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Epinephrine addiction in bronchial asthma
9“ .I
THE
JOURNAL
OF
ALLERGY
Frankel, E., and Levy, E.: Experiments With Filter Allergic Patients. Klin. Wchnschr. 7: 2292, 1928.
Apparatus
With
A small. portable filter apparatus and mask is described for the uw of those patients whose upper respiratory tract serves as portal of entry to t,hr offending allergens. The filter is so constructed that it, keeps back both gaseous and c~orpuscular material. Tests with Bacillus prodigiosus and Bacillus coli gave an impermeability of 97 1~1 cent as against the control without filt,er. The length of time ant1 1)eriodicitp with which the filter should be Itsed vary with the severit), of the case. Favorable results with its use are report,& It has a further diagnostic value. in that the exact portal of entry, whether nose or mout~h, etc., can be ascertained by proper adjustment of the mask. E’or very severe cases and for those in which the entire skin, or portions of it. serve as portals of entry, a dust free chamber. built in general along the lines of that used for Storm van Leeuwen, is describrcl Favorable results are reported with its use.
Leriche, R., and Fontaine R.: Present Treatment of Bronchial Asthma. Arch. 3: 500,1928.
Attitude N&l.-Chir.
Toward
Surgical
de L’App.
Resp.
The authors assert a long-known physiologic fact, that stimulation of hronchoconstrictor fibers in the vagus nerve induces asthmatic breathing. Two cases of asthma in which resection of one st,ellatc ganglion was done, were reported. One patient has remained free from attacks for three years and seven months, and the other for three years and one month. In both cases, various t,herapeutic measures had hwn tried previously without effect. Three other patients were likewise operated upon without benefit’. One of these was later eomplrtely relieved by a vagotomy. The authors favor operaCon in those cases in which nothing seemingly can be done as 30 per cent of these may thus be expected to he relieved. Various operative procedures are discussed.
Lamson, R. W.: Epinephrine
Addiction
in Bronchial
Asthma.
,J. I,ab.
and Clin. Med. 14: 931, 1929. Three cases are reported in which asthmatic patients develop an epinephrine habit, taking large doses of the drug even though a very slight relief is obtained. Such misu se of epinephrine is not infrequent, and is often due to the faulty instruction given by the physician who first advises the self-medication. In the chronically ill patient, the drug should be titrated against t,he patient instead of being administered according to a fixed rule. In this way the initial dosage could be adjusted to the individual so that complete relief could be obtained
SELECTED
ABSTRACTS
93
with the minimum amount of the drug necessary. Any marked increase should be only on advice of the physician. This increase often may be delayed by the substitution of another drug, with a subsequent return to epinephrine.
Lewisi E. B.: Otitis Media and Allergy. Ann. Otol. Rhin. and Laryng. 38: 185, 1929. TWO cases of acute otitis media are given in some detail. In each instance the onset of the attack was without premonitory symptoms. In each case spontaneous perforation with profuse serous discharge, occurred. Temperature, pulse, respiration and white cell count were normal. Rest in bed and a high alkaline fluid intake resulted in a cessation of discharge within thirty-six hours, followed by closure of. the perforation and a return to normal condition. In one case there was a definite history of allergy. In the other, the patient could give very little information. Four other cases of a similar nature were observed. All of these cases suggested an allergic etiology. The author considers it probable that many cases of acute otitis media originate as allergic and subsequently become infectious as a result of secondary bacterial activity.
Freiberg, J. A. : Allergy as a Factor in the Production of Proliferative Arthritis.
Arch.
Surg. 18: 645, 1929.
An experimental arthritis simulating the proliferative arthritis of man was produced in rabbits by the repeated injection, intraarticularly, of a bacterial extract. The extract employed consisted of a Berkefeld filtrate of B. dysenteriae Flexner, suspended in physiologic sodium chloride solution which had remained at 37” C. for fourteen days. The extract, as shown by repeated intravenous injections, was not highly toxic, when so introduced. The varying acidity and alkalinity of the filtrate proved to have no effect upon the production of lesions. Heating of the extract appeared to have no effect upon its antigenic properties. “The repeated parenteral introduction of the bacterial extract was accompanied by two types of reaction: an antibody reaction, characterized by the formation of specific agglutinins, and an allergic or altered tissue response, characterized by a gradually increasing intraarticular tissue reaction. ” Intradermal reactions, 1 cm. or more in diameter, ran parallel courses with the joint reactions. Subcutaneous injections of the extract produced no lesion. The animals, however, became sensitized to the exA single intraarticular injection made into an animal having tract. received previous subcutaneous injections, resulted in a marked arthritis. The initial intraarticular injection, without previous subcutaneous injection, resulted in no lesion. There was but one exception
THE
JOURNAL
OF
ALLERGY
Frankel, E., and Levy, E.: Experiments With Filter Allergic Patients. Klin. Wchnschr. 7: 2292, 1928.
