactic injections he should have had and has had a