CYSTIC FIBROSIS HETEROZYGOSITY IN PATHOGENESIS OF ALLERGY

1241 CYSTIC FIBROSIS HETEROZYGOSITY IN PATHOGENESIS OF ALLERGY

SiR,—The article by Dr Warner and his colleagues (May 8, p. 990) may be of great significance to our understanding of the setiotogy and pathogenesis of cystic fibrosis (c.F.), and accords with our observations 12 that allergic symptoms and positive skin tests are more common in c.F. homozygotes than in healthy controls. Apart from the fact that 59% of our c.F. homozygotes gave

positive

a

skin

test to one or more

Bencard antigens, the main

remarkable manifestation of allergies. For example, homozygote the mother had various skin hypersensitivities, the paternal great-grandfather had asthma, and the maternal great-aunt had severe eczema, whilst the maternal aunt had various skin hypersensitivities. Further studies are required to establish the relationship, if any, between the a

one c.F.

SUMMARY OF TOTAL

states

in C.F.

Department of Medical Biochemistry, University of Manchester, Manchester M13 9PT

H. MCFARLANE

Macclesfield Cheshire

J. D. ALLAN

Hospital,

one

sensitivities, asthma, and eczema. Where the information was available, the grandparents as well as the great-grandparents showed

various types of hypersensitivity

of 40 different classes of

being Aspergillus fumigatus, at least 85% of the c.F. heterozygotes had a strong positive history of allergy, of which the mother and her maternal progenitors, followed by the siblings, accounted for most. The main allergic manifestations in these were hayfever, skin hyper-

in

migrating secretory component, as well as autoantibodies to SIgA, may exist in c.F. patients and could5 account for the

tic

SERUM-lgE

BRAIN DAMAGE IN JOCKEYS

SIR,-I

menting 8, p. 981).

am

on

I

grateful

Dr Allen (May 22, p. 1135) for comby Dr Foster and his colleagues (May

to

the article

consultant surgeon to the Jockey Club and the Betting Board. We all agree on the importance of prevention, and Levy I pay tribute to the Jockey Club and the Levy Board for their interest-not merely in talking about it but in taking action. In 1968 a meeting of all racecourse doctors and representatives of the racing authorities held conferences in London and Newcastle, and I presented a paper on injuries in racing. The Jockey Club records all injuries to jockeys so it was easy to assess the number of accidents and to find out which were the most frequent and the most dangerous. After the conferences the Jockey Club instituted the following measures: (1). The obligatory use of the British helmet researched by the late Brigadier Teacher, now the envy of foreign racing authorities. (2). The wearing of a ’Plastazote’ spine protector was encouraged, and this is now worn by most National Hunt am

jockeys. (3). Most important, perhaps,

gene responsible for the allergic manifestation in the population and the c.F. phenotype. Whereas the c.F. patients were chiefly positive to A. fumigatus, the asthma patients had positive skin tests to grass pollen and to Dermatophagoides pteronyssinus. The table summarises the mean total serum-IgE in different groups. Whereas 5 of 17 of the C.F. heterozygotes and 3 of 10 of the c.F. siblings had a raised total serum IgE, 45% of the c.F. homozygotes had raised IgE values. Radioimmunoassay of serum specific IgE and extensive tests of passive cutaneous anaphylaxis reactions in baboons confirmed that, although A. fumigatus was the main offending allergen in the c.F. homozygotes, in both the asthma patients and in the c.F. heterozygotes it was D. pteronyssinus and

timothy-grass pollen. It must be stated, however, that in most C.F. patients there is not only a type-i immediate hypersensitivity reaction but also a type-in Arthus reaction with immune-complex deposits in target organs of lung and pancreas, as well of circulating immune complexes, especially in the c.F. sputum.3 Furthermore, up to 85% of 71 C.F. homozygotes had positive precipitins in their sputum to a wide variety of antigens including food, fungi, bacteria, and human tissue antigens. Leucocytes from c.F. patients but not from controls, produced macrophange-inhibition factor toA.fumigatus, Pseudomonas ceruginosa, and human ling and pancreatic extracts but not to brain, heart, or kidney, indicating that a type-iv hypersensitivity state also exists in C.F.4 Extensive immunochemical studies showed that a variety of SIgA abnormalities, which includes the presence of free J chain, presence or absence of free secretory component or of SIgA from secretion, a fast-electrophore-

1.

Wallwork, J. C., Brenchley, P., McCarthy, J., Allan, J. D., Moss, D., Ward, A. M., Holzel, A., Williams, R. F., McFarlane, H. Clin. exp. Immun. 1974, 18, 303. 2. Allan, J. D., Moss, A. D., Wallwork, J. C., McFarlane, H. J. clin. Allergy,

1975, 5, 255 3. McFarlane, H., Holzel, A., Brenchley, P., Allan, J. D., Wallwork, J. C., Singer, B. E., Worsley, B. Br. med. J. 1975, i, 423. 4 Gibbons, A., Allan, J. D., Holzel, A., McFarlane, H. ibid. 1976, i, 120.

was the institution of the medical passport, which carries full details of previous illnesses and injuries, and which has to be seen by the racecourse medical officer before the jockey is allowed to ride. These measures resulted in a reduction of head injuries from the 1967/68 figures of 46 to 27 in 1973/74, and of spinal injuries from 27 to 8. A representative of the Royal College of Physicians team investigating traumatic encephalopathy in boxers, Dr (now Professor) J. A. N. Corsellis, has had discussions with me on the very matters that Dr Foster and his colleagues are concerned about. Dr Corsellis gave a paper at the Institute of Sports Medicine symposium held on April 18, 1975, and told us how impressed he was by the careful records kept by the Jockey Club. Mr J. R. W. Gleave gave a detailed account of hospital admissions for head injuries in every form of sport over a 12-year period. Horse riding topped the list with 162 admissions, followed by rugby football (131) and association football (113); of the admissions associated with horse riding only 16 were professional jockeys. The remainder were amateurs, the list being headed by 111 females, all following accidents while hacking-surely another reason for locking up one’s daughters. Of the 16 professionals admitted, 13 fell during training where the protective measures of the Jockey Club and the racecourse medical officers do not apply, and only 2 of the accidents happened during steeplechasing. These figures show that our attention should be directed towards the amateur rather than the professional. The 4 deaths in Mr Gleave’s series were all in amateur horse riders. The next most dangerous sport would appear to be rugby football, and it is here, and in the emergent sports of judo and karate, that medical support is lacking, including stipulations as in racing and boxing that anyone who is concussed should not resume the sport for a specified period. It is, in my view, essential that there should be properly trained sports-medicine doctors with authority to institute preventive measures for unacceptable risks in every branch of modern sport.

Hospital of St. John and St. London NW8 9NH 5. Wallwork, J.

Elizabeth,

FRANK D’ABREU

C., McFarlane, H. J. clin. Allergy (in the press).