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The value of calcium in asthma, hay fever and urticaria
THE
VALUE
OF CALCIUM IN ASTHMA, TJRTICARIA” iwAXIMILIAN
NEW
A.
~~~~~~~~~~
YORK
HAY
FEVER
AND
n4.ll.
CITY
B
ECATJSE of the traditional idea that a deficiency of blood calcium exists in so-called allergic diseases, and that calcium therapy is indicated in the treatment of these conditions, a series of observations was started in 1920, in order to determine the true value of calcium in asthm’a, hay fever, and urticaria. The staGstics and opinions express’ed in this report are based on a study of 150 cases : 50 cases of asthma, 50 of hay fever, and 50 of urt,icaria. A great many more cases have been studied from this angle, but for purposes of simplicity in drawing up st,atistics, 150 cases were picked at random from the several hundred completed records. Only those cases showing at the initial examination a blood calcium of less than 10 milligrams per 100 C.C. of blood were selected for this report. At t,his time it may be well to st.ate, without going into lengt,hy detail, that a review of a very large number of determinations of blood calcium in asthma, etc., has failed to The vast majority had a blood show a consist,ently marked deficiency. calcium above 10 milligrams and quite a few above 1.0.5 milligrams; and furthermore, as will be shown by the charts herein published, the administration of calcium, or calcium and phosphorous, did not influence the symptoms or course of the disease in a single case, even though the blood calcium was actually increased. It is quite apparent from a study of Table I that in most cases t,here was a definite influence on the amount of blood calcium. However, in not a single case was there any demonstrable clinical beneficial effect. This is also true of cases having a high calcium (above eleven) at the initial examination, and whose calcium was raised even higher. The accompanying figures show that t,here seems to be no definite reaction trend; some were higher on the second determination, others were lower. Some continued”increasing for eight weeks: others returned to their original level, etc. Any number of cross statistical tables have been drawn from the accompanyin, v list, but were omitted because they would serve only to confuse the reader. For the same reason and for the sake of eliminating tables of useless figures, I am omitting a detailed report of the calcium figures in the 50 cases of hay fever and the 50 cases of urticaria. I shall give only the conclusions and impres*From th@ Depadment of .4wnnr Hospital, New York.
Applietl
Immunolom~
283
of
the
Fwnch
Hospital
and
Fifth
284
THE
JOURNAL
OF
ALLERGY
sions of a review of these figures which parallel very closely those printed in Table I for asthma. A great many cases of hay fever and urticaria showed normal or higher than normal calcium values, but only 50 of those having calTABLE DE~RMINATIONS
CASE 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 33. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. *First determination Second determination Third determination
IN
ASTHMA. EVERY HYPERSENSITIVE FIRST DETERMINATION*
CASE WAS TYPE
OF THE
SECOND DETERMINATION
8.2 8.0 7.2 7.2 7.6 8.5 9.0 9.2 9.5 9.4 9.0 8.2 8.2 9.8 9.0 9.0 8.0 8.2 8.8 9.0 7.6 8.6 7.7 7.8 9.2 9.2 8.3 8.2 8.0 8.0 7.2 7.2 6.5 6.5 9.1 7.0 6.8 6.2 7.0 7.2 8.0 8.2 9.0 9.8 9.4 7.4 7.0 6.4 7.5 7.0 was at the was four was eight
I
8.0 8.0 8.5 8.5 9.5 8.0 9.2 8.8 10.0 10.2 8.8 9.0 8.0 9.8 8.2 9.8 10.6 11.2 9.6 9.0 9.8 9.0 7.7 7.4 9.0 9.4 8.5 8.0 8.0 8.2 7.8 7.4
:.i 8:4 7.4 8.0 8.0 7.4 10.0 8.5 11.0 8.8 9.0 9.8 8.0 8.5 10.0 9.0 8.2 initial weeks weeks
visit after after
before treatment. starting administration starting administration
SPECIFICALLY -___THIRD DETERMINATION 8.4 7.8 8.0 9.8 9.5 9.2 9.2 9.2 10.4 11.0 9.8 10.5 8.0 9.8 9.5 10.4 11.8 11.0 9.8 9.4 9.0 9.2 8.4 7.9 9.8 11.2 8.6 8.4 8.2 8.0 7.7 7.4 7.4 8.0 9.0 8.8 8.0 8.2 9.0 10.5 9.3 11.5 9.4 9.5 9.8 8.6 11.2 10.4 9.8 8.2 of calcium. of calcium.
