John M. Sheldon

The vexing urticaria problem: Present concepts of etiology and management

Abstract The recognition and symptomatic management of urticaria and angioneurotic edema usually are quite simple. Good long-range results, however, in the treatment of such cases require the physician to exert every effort to determine the etiology of the hives in each individual case. The recent literature (since 1945) has been reviewed in an attempt to find new, helpful information which might be of aid in evaluating the more difficult cases. A procedure for the management of these patients has been described.

A study of relationships between family situation, bronchial asthma, and personal adjustment in children.

Summary The first phase of a research project on childhood asthma carried out jointly by allergists at the University of Michigan Medical Center and child psychiatrists at Hawthorn Center is described. The focus of the present investigation is the relationship between family psychological situation and the childs asthma situation. Seventy-one children with chronic bronchial asthma and their families were studied to test the following hypothesis: A study of asthmatic children and their families will reveal a positive relationship between the asthma situation (onset, severity, response to treatment) and the family situation (quality of family relationships, identification opportunities, and care and handling). As a control a second hypothesis was tested: A study of the same group of children and their families will reveal a positive relationship between level of disturbance in the childs personality and/or behavior, and level of disturbance in family relationships, and care and handling. The patients were drawn from the regular office and clinic patients of practicing allergists. The asthma situation was studied with emphasis on severity, course, and response to medical management over a period of at least 2 years. Psychiatric study involved individual interviews with each parent and with each patient and systematized recording of findings. Seventy-one variables relating to family situation, the childs adjustment, and asthma situation were recorded for statistical analysis. Three statistical assessments of the data were made: 1. Exploration of relationships between variables. No significant relationships between variables of the family situation and those of the childs asthma are found. In contrast, there is frequent occurrence of significant correlation of variables of the family situation and those of the childs adjustment. Thus the first hypothesis is not supported, while the second hypothesis is strongly supported. 2. Comparison of 2 subgroups representing extremes of family adjustment, including relationships, stability, and child care. The 20 families showing best adjustment and the 20 families showing poorest adjustment are compared on 23 variables including those dealing with severity of asthma and response to treatment. The independent grouping of subjects is confirmed by consistently significant contingencies for all variables concerned with family adjustment. The first hypothesis is not supported; no differences are found between the 2 extreme groups on the asthma variables. The second hypothesis is strongly supported; there is positive relationship between family pattern and child personality and adjustment. 3. Three groups differentiated on the basis of good, moderate, and poor family situation are compared on the changes shown in severity and response to treatment from initial to follow-up status. None of the 3 groups shows significant differences from each other in pattern of changes. All these statistical explorations lead to the conclusion that, in the areas of severity of asthma and response to treatment, no relationships with family situation are demonstrable. On the other hand, close relationships between family situation and childs adjustment are consistently demonstrated by the findings. Child psychiatry is seen to have a selective role in the treatment of the asthmatic child. Routine referral is unnecessary. On the other hand, the disturbed asthmatic child requires psychiatric help, and medical-psychiatric treatment is clearly indicated for a good many of the parents. The deciding factor is not the childs asthma but the emotional status of both child and family, with the recognition that the asthma may add new problems requiring therapeutic intervention through the coordinated efforts of allergists, child psychiatrists, and case workers.

Hypersensitivity to beetles (coleoptera): Report of a case

Abstract 1.1. A case of hypersensitivity to beetle emanations is reported. References to entomologic data of Coleoptera are given. 2.2. The question of wheter this source of antigen could be of importance in some cases of environmental allergies is raised.

A CONTROLLED STUDY ON THE USE OF PARENTERAL AND ORAL ANTIHISTAMINES IN PREVENTING PENICILLIN REACTIONS

M UCH has been written about penicillin allergy. Even by 1948, Brown1 found well over 300 articles to review on this subject, and numerous publications have appeared since then. A perusal of the early case reports reveals that more than fifty different types of alleged penicillin reactions have been described, although all these are not allergic in type. As to the incidence of reactions, statistics may be found indicating reaction rates varying from less than 1 per cent? to 53 per cent,3 with all graclations between. These comments are made not to compound the confusion but, rather, to emphasize how difficult it is to reach valid conclusions in this field. No doubt a major factor at the root of the difficulty is that there is no reliable, objective test for proving the diagnosis of all types of penicillin allergy. It is true that patch testing is a relatively reliable procedure in the occasional cases of penicillin contact dermatitis which are still encountered, and positive scratch or intracutaneous tests usually are obtained in the rare cases of anaphylactic type penicillin hypersensitivity. However, there has evolved a rather strong consensus, with which we are in agreement, that skin testing is not generally reliable in evaluating the vast majority of penicillin reactions. Thus, the diagnosis of penicillin allergy usually must be based on clinical judgment, and it is not surprising, therefore, that the st,atistics of various investigators are not entirely comparable. In addition to various sources of error, there are a number of factors inherent in the data themselves which account in part for variations in the

