Theodore L. Squier

Primary granulocytopenia due to hypersensitivity to amidopyrine

Abstract 1.1. In a series of 19 patients observed by us the onset of acute primary granulocytopenia was directly preceded by the use of amidopyrine alone or in combination with a barbiturate. A similar relationship has been reported in the literature and by personal communication in 52 additional cases. 2.2. The administration of a single dose of amidopyrine to each of two patients who had recovered from the acute disease was followed by a rapid profound fall in the total and granulocyte counts. 3.3. All patients under our observation who recovered from the acute disease and avoided the use of amidopyrine have had no recurrences over periods of from twelve to thirty-one months. 4.4. Skin sensitivity to amidopyrine was demonstrated in two of these patients by patch testing, and systemic reactions with marked depression of the total and granulocyte counts and elevation of temperature were present in both after application of a 10 per cent solution of amidopyrine to the unabraded skin. 5.5. On the basis of this evidence we believe that acute primary granulocytopenia can be caused by repeated administration of amidopyrine to persons who have developed allergic or anaphylactoid hypersensitivity to that drug. From analogy we believe that certain other drugs may be responsible for a similar granulocytic response.

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 Some skin-sensitizing activity could still be demonstrated in serum withdrawn thirty days after the patients reaction to Tolserol.

Absence of nonspecific anamnestic stimulation of antistreptolysin in pneumococcus pneumonia

Abstract 1.1. Antistreptolysin determinations were made from 104 patients with pneumonias. Elevated levels were found in 32 (30.7 per cent) of these patients. 2.2. In 30 of these patients pneumococci were isolated. An elevated antistreptolysin level was found in 9 (30.0 per cent). 3.3. In the remaining group of 74 patients with pneumonias of nonpneumococcal etiology, 23 (31.0 per cent) were found to have an increased antistreptolysin titer. 4.4. The uniform percentages of elevated antistreptolysin levels found in the pneumococcal and nonpneumococcal groups of pneumonias indicate that pneumococcal infections do not cause a significant anamnestic stimulation to antistreptolysin production.

The significance of the antistreptolysin titer in respiratory allergy

Abstract 1.1. Antistreptolysin determinations were made on sera from 160 patients with respiratory allergy. 2.2. Forty-one patients (25.6 per cent) had elevated antistreptolysin titers on one or more occasions. 3.3. No significance relevant to the allergic state could be attached to transitory antistreptolysin increases. However, the demonstration of repeated abnormal antistreptolysin titers in 9 asthmatic patients was considered significant. 4.4. These 9 patients comprised 11.5 per cent of 78 patients with infectious asthma. This figure bears great significance in the realization that sensitization to numerous other bacterial antigens can take place. 5.5. It did not seem probable that earlier streptococcal diseases (scarlet fever, rheumatic fever) had any direct influence on the antistreptolysin index of the present study. 6.6. Persistently elevated antistreptolysin titers apparently indicate the presence of a focus of hemolytic streptococcal infections. Since such a focus is capable of inducing bacterial sensitization, a persistently elevated antistreptolysin titer in patients with infectious asthma could imply that sensitization to Group A hemolytic streptococcus exists and is of clinical importance in the allergic state. 7.7. Continued critical study of the antistreptolysin titer in infectious allergy appears justified by the suggestive results of the survey.

Leucocyte fragility in transitory leucopenia

Abstract 1.1. A method is described by which estimates can be made of white cell fragility roughly comparable to the estimation of red cell fragility in hypotonic saline. 2.2. Evidence is presented to show that the transitory leucopenia seen following the ingestion of certain foods is accompanied by increased fragility of leucocytes. 3.3. This increased fragility does not appear to be caused by a change in the relative proportions of the different types of white cells. 4.4. It may well be the result of some alteration in the white cell membrane. 5.5. No conclusion as to whether this change results from an antigen-antibody reaction or from chemical or mechanical trauma can be made from the present data.

Asthma and Asthmatoid Dyspnea

In the treatment of patients with wheezing dyspnea it is essential to know whether true asthma is the cause. The underlying mechanisms of asthma and the principles of diagnosis and treatment are discussed.