_
RAMIREZ
:
CALcIuM
IN
ASTHMA.
HAY
FEVER
~SD
UKTICARIA
2x5
cium values below 10 milligrams were chosen for this report. As a whole, the hay fever cases showed a higher init,ial calcium figure than the asthma and urticaria cases, and the urticaria cases lower on an average than the asthma cases. The general response to calcium preparat’ions was similar to that shown in the ast,hma series, and the clinical result was the same. It is my conviction that calcium is of very little clinical value in the treatment of asthma, hay fever, and urticaria. These conclusions agree with those of Criep and McElroy,1 but are at variance with the opinion of many ot,hers, notably Sterling,” Brown and IIunter,” PottengerT4 Novak and Hollender,“, 6 Patterson.? The work recently published by Blyers” regarding so-called vagotonia and sympat,heticot,onia is well wort,h careful consideration by those interested in this phase of the asthma problem. In stating that I have not seen clinical improvement following t,hr raising of blood calcium in allergic conditions, I do not mean t,o imply that some cases have not shown temporary improvement. This is particularly true in urticaria, but the improvement does not last long and may have been occasioned by many other factors unrelat,ed to calcium a,dministration. Calcium has been used in this series in the form of vigantol, calcium lactate, and afenil. We have also observed the effect on the blood calcium of the quartz lamp and of the combined administration of calcium and phosphorous and also of calcium, phosphorous, and parathyroid and thyroid ext,ract ; and, again, not desiring to fill pages with unnecessary lists of figures and graphs, I repeat that there is no change in my stat,ed opinion of the ~-alue of these drugs and combinations, in the treatment of allergic conditions. IIEl?ERENCES 1. Criep, 2. 3. 1.
.?. 6. 7. 8.
Leo H., and McElroy, William S.: Atop? : Blood Calcium and Gastric Analysis, Arch. Int. Med. 42: 863, 1928. Sterling, Alexander : The Value of Phosphorus and Calcium in Asthma, H:c! Fever. and Allied Diseases. J. Lab. & Clin. Med. 13: 997. 1928. Brown, G: T., and Hunter, 0. B:: Calcium Deficiency in Asthma: Hay Fever,, and Allied Conditions, Ann. Clin. Med. 4: 299, 1925. Pottenger, F. M.: A Discussion of the Etiology of Asthma in Its Relation to the Various Systems Composing the Pulmonary Neurocellular Mechanism With the Physiological Basis for the Employment of Calcium in Its Treatment, Am. J. Med. SC. 167: 203, 1924. Novak, F. J. Jr., and Hollender, A. K.: (‘alcium and I’arathyroid Glands in Relation to Hyperesthetie Rhinitis, J. A. M. A. 84: ,534, 1925. Novak, F. J. Jr., and Hollendrr, A. K.: Influence of Ultraviolet Irradiation on Calcium Cont,ent of Blood Serum, J. A. M. A. 81: 2003, 1923. Pa,tterson. Harold A.: Asthma and the Calcium Ion, N. 1’. State .I. Med. 26: 661, i926. Myers, Kurt: Zur pharmakologischen Analyse der Anaphylaktischen Ncaktion, Ztschr. f. Immunitiitsforsch. n. axper. Therap. 62: 270, 1929.
383
P,uni
AVENUE.
VALUE
OF CALCIUM IN ASTHMA, TJRTICARIA” iwAXIMILIAN
NEW
A.
~~~~~~~~~~
YORK
HAY
FEVER
AND
n4.ll.
