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Alimentary anaphylaxis
ABSTRACTS
345
The initial dosage for desensitization was arrived at by selecting the dilution the next below that which gave the least positive intradermal reaction. The first dose was usually 0.05 cc. subcutaneously. Injeetions were given at from three to four day intervals, and the dose was gradually increased or decreased as indicated by the patient’s clinical progress. Thirteen cases were treated : 11. were of the early type of hay fever, and 2 of the late type. Of these 13 cases, 5 secured complete relief, 3 almost complete relief, and 5 partial relief. The theories of the mechanism of desensitization are discussed.
Alimentary
Anaphylaxis.
Haritanis,
A. : Presse Medicale 41: 119,1933.
A report is given of a case of alimentary anaphylaxis, unusual in that it presented none of the classical symptoms associated with the condition. The patient complained of a fever of about 38” with no sweats and no chills, which appeared in the afternoon and disappeared toward midnight, leaving the patient exhausted. This fever had persisted for three months and had resisted quinine treatment and treatment for typhoid and paratyphoid fever. Diet had been restricted 60 milk and a meat bouillon. Such was the condition when the patient was seen by the author. Examination showed a good general condition. There were no unusual findings except for the liver, which was enlarged and upon palpation was slightly painful. The patient having spent some considerable time in Russia and in Egypt, it was considered possible that the condition might be due to amoebae and accordingly treatment was instituted, which, however, gave no results. Antisyphilitic treatment was then given with no results. A leucocyte count, showing a relatively low number about an hour after the noon meal, led the author to consider the possibility of a digestive anaphylaetic crisis. It was then remembered that the patient had complained of an erythema, periodic and fleeting, accompanied by a pruritus, and that he had noted that he found himself improved on days when in traveling he had been forced to limit his meals to watermelon. The patient was immediately put upon a liquid diet. The next day, for the first time in four months, the fever d.id not rise above 37”. The same diet was continued for another twenty-four hours without rise in temperature. Fruit juices and vegetable bouillon were successfully added to the diet. Further dietary experimentation showed that albumin was largely the offending element. Skin tests to peptone, milk and butter gave positive reactions. On an albumin-free diet the patient experienced a complete cessation of fever. After twenty days of such treatment the patient was fed a light albuminous meal and the fever recurred. Convinced that the case was one of alimentary anaphylaxis, desensitization was attempted with good results. The liver returned to nearly normal size and to date there have been no more attacks of fever.
345
The initial dosage for desensitization was arrived at by selecting the dilution the next below that which gave the least positive intradermal reaction. The first dose was usually 0.05 cc. subcutaneously. Injeetions were given at from three to four day intervals, and the dose was gradually increased or decreased as indicated by the patient’s clinical progress. Thirteen cases were treated : 11. were of the early type of hay fever, and 2 of the late type. Of these 13 cases, 5 secured complete relief, 3 almost complete relief, and 5 partial relief. The theories of the mechanism of desensitization are discussed.
Alimentary
Anaphylaxis.
Haritanis,
A. : Presse Medicale 41: 119,1933.
A report is given of a case of alimentary anaphylaxis, unusual in that it presented none of the classical symptoms associated with the condition. The patient complained of a fever of about 38” with no sweats and no chills, which appeared in the afternoon and disappeared toward midnight, leaving the patient exhausted. This fever had persisted for three months and had resisted quinine treatment and treatment for typhoid and paratyphoid fever. Diet had been restricted 60 milk and a meat bouillon. Such was the condition when the patient was seen by the author. Examination showed a good general condition. There were no unusual findings except for the liver, which was enlarged and upon palpation was slightly painful. The patient having spent some considerable time in Russia and in Egypt, it was considered possible that the condition might be due to amoebae and accordingly treatment was instituted, which, however, gave no results. Antisyphilitic treatment was then given with no results. A leucocyte count, showing a relatively low number about an hour after the noon meal, led the author to consider the possibility of a digestive anaphylaetic crisis. It was then remembered that the patient had complained of an erythema, periodic and fleeting, accompanied by a pruritus, and that he had noted that he found himself improved on days when in traveling he had been forced to limit his meals to watermelon. The patient was immediately put upon a liquid diet. The next day, for the first time in four months, the fever d.id not rise above 37”. The same diet was continued for another twenty-four hours without rise in temperature. Fruit juices and vegetable bouillon were successfully added to the diet. Further dietary experimentation showed that albumin was largely the offending element. Skin tests to peptone, milk and butter gave positive reactions. On an albumin-free diet the patient experienced a complete cessation of fever. After twenty days of such treatment the patient was fed a light albuminous meal and the fever recurred. Convinced that the case was one of alimentary anaphylaxis, desensitization was attempted with good results. The liver returned to nearly normal size and to date there have been no more attacks of fever.