Apparatus
With
A small. portable filter apparatus and mask is described for the uw of those patients whose upper respiratory tract serves as portal of entry to t,hr offending allergens. The filter is so constructed that it, keeps back both gaseous and c~orpuscular material. Tests with Bacillus prodigiosus and Bacillus coli gave an impermeability of 97 1~1 cent as against the control without filt,er. The length of time ant1 1)eriodicitp with which the filter should be Itsed vary with the severit), of the case. Favorable results with its use are report,& It has a further diagnostic value. in that the exact portal of entry, whether nose or mout~h, etc., can be ascertained by proper adjustment of the mask. E’or very severe cases and for those in which the entire skin, or portions of it. serve as portals of entry, a dust free chamber. built in general along the lines of that used for Storm van Leeuwen, is describrcl Favorable results are reported with its use.
Leriche, R., and Fontaine R.: Present Treatment of Bronchial Asthma. Arch. 3: 500,1928.
Attitude N&l.-Chir.
Toward
Surgical
de L’App.
Resp.
The authors assert a long-known physiologic fact, that stimulation of hronchoconstrictor fibers in the vagus nerve induces asthmatic breathing. Two cases of asthma in which resection of one st,ellatc ganglion was done, were reported. One patient has remained free from attacks for three years and seven months, and the other for three years and one month. In both cases, various t,herapeutic measures had hwn tried previously without effect. Three other patients were likewise operated upon without benefit’. One of these was later eomplrtely relieved by a vagotomy. The authors favor operaCon in those cases in which nothing seemingly can be done as 30 per cent of these may thus be expected to he relieved. Various operative procedures are discussed.
Lamson, R. W.: Epinephrine
Addiction
in Bronchial
Asthma.
,J. I,ab.
and Clin. Med. 14: 931, 1929. Three cases are reported in which asthmatic patients develop an epinephrine habit, taking large doses of the drug even though a very slight relief is obtained. Such misu se of epinephrine is not infrequent, and is often due to the faulty instruction given by the physician who first advises the self-medication. In the chronically ill patient, the drug should be titrated against t,he patient instead of being administered according to a fixed rule. In this way the initial dosage could be adjusted to the individual so that complete relief could be obtained
SELECTED
ABSTRACTS
93
with the minimum amount of the drug necessary. Any marked increase should be only on advice of the physician. This increase often may be delayed by the substitution of another drug, with a subsequent return to epinephrine.
Lewisi E. B.: Otitis Media and Allergy. Ann. Otol. Rhin. and Laryng. 38: 185, 1929. TWO cases of acute otitis media are given in some detail. In each instance the onset of the attack was without premonitory symptoms. In each case spontaneous perforation with profuse serous discharge, occurred. Temperature, pulse, respiration and white cell count were normal. Rest in bed and a high alkaline fluid intake resulted in a cessation of discharge within thirty-six hours, followed by closure of. the perforation and a return to normal condition. In one case there was a definite history of allergy. In the other, the patient could give very little information. Four other cases of a similar nature were observed. All of these cases suggested an allergic etiology. The author considers it probable that many cases of acute otitis media originate as allergic and subsequently become infectious as a result of secondary bacterial activity.
Freiberg, J. A. : Allergy as a Factor in the Production of Proliferative Arthritis.
Arch.
Surg. 18: 645, 1929.
An experimental arthritis simulating the proliferative arthritis of man was produced in rabbits by the repeated injection, intraarticularly, of a bacterial extract. The extract employed consisted of a Berkefeld filtrate of B. dysenteriae Flexner, suspended in physiologic sodium chloride solution which had remained at 37” C. for fourteen days. The extract, as shown by repeated intravenous injections, was not highly toxic, when so introduced. The varying acidity and alkalinity of the filtrate proved to have no effect upon the production of lesions. Heating of the extract appeared to have no effect upon its antigenic properties. “The repeated parenteral introduction of the bacterial extract was accompanied by two types of reaction: an antibody reaction, characterized by the formation of specific agglutinins, and an allergic or altered tissue response, characterized by a gradually increasing intraarticular tissue reaction. ” Intradermal reactions, 1 cm. or more in diameter, ran parallel courses with the joint reactions. Subcutaneous injections of the extract produced no lesion. The animals, however, became sensitized to the exA single intraarticular injection made into an animal having tract. received previous subcutaneous injections, resulted in a marked arthritis. The initial intraarticular injection, without previous subcutaneous injection, resulted in no lesion. There was but one exception