Sensitivity to gum acacia, with a report of ten cases of asthma in printers

Abstract 1. A group of ten patients in whom direct exposure to acacia initiated severe asthmatic seizures have been studied. All were exposed to this material by offset sprays used in the printing industry. 2. Apparently acacia (gum arabic) is an industrial hazard, and sensitization to it is not rare. It is suggested that dextrose be substituted for acacia in offset sprays. 3. The time of gross exposure to this spray material before the onset of asthmatic symptoms varied from two weeks to twelve months. 4. Eight of the ten patients were adult males ranging in age from 22 to 53 years. This high incidence of males may be explained by the fact that relatively few females are employed in the printing industry. 5. The increasing use of gum arabic in the printing of magazines, ☐ labeling, and other industrial sources presents the possibility of more widespread allergy to acacia.

Dermatitis venenata from tree pollen oils: A clinical report

Abstract 1.1. Pollen oil dermatitis is a recognizable entity. Dermatitis venenata due to tree pollen oil appears to be extremely rare. 2.2. Two cases of dermatitis venenata are reported, and observations are made on a third case in which the symptoms occurred coincident with the tree pollination period in Michigan. These patients had typical lesions of plant dermatitis on the exposed areas of their skin. The two patients tested gave positive patch reactions with the ether-soluble fraction of the tree pollens. 3.3. Oral hyposensitization with pollen oil caused an exacerbation out of season in the dermatitis of both patients, causing one patient to discontinue treatment. The second person treated by oral hyposensitization to tree pollen oil now is tolerating it well. 4.4. Testing for possible sensitivity to plant pollen oils in dermatitis venenata might well include representatives of tree pollen oils.

REPOSITORY THERAPY IN ALLERGIC RESPIRATORY DISEASE.

Allergenic emulsions appear to be as effective as conventional aqueous therapy for treating allergic respiratory disease in properly selected patients.Rigorous pretreatment screening of candidates for repository therapy is essential to avoid treatment failures and prevent the induction of skin reactivity to the antigens which are used.The incidence of adverse local and systemic reactions which can occur following repository therapy can be minimized by careful preparation and testing of emulsions.

Some untoward reactions to repository therapy

Abstract The types of untoward reactions seen with repository therapy have been divided into three groups. The transient local reactions of pain and swelling are mild and not significant. Allergic overdose reactions are occasionally seen and are similar to those occurring with conventional aqueous hyposensitization treatment, except that they are delayed several hours. Eleven patients of 854 who received repository treatments (1.3 per cent) had such allergic overdose reactions (asthma and/or urticaria), which either subsided spontaneously or responded to oral antihistamines or epinephrine. The more serious late local reaction is described in four patients, with local abscess formation of the sterile type in two patients. One patient required incision and drainage at both injection sites, and the other patient had a spontaneous regression in 912 months. The etiology of these late local reactions is discussed, and it is concluded that they represent a type of foreign-body irritative process.

PANEL DISCUSSION ON THE MANAGEMENT OF ALLERGIES IN GERIATRIC PATIENTS

Moderator: JOHN M. SHELDON, M.D. Professor of Internal Medicine, and Director, Department of Post-Graduate Medicine, University of Michigan Medical School, Ann Arbor, Michigan. Panelists: ROBERT A. COOKE, M.D., Director, Institute of Allergy, Roosevelt Hospital, New York, N. Y. STANLEY G. HAMPTON, M.D., Assistant Clinical Professor of Medicine, and Director, Allergy Clinic, Washington University School of Medicine, St. Louis, Missouri. BRAM ROSE, M.D., Associate Professor of Medicine, McGill University, and Associate Physician, Royal Victoria Hospital, Montreal, Canada. WILLIAM B. SHERMAN, M.D., Associate Clinical Professor of Medicine, Columbia University, College of Physicians and Surgeons, New York, N. Y.