Ionization of the nasal mucosa. Relationship between reagins in the blood and effect of treatment

IONIZATION

OF THE

BETWEEN

NABAD

MUCOSA.

REAGINS IN THE BLOOD OF TREATMENT

RELATIONSHIP AND

EFFECT

PRELIMINARY REPORT"~ H.

IJ.

ALEXANDER, M.D., AND J. II. ALEXANDER, A.B. ST.

LOUIS,

MO.

T

HE application of the principle of iontophoresis to the nasal mucous membranes is not new. However, apparatus for such therapy has been improved by Warwick,l who reported striking results in the treatDuring the past year, ment of hay fever and hyperesthetic rhinitis. “ionization” of the nose has come to bc applied somewhat extensively for local allergic disorders. The procedure consists of a.pplying a solution off certain metallic salts to the mucous membrane by means of a nasal pack. When passing a galvanic current through this solution, ions thereby released presumably act on the surrounding tissue. In a few days a slough is discharged, and restitution of what appears to be normal mucous membrane follows. The mechanism by which a slough is formed was not investigated, although it is possible that ionization under the above circumstances is but an efYective form of cautery. The mechanism of relief under these circumstances is of interest. If symptoms before treatment are regarded to result from contact between the specific allergen and the tissue antibody, then relief may be attributed to mechanical removal of antibody. The restored mucous membrane is not sensitive so that inhaled or ingested allergens evoke no response. The procedure of ionization offers an opportunity to observe how soon and under what circumstances t,he newly formed It, was surmised that if the epithelial tissue may become sensitive. reagin content of the blood persisted, sensitization would soon return. On the other hand, if no reagins could be demonstrated, t,he process of There are new local antibody formation would probably be slower. other possibilities to explain relief of symptoms, but the above only was investigated. Patients were treated at the Washingt,on University Out-Patient Department after a routine allergic history was taken and a careful otorhinologic examination was made by a member of the staff. This included a study of nasal secretions in which the relative number of *From the Department and the Oscar Johnson iThis investigation was by Dr. Arthur M. Alden. this report.

cine

of

Otolaryngology. Washington University School of MediInstitute and McMillan Hospital. made possible by a gift secured from an anonymous donor Dr. Alden also referred several of the patients included in 240

Hay fever Asthma Hay fever

Hay fever Hay fever Asthma

Gu.

Ja. Hem.

De.

Hay

SC.

fever

Hay fever Hay fever Hay fever Hay fever Hay fever Hay fever Hay fever Hay fever Vasomotor

DIAGNOSIS

Wi. Br. McC. Ste. Wei. Sh. Bl. Pl. str.

PATIENT

rhinitis

RESULTS

TESTS

++t

+t+

tt

+t+ +tt t-l-t +t tt +t t+

t+

SKIN TEST

+ -

+

+t

tt ++

++

L

-

-

+ + -

+

PASSIVE TRANSFER

PRELIMINARY

OF SKIN

+tt

tt+

t+

+++ tt ttt

+tt

ttt

tt t++

No

I

-

+ t t

+

ttt

2

++

Relief

ttt

tt

Relief t-i-

PASSIVE TRANSFER

WEEKS

TRANSFELX

Partial

+ -

t t

SKIN TEST

TWO

AND PASSIVE

TABLE

ttt

+tt

+tt

2 -

tt tt+ ttt tt+ t+ tt ++t + -

SKIN TEST

THREB

ON 25 PATIENTS

WERE

t+

t+

-

-

++ tt +t ++ t + t+ -

PASSIVE TRANSFER

MONTHS

WIIO

IONIZED

improvement at No relief at Bad sinus infection. Symptoms delayed 10 days. About 50% improvement. Hay fever improved. Asthma persisted. Hay fever improved. Developed asthma. About 50% improvement. Some improvement.

Very slight months. months.

REMARKS

3 6

s-4

= =

-

0.75 sq. cm. to 1.0 sq. cm. area of wheal. ++ 1.0 sq. cm. to 1.5 sq. cm. at-en of wheal. +++ I greater than 1.5 sg. cm. area of wheai. Dilution of pollen extracts for direct testing = 1 :lO,OOO. Dilution of pollen extracts for passive transfer. test = 1 :l,O@O.

+

-

-

-

rhinitis

-

tt+

++

CompZt

~-

f e Relief

PASSIVE TRANSFER

WEEKS

I-CON~"D

+

T in

-t

++

i -t + -

tt

!-

+t+

EssPntiazzy

SKIN TEST

rhinitis rhinitis

Asthma Vasomotor Vasomotor Hay fever __-Vasomotor

Sa. BU. Ed. Way. Tou.

t+

+t

-

TWO

TAELE

-

rhinitis

Hay fever Vasomotor

wt. Ba.

-

t

-1 t

t:

PREJ,IMINARY .__.SKIN ___ PASSIVE TEST TRAXSFER

-~~

-

rhinitia

Vxsomotor

Di.

fever

Hay

Hay fever Asthma Hay fever

DIAONOSIS

~~ ---

St.

cr.

Ea.

PATIEST

~__

i-t

-

.-

+

- i L -

+tt

SKIN TEST ~~~ ___~

THREE

t

t

PASSIVE TRAXSFER ~~~- ~~~~

XONTHS

in

improvement season).

improvement.

6 refor

(ionizetl

--

Great improvement. Great improvement; at months reported complete lief. Could not appear tests. Great improvement. Complete relief. Complet e relief. Complete relief. (‘omplete ~__-~ relief.

Great late

Great

REMARKS

___~.

ALJ3XANDER

AND

ALEXANDER

:

IONIZATION

OF

NASAL

MUCOSA

243

eosinophiles was noted. Intradermal skin tests were made and positive reactions measured with a planimeter and recorded in square centimeters. Only decidedly positive reactions were recorded. Reagins were sought for by the usual technic of passive transfer of blood serum to normal skin. Blood eosinophilia was determined. The nose was then ionized, and reexaminations by the above procedures were recorded at the end of two weeks and at three months. In a few cases observations were made at the end of six months. In some patients topical application of allergens which had caused trouble was ma.de to the nasal mucous membranes before and after treatment. The series studied was quite small and is being reported at this time in answer to many inquiries concerning the rationale and effect of nasal ionization. In all, 53 patients received treatment by ionization. Of these, 23 were reexamined at the end of two weeks but failed to return at the end of three months. Five others were examined after two weeks but their three-month period has not yet expired. The remaining 25 are tabulated in Table I. As a result of ionization, the size of the initial direct skin reaction did not change materially. The size of the passive transfer test was somewhat variable, but this may be attributed to the fact that the recipients were changed. Ward patients were used, so that a repetition of the test at three months was almost always done on a different skin which may have been more or less receptive than that upon which the first transfer had been done. Blood eosinophilia was not’ particularly altered, and it is interesting that eosinophiles persisted in the nasal secretions, even in those patients who were relieved. The significance of this finding is not clear. Topical applications of allergens gave variable and inconsistent response. It is, perhaps, noteworthy that of the 9 patients who secured no relief, 8 had hay fever, and of these 7 showed demonstrable8 reagins. On the other hand, in the group of 11 that were relieved, including 5 patients with hay fever, in only 3 were reagins found. SUMMARY

From these preliminary findings it would appear that in patients seeking ionization trea,tment for nasal allergy the chances of relief are greater if no reagins in the blood are present. Whether or not this is a probability can be confirmed only by further sta,tistics. REFERENCE 1. Warwick,

H.

I,.:

Laryngoscope

44:

172,

1934.