John A. Arkins

Late sequelae of allergic bronchopulmonary aspergillosis

Seven patients with late sequelae of allergic bronchopulmonary aspergillosis (ABPA) are described. All seven had significant chronic symptoms from asthma. At the time of diagnosis of ABPA all patients had marked irreversible pulmonary function abnormalities; symptoms of chronic bronchitis were present in all. Pulmonary fibrosis was present in six of seven patients. Three patients have died from irreversible lung disease with terminal cardiac failure. Despite the difficulty in establishing an early diagnosis of ABPA, its importance must be emphasized in order to attempt to prevent progression of the disease to severe irreversible and potentially fatal end-stage lung disease.

Acquired angioedema associated with rectal carcinoma and its response to danazol therapy. Acquired angioedema treated with danazol.

Cases of the acquired form of angioedema have been recognized as a separate entity since 1972. Previously reported cases have been related to various hematologic malignancies. We have recently studied a patient with rectal carcinoma who manifests a complement pattern compatible with the acquired form of angioedema. No previous personal or family history of allergic disease or angioedema was present. Because the episodes of angioedema were laryngeal in location and required emergency intubation to maintain an adequate airway, a trial of danazol prophylaxis, which has been shown to be effective in hereditary angioedema, was undertaken. His beneficial response to this form of therapy is also documented.

The incidence of skin reactivity to insulin in diabetic patients

Abstract Skin tests for the presence of skin reactivity to insulin were done on 168 diabetics and 20 nondiabetic individuals. The individuals were divided into 4 groups. Group I consisted of diabetics on insulin, Group II consisted of diabetics formerly on insulin, Group III consisted of diabetics who had never received insulin, and Group IV consisted of nondiabetic controls. Group I demonstrated 53 per cent with skin reactivity; Group II, 18.6 per cent; Group III, 10 per cent; and Group IV, none. There was no positive correlation with age, duration of diabetes, control, or history of allergic disease.

Cytotoxic testing for food allergy: Evaluation of reproducibility and correlation☆☆☆

Cytotoxic food tests still present conflicting opinions concerning their validity. Nine atopic patients with or without a history of food allergy were studied along with 5 nonatopic patients. All tests were conducted in a double-blind fashion with 6 determinations for each of 10 food antigens. Reproducibility of the test (5/6 positive or negative) was demonstrated with wheat, milk, yeast, chocolate, and orange. In the nonatopic group, reproducible results were obtained for wheat, egg, yeast, chocolate, and chicken. Clinical correlation with 11 foods in 7 patients was demonstrated. However, there were 46 positive tests without correlation and 2 negative tests with positive histories. Therefore, there appears to be reproducibility of the tests to only 3 foods but no apparent correlation with clinical symptoms. At the present time, cytotoxic tests offer no reliable help in establishing the diagnosis of food allergy.

The effect of corticosteroids on methacholine inhalation in symptomatic bronchial asthma

Abstract The airway responses of 11 symptomatic patients with asthma to metacholine inhalation were determined before and after a two-week course of corticosteroids and compared with those of 5 patients with chronic obstructive pulmonary disease and 4 individuals without respiratory illness. A significant increase in response to cholinergic stimulation as measured by a fall in the FEV 1 occurred after corticosteroids only in the asthmatic group. The mechanism of this response is not clear.

Clinical effectiveness of 6-mercaptopurine in bronchial asthma

Abstract Ten patients with perennial atopic and infectious asthma were given the immunosuppressant, 6-mercaptopurine and/or placebo in a double blind study. The patients received 6-mercaptopurine and/or placebo in two consecutive courses of three weeks each. The dosage was 150 mg. (2 to 2.5 mg. per kilogram) daily. The patients were seen weekly during the study. The clinical responses were determined by measuring the amount of bronchodilators required, subjective response, and pulmonary function studies. Serum proteins, complcte blood counts, platelet counts, sedimentation rates, and skin tests to inhalants were serially followed. There was improvement in both the placebo group and those receiving 6-mercaptopurinc. Analysis of the responses revealed that the changes were not statistically significant and, therefore, under the conditions of this study, we could not demonstrate benefit from 6-mercaptopurine.

Skin test reactivity to dog-derived antigens

Skin test reactivity to canine antigens was studied by testing atopic patients and veterinarians using a commercially prepared mixed‐dog epithelial antigen and breed‐specific antigens including dander extracts, serum and urine, obtained from thirty‐one different pure‐bred dogs. Increased skin test reactivity was noted using breed‐specific antigens as compared to the mixed‐dog commercial screening extract. Variation in skin test responsivity related to specific breed antigens was also noted. The results suggest that skin tests using canine urine and serum antigens, in addition to the conventional dander antigens, may be useful in the diagnosis of hypersensitivity to dogs.

The characterization of skin-sensitizing antibody induced in nonsensitive dogs.

Abstract Skin-sensitizing antibody (SSA) to ragweed was induced in four nonatopic dogs following four weekly injections of ragweed emulsion. The characteristics of the SSA are similar to those occurring spontaneously in man and dog. A challenge of one of the dogs by insufflation and intravenous administration of ragweed pollen extract failed to produce any systemic symptoms. This suggested the presence of a high level of blocking antibody. One of the dogs developed ulceration and granuloma formation at each site of injection. Biopsies were taken during the stage of active ulceration and after complete healing.

The effect of 6-mercaptopurine on spontaneous canine asthma

Abstract The responses to 6-mercaptopurine in 2 spontaneously ragweed-sensitive dogs were measured before, during, and after drug therapy. Measurements of skin-sensitizing antibody, response to inhalation challenge, and passive anaphylaxis were made monthly, 2 months prior to drug administration, during the 3 months of therapy, and one month after cessation of therapy. There were no changes in the skin-sensitizing antibody titer. There was partial suppression of passive anaphylaxis. There was a marked inhibition in the production of asthma by direct inhalation challenge. The later response returned to pretreatment levels one month after completion of 6-mercaptopurine administration.

Mephenesin (Tolserol) sensitivity with demonstrable skin-sensitizing antibody in the serum

Abstract Skin sites were sensitized in normal recipients with serum obtained from a patient immediately after an allergic reaction to ingested Tolserol. Positive reactions occurred within thirty to ninety minutes in the sensitized skin sites of three of the four subjects tested by ingestion of a challenging dose of 500 mg. of Tolserol. Some skin-sensitizing activity could still be demonstrated in serum withdrawn thirty days after the patients reaction to Tolserol.