S.Roger Hirsch

Recommendations for the use of residential air-cleaning devices in the treatment of allergic respiratory diseases

In an attempt to recommend standards for room air-cleaning devices, a committee reviewed (1) the types and performance characteristics of available domestic air-cleaning devices, (2) the available data on concentrations of allergens in the indoor air, and (3) the studies that have examined the health effects of the use of indoor air-cleaning devices. Absense of adequate data on the clinical relevance of indoor ambient allergen levels, as well as the effect of air-cleaning devices on these levels, plus a general lack of health effects by these devices in published double-blind studies precluded any firm recommendations for their use. It was clear, however, that use of room air-cleaning devices in the absence of other forms of environmental control was not reasonable.

A multicenter trial of nedocromil sodium, 1% nasal solution, compared with cromolyn sodium and placebo in ragweed seasonal allergic rhinitis*

This study was a double-blind, parallel-group study to evaluate a new medication, nedocromil sodium, 1%, in comparison with placebo and cromolyn sodium, 4%, for treatment of ragweed seasonal allergic rhinitis. Two hundred thirty-three patients (aged 12 to 65 years) from eight centers were randomized to treatment, one spray per nostril, four times daily, with nedocromil sodium, cromolyn sodium, or matched placebo (80, 76, and 77 patients, respectively). All patients had at least a 2-year history of ragweed seasonal allergic rhinitis. Treatment was for 8 weeks during the ragweed season, and daily pollen counts were used to identify the peak 3-week period. Clinic examinations were made before and after the 1-week baseline and after 1, 3, 5, and 8 weeks of treatment. Rhinitis symptoms were recorded each day by the patients. Nedocromil sodium was more effective than placebo (p less than 0.05) in relieving symptoms as recorded by the patients. Cromolyn sodium was also more effective than placebo, but the difference was not usually significant. Similarly, the active treatments were both better than placebo for clinical parameters measured at visits and for global opinions of treatment, and more rescue therapy was used by the placebo-treated group. There was no significant difference between the two active treatments, but the trend throughout was in favor of nedocromil sodium. Our findings demonstrated nedocromil sodium to be at least as effective as an established therapy (cromolyn sodium) in reducing symptoms of rhinitis during the peak ragweed pollen season.

An evaluation of the effect of nebulized N-acetylcysteine on sputum consistency.

Abstract In order to ascertain the effectiveness of N-acetylcysteine (N-ac) as an expectorant, nebulized N-ac in 10 and in 20 per cent concentrations were compared with nebulized saline in a group of 70 patients with chronic obstructive pulmonary disease. Sputum volume and consistency were determined by a new method before and after nebulization through an intermittent positive pressure breathing apparatus in all patients. Spirometry was performed before and after nebulization in 47 patients. It was concluded that nebulized N-acetylcysteine is more effective than saline in thinning sputum and increasing volume and that 10 per cent N-ac is as effective as 20 per cent. Most patients failed to show spirometric changes as a result of either saline or N-ac nebulization. In those cases with decreased spirometric values, N-acetylcysteine was associated with obstruction in more cases than was saline; 10 per cent N-ac was less frequently associated with bronchial obstruction than was the 20 per cent concentration.

Circulating basophils in normal subjects and in subjects with hay fever

The relationship of hay fever symptoms and changes in the number of circulating basophils was studied in 12 subjects clinically sensitive only to ragweed and in 10 nonatopic subjects before, during, and after the ragweed season. Total white blood counts, absolute basophil counts, and symptom scores were recorded twice weekly from mid-June through October, 1974, and compared with the ragweed pollen count. The results indicated that the absolute and relative number of basophils were significantly elevated (p less than 0.001) in the hay fever group when symptoms occurred. As the symptom score of the allergic group increased during the ragweed season, the number of basophils also increased, only to decrease to control values when symptoms subsided. The basophil counts of the atopic group were significantly higher than those of the nonatopic group during the control periods. The nonatopic group also showed a significant elevation of basophils during the ragweed season, but to a much lesser extent than the atopic group. It is concluded that: (1) subjects with symptomatic hay fever have a significantly elevated absolute and relative basophil count which correlates with the exacerbation and remission of symptoms; (2) nonatopic subjects also have a small but significant elevation of basophils during the ragweed season; and (3) the elevation of basophils in the atopic group during symptoms is significantly greater than in the nonatopic group during the ragweed season.

