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Allergy and immunization for wasp sting
THE J~URNAI,
76
01.7 ~I,LEROP
This investigation was designed to test the hypothesis of ~llulur transfrr of the dermal (delayed) neoarsphenarnine hypersensitivity in the guinea pig. The packed peritoneal cells obtained from 10 animals with high dermal sensitivity to neoarsphenamine were polled and resuspended in about 14 ml. of Tyrode’s solution containing 10 per vent normal guinea pig serum. About 0.2 ml. of this suspension containing approximately 0.15 ml. of viable cells 13’0~ normal was injected int,raperitoneally into each of X normal recipients. animals received, as control. about 0.2 ml. of pooled peritoneal cells similarI> obtained from 5 nonsensitized guinea pigs. The recipient animals (scnsitixecl and control ) were t,ested for skin sensitivity forty-eight, or seventy-two hours after cell transfer, by intt*atlet*mal injectiolrs of 0.15 mg. of neoarsI)henan~iile in 0.1 ml. saline. The results of this inr-estigat,ion showed unequivocally that the peritollr:ll cells from sensitized guinea pigs were able to induce a specific dermal sensitivity to the whole skin of homologous nonsensitized recipients. 23. AT,T,ERGY
TO FOODS CONTAISIS(I SULT~UIZ-AnIIn’O-A(“IL)8 CASE REPORT AND (‘T,ISl(:AI, STI’DY
:
LOUIS TUFT, M.D.,
1;. N. ETTIZLSON, iII.~D., .\su TTBXRICRTSCHIV~IRTZ, B.S., PHIL~~DICIJWI.~, P.z. (Prom The Veterans Administration Regio~cal OJ@P and 1’~mplr rT,nirusity AZler,qy Cli~tk-)
A clinical study was carried out upon a 27-year-old atopic mule chemist with recurrent urticaria and nasal and cerebral symptoms of allergy. The latter had been attributed since childhood to “sinusitis” but, despite negative intracutaneous skin reactions? were proved by diet trial to be due to allergy to certain foods, including egg, garlic, and molded cheeses. Thus on repeated occasion ingestion of egg would be followed by nasal and cerebral symptoms lasting varying lengths of time according to the amount eaten. &ce egg is high in content of sulfur-containing amino acids, notably nlet,hionine and cystine, and because repeated and deliberate inhalation of IT,8 fumes seemed to induce similar reaction, the possibility of an allergy to these amino acids was suggested. Because ordinary labol~atory procedures, including oral passive transfer, were of no value in verifying such a possibility, ingestion experiments were carried out, using varying amounts of methionine and cystine as These esperiwell as empty capsules and some containillg talc as controls. ments were done first with the knowledge of’ the ljntient but later as a 1)lind In both instances, we were able study so as to eliminate possible prejndicc. to show repeatedly that ingestion of nlcthionine was followed IQ- the same symptoms which followed the ingtstioll of egg, whereas cystinc produced only slight symptoms and talc none nt all. l)rnlonstration of the existence of allergy to protein split-products (in this case amino acids) would help explain some instances of food allergy with ;I ])ositivr clinical history hut negative skin test reactions.
Four adult subjects and two boys have been immunized aga.inst wasi) stings for one or more seasons during the I)ast six years. Each gave a history of having had, within twenty minutes of receiving one sting, violent, urticarial was carried on in various reactions associated with collapse. Immunization ways, ranging from multiple intracutaneous injections during one or more visits to a single depository of the allergen emulsified in mineral oil according to Freund. The allergen employed six years ago was bee venom, since no
77
AMERICAN ACADEMT OV AI,I,ERGy
yellow jacket allergen was commercially available. Subsequently, extract of the whole wasp, or of its pupae and larvae, was used. This year, venom sacs were surgically removed from anesthetized wasps immediately before dilution for inoculation into the patient. The degree of allergy existing prior to treatment as well as the resistance acquired during the course were judged by means of controlled tests of the skin and eye. Proof of a high clinical immunity was found during challenge tests with large doses of the immunizing material and, in some instances, with insect, stings that were inflicted deliberately in the laboratory or accidentally in the field. Serologic studies failetl to reveal either rea.ginic or precipitating antibodies. 27. HOIWE
DUST ALT,ERGY. I. OCCURRENCE AND INCIDENCE SEASONAL PATTERNS OF ASTHMA AND RHINITIX
OF
A. M. TARGOW, PH.D., ?II.D., Los ANGELES, CALIF. (From
the Division
of Allergy,
Department School
of IUedicine, of Xcdicine)
Unicersity
of Southern
California