Basophil degranulation: A new method of observation and its correlation with skin testing

Abstract For improved study of the atopic reaction, we have devised a new method of assessing degranulation of the human basophil. The procedure involves the concentration of basophils from 20 ml. of peripheral blood, incubation of the basophil concentrate with dilutions of antigen extract, counting of nondegranulated basophils, and comparison of the maximal percent degranulation of the test suspensions with a control. A significant difference in degranulation between the control and test suspensions constitutes a positive test. In a group of 17 ragweed-sensitive patients, the mean maximal per cent degranulation was 77.4 per cent. In a group of 13 nonsensitive subjects, the mean maximal per cent degranulation was 8.8 per cent (p

The direct basophil degranulation test and the intracutaneous test: A comparison using food extracts

The purpose of this study was to compare the direct basophil degranulation test (DBDT) of Hirsch and Zastrow with the intracutaneous (IC) test in subjects with and without histories of food allergy. The DBDT was perfomred by incubating the concentrated leukocytes of subjects with dilutions of the suspected allergenic extract and comparing the number of nondegranulated basophils remaining in the test samples with the number remaining in a control. The test sample with the least number of basophils represents maximal basophil degranulation. The DBDT was perfromed with extracts of the suspected food on 14 subjects with reliable clinical histories and positive IC tests indicative of food hypersensitivity. Thirteen of these 14 food-sensitive subjects also had IC and DDBT8 to the extracts of foods to which they were not clinically sensitive. Fourteen different subjects not allergic to foods were also tested with food extracts by the IC and DBDTS. There was a 92% correlation between the IC test and the DBDT, a 90% correlation between the IC test and the history, and an 86% correlation between the DBDT and the history. We conclude that, in this study of subjects clearly sensitive to foods, the DBDT correlates favorably with the history and IC test.

Existence of basophil chemotaxis in subjects with hay fever

From an earlier study we proposed that the relative peripheral basophilia of subjects with symptomatic hay fever might be associated with a basophil chemotactic factor in the serum. Six subjects with symptomatic hay fever and six nonallergic subjects were tested for basophil chemotaxis (BC) weekly during and after the hay fever season. Cells of the allergic subjects with autologous serum showed significantly more BC than with control serum during the symptomatic weeks. After they hay fever season there was no difference in BC between the allergic and nonallergic groups. We conclude that there is a BC factor(s) in the serum of symptomatic subjects with hay fever which requires basophils from symptomatic subjects to be demonstrable.

Tilarin in combination with astemizole

Bukstein D. A., Biondi R. M., Blumenthal M. M., Dockhorn R. J., Filley W I!, Fink J., Goldstein S., Graft D. E, Hirsch S. R., Joos T. H., Melamed J., Rowe M. S., Townley R. G. Tilarin in combination with astemizole.

The absolute peripheral basophil count: A new and more precise method

Abstract We have devised a new method for performing the absolute peripheral basophil count (APBC). The method consists of making a thick smear of 2λ blood on a slide, fixing in methanol, staining with toluidine blue, and counting all the basophils on the slide. We compared this method with a chamber counting method in 10 subjects by performing 2 sets of counts in duplicate of each method in an alternate fashion from the same finger puncture and having each specimen counted twice by each of 3 observers. We also compared the APBC of blood from a finger puncture with heparinized blood in 35 subjects. In another 37 subjects, we compared 3 daily APBCs by the smear method with the APBC calculated from the standard differential smear and total white cell count taken from the same specimen. The mean basophils per cubic millimeter of the 10 subjects by our method was 36.7 ± 6.4 (S.D.) and 55.0 ± 21.1 (S.D.) by the chamber count. The basophil counts of herparinized and finger puncture blood were virtually identical. The mean basophils per cubic millimeter and the day-to-day variation for each patient expressed as the S.D. calculated from the standard differential smear and total white cell count were 54.4 ± 60.7 as compared to 27.0 ± 9.3 for the thick smear method. We conclude that the thick smear method for performing the APBC is more reproducible and precise than previous methods.

The Wisconsin Allergy Society fee and practice survey: A study for Professional Standard Review Organizations

Physicians practicing allegy in the State of Wisconsin were surveyed regarding their fees charged and norms of practice relating to the diagnosis and management of patients with allergic diseases. Over 50% of the physicians surveyed responded and the results were compiled and analyzed. The data obtained provide an over-view of the practice of a medical subspecialty and can thus be used for possible peer evaluation.