The present-day conception of the course of symptoms of house dust allergy is that when the symptoms are seasonal they tend to occur primarily during the winter months and to disappear during warm weather. This paper offers evidence to show that t,he foregoin g concept fails to encompass the whole picture. Analysis of the actual course of events in 156 patients sensitive only to house dust shows that any calendar period of the year may serve as a regular annual period of recurrence of seasonal symptoms or of exacerbation of otherwise perennial symptoms. For any one patient, both t,he duration of the house dust season and the time of the year involved are strikingly constant from year to year. The phenomenon a.ppears to hold true for patients in all parts of the country. Figures are given to show the absolute and relative incidence of the various seasonal patt,erns that may be encountered. When the season occurs during the summer, the house dust allergy may be confused with pollen allergy. Wher implications of the phenomenon for the diagnosis and management of house dust sensitive cases are discussed. 28. FURTHER
STUDIES ON BIOLOGICAL PROPERTIES STAPHYLOCOCCUS EXTRACT
OF
~IURRAY DWORETZKY, M.D., HORACE S. BALDWIN, M.D., &IORTON C. KAHN, D.Sc., AND MARILYN K. SMART, M.A., NEW YORK, N. Y. (Prom Cornell University iMedical College,Dcpartm,cnt of Xediciw, Blleryy Ilicisioil [X.1). and H.S.B.] n?zd Public Hralth and Preventive Medicine [N.E.S. and X.C.E.]) Previous studies from this laboratory on the pharmacologic and anaphylactogenic properties of extract made from pathogenic staphylococci washed free of culture medium ancl exotoxin have demonstrated that bhis material consistently produces anaphylactoid reactions in intact guinea pigs and contraction of isolated segments of guinea pig ileum. This work has been confirmed and extended to include comparative studies with culture filtrates of pathogenic staphylococcus and staphylococci toxoid. The effects of these materials upon intact rabbits and guinea pigs and upon isolated suspended segments of guinea pig ileum will be reported. Studies have also been carried out with rabbit a,ntisera produced respectively by injections of culture filtrates of staphylococcus, toxoid, and extracts of pathogenic staphylococci washed as free as possible of exotoxin, to determine the degree of protection conferred by t,hese three antisera.
76
01.7 ~I,LEROP
This investigation was designed to test the hypothesis of ~llulur transfrr of the dermal (delayed) neoarsphenarnine hypersensitivity in the guinea pig. The packed peritoneal cells obtained from 10 animals with high dermal sensitivity to neoarsphenamine were polled and resuspended in about 14 ml. of Tyrode’s solution containing 10 per vent normal guinea pig serum. About 0.2 ml. of this suspension containing approximately 0.15 ml. of viable cells 13’0~ normal was injected int,raperitoneally into each of X normal recipients. animals received, as control. about 0.2 ml. of pooled peritoneal cells similarI> obtained from 5 nonsensitized guinea pigs. The recipient animals (scnsitixecl and control ) were t,ested for skin sensitivity forty-eight, or seventy-two hours after cell transfer, by intt*atlet*mal injectiolrs of 0.15 mg. of neoarsI)henan~iile in 0.1 ml. saline. The results of this inr-estigat,ion showed unequivocally that the peritollr:ll cells from sensitized guinea pigs were able to induce a specific dermal sensitivity to the whole skin of homologous nonsensitized recipients. 23. AT,T,ERGY
TO FOODS CONTAISIS(I SULT~UIZ-AnIIn’O-A(“IL)8 CASE REPORT AND (‘T,ISl(:AI, STI’DY
:
LOUIS TUFT, M.D.,
1;. N. ETTIZLSON, iII.~D., .\su TTBXRICRTSCHIV~IRTZ, B.S., PHIL~~DICIJWI.~, P.z. (Prom The Veterans Administration Regio~cal OJ@P and 1’~mplr rT,nirusity AZler,qy Cli~tk-)
A clinical study was carried out upon a 27-year-old atopic mule chemist with recurrent urticaria and nasal and cerebral symptoms of allergy. The latter had been attributed since childhood to “sinusitis” but, despite negative intracutaneous skin reactions? were proved by diet trial to be due to allergy to certain foods, including egg, garlic, and molded cheeses. Thus on repeated occasion ingestion of egg would be followed by nasal and cerebral symptoms lasting varying lengths of time according to the amount eaten. &ce egg is high in content of sulfur-containing amino acids, notably nlet,hionine and cystine, and because repeated and deliberate inhalation of IT,8 fumes seemed to induce similar reaction, the possibility of an allergy to these amino acids was suggested. Because ordinary labol~atory procedures, including oral passive transfer, were of no value in verifying such a possibility, ingestion experiments were carried out, using varying amounts of methionine and cystine as These esperiwell as empty capsules and some containillg talc as controls. ments were done first with the knowledge of’ the ljntient but later as a 1)lind In both instances, we were able study so as to eliminate possible prejndicc. to show repeatedly that ingestion of nlcthionine was followed IQ- the same symptoms which followed the ingtstioll of egg, whereas cystinc produced only slight symptoms and talc none nt all. l)rnlonstration of the existence of allergy to protein split-products (in this case amino acids) would help explain some instances of food allergy with ;I ])ositivr clinical history hut negative skin test reactions.
Four adult subjects and two boys have been immunized aga.inst wasi) stings for one or more seasons during the I)ast six years. Each gave a history of having had, within twenty minutes of receiving one sting, violent, urticarial was carried on in various reactions associated with collapse. Immunization ways, ranging from multiple intracutaneous injections during one or more visits to a single depository of the allergen emulsified in mineral oil according to Freund. The allergen employed six years ago was bee venom, since no
77
AMERICAN ACADEMT OV AI,I,ERGy
yellow jacket allergen was commercially available. Subsequently, extract of the whole wasp, or of its pupae and larvae, was used. This year, venom sacs were surgically removed from anesthetized wasps immediately before dilution for inoculation into the patient. The degree of allergy existing prior to treatment as well as the resistance acquired during the course were judged by means of controlled tests of the skin and eye. Proof of a high clinical immunity was found during challenge tests with large doses of the immunizing material and, in some instances, with insect, stings that were inflicted deliberately in the laboratory or accidentally in the field. Serologic studies failetl to reveal either rea.ginic or precipitating antibodies. 27. HOIWE
DUST ALT,ERGY. I. OCCURRENCE AND INCIDENCE SEASONAL PATTERNS OF ASTHMA AND RHINITIX
OF
A. M. TARGOW, PH.D., ?II.D., Los ANGELES, CALIF. (From
the Division
of Allergy,
Department School
of IUedicine, of Xcdicine)
Unicersity
of Southern
California
The present-day conception of the course of symptoms of house dust allergy is that when the symptoms are seasonal they tend to occur primarily during the winter months and to disappear during warm weather. This paper offers evidence to show that t,he foregoin g concept fails to encompass the whole picture. Analysis of the actual course of events in 156 patients sensitive only to house dust shows that any calendar period of the year may serve as a regular annual period of recurrence of seasonal symptoms or of exacerbation of otherwise perennial symptoms. For any one patient, both t,he duration of the house dust season and the time of the year involved are strikingly constant from year to year. The phenomenon a.ppears to hold true for patients in all parts of the country. Figures are given to show the absolute and relative incidence of the various seasonal patt,erns that may be encountered. When the season occurs during the summer, the house dust allergy may be confused with pollen allergy. Wher implications of the phenomenon for the diagnosis and management of house dust sensitive cases are discussed. 28. FURTHER
STUDIES ON BIOLOGICAL PROPERTIES STAPHYLOCOCCUS EXTRACT
OF
~IURRAY DWORETZKY, M.D., HORACE S. BALDWIN, M.D., &IORTON C. KAHN, D.Sc., AND MARILYN K. SMART, M.A., NEW YORK, N. Y. (Prom Cornell University iMedical College,Dcpartm,cnt of Xediciw, Blleryy Ilicisioil [X.1). and H.S.B.] n?zd Public Hralth and Preventive Medicine [N.E.S. and X.C.E.]) Previous studies from this laboratory on the pharmacologic and anaphylactogenic properties of extract made from pathogenic staphylococci washed free of culture medium ancl exotoxin have demonstrated that bhis material consistently produces anaphylactoid reactions in intact guinea pigs and contraction of isolated segments of guinea pig ileum. This work has been confirmed and extended to include comparative studies with culture filtrates of pathogenic staphylococcus and staphylococci toxoid. The effects of these materials upon intact rabbits and guinea pigs and upon isolated suspended segments of guinea pig ileum will be reported. Studies have also been carried out with rabbit a,ntisera produced respectively by injections of culture filtrates of staphylococcus, toxoid, and extracts of pathogenic staphylococci washed as free as possible of exotoxin, to determine the degree of protection conferred by t,hese three antisera.