CITY
B
ECATJSE of the traditional idea that a deficiency of blood calcium exists in so-called allergic diseases, and that calcium therapy is indicated in the treatment of these conditions, a series of observations was started in 1920, in order to determine the true value of calcium in asthm’a, hay fever, and urticaria. The staGstics and opinions express’ed in this report are based on a study of 150 cases : 50 cases of asthma, 50 of hay fever, and 50 of urt,icaria. A great many more cases have been studied from this angle, but for purposes of simplicity in drawing up st,atistics, 150 cases were picked at random from the several hundred completed records. Only those cases showing at the initial examination a blood calcium of less than 10 milligrams per 100 C.C. of blood were selected for this report. At t,his time it may be well to st.ate, without going into lengt,hy detail, that a review of a very large number of determinations of blood calcium in asthma, etc., has failed to The vast majority had a blood show a consist,ently marked deficiency. calcium above 10 milligrams and quite a few above 1.0.5 milligrams; and furthermore, as will be shown by the charts herein published, the administration of calcium, or calcium and phosphorous, did not influence the symptoms or course of the disease in a single case, even though the blood calcium was actually increased. It is quite apparent from a study of Table I that in most cases t,here was a definite influence on the amount of blood calcium. However, in not a single case was there any demonstrable clinical beneficial effect. This is also true of cases having a high calcium (above eleven) at the initial examination, and whose calcium was raised even higher. The accompanying figures show that t,here seems to be no definite reaction trend; some were higher on the second determination, others were lower. Some continued”increasing for eight weeks: others returned to their original level, etc. Any number of cross statistical tables have been drawn from the accompanyin, v list, but were omitted because they would serve only to confuse the reader. For the same reason and for the sake of eliminating tables of useless figures, I am omitting a detailed report of the calcium figures in the 50 cases of hay fever and the 50 cases of urticaria. I shall give only the conclusions and impres*From th@ Depadment of .4wnnr Hospital, New York.
Applietl
Immunolom~
283
of
the
Fwnch
Hospital
and
Fifth
284
THE
JOURNAL
OF
ALLERGY
sions of a review of these figures which parallel very closely those printed in Table I for asthma. A great many cases of hay fever and urticaria showed normal or higher than normal calcium values, but only 50 of those having calTABLE DE~RMINATIONS
CASE 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 33. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. *First determination Second determination Third determination
IN
ASTHMA. EVERY HYPERSENSITIVE FIRST DETERMINATION*
CASE WAS TYPE
OF THE
SECOND DETERMINATION
8.2 8.0 7.2 7.2 7.6 8.5 9.0 9.2 9.5 9.4 9.0 8.2 8.2 9.8 9.0 9.0 8.0 8.2 8.8 9.0 7.6 8.6 7.7 7.8 9.2 9.2 8.3 8.2 8.0 8.0 7.2 7.2 6.5 6.5 9.1 7.0 6.8 6.2 7.0 7.2 8.0 8.2 9.0 9.8 9.4 7.4 7.0 6.4 7.5 7.0 was at the was four was eight
I
8.0 8.0 8.5 8.5 9.5 8.0 9.2 8.8 10.0 10.2 8.8 9.0 8.0 9.8 8.2 9.8 10.6 11.2 9.6 9.0 9.8 9.0 7.7 7.4 9.0 9.4 8.5 8.0 8.0 8.2 7.8 7.4
:.i 8:4 7.4 8.0 8.0 7.4 10.0 8.5 11.0 8.8 9.0 9.8 8.0 8.5 10.0 9.0 8.2 initial weeks weeks
visit after after
before treatment. starting administration starting administration
SPECIFICALLY -___THIRD DETERMINATION 8.4 7.8 8.0 9.8 9.5 9.2 9.2 9.2 10.4 11.0 9.8 10.5 8.0 9.8 9.5 10.4 11.8 11.0 9.8 9.4 9.0 9.2 8.4 7.9 9.8 11.2 8.6 8.4 8.2 8.0 7.7 7.4 7.4 8.0 9.0 8.8 8.0 8.2 9.0 10.5 9.3 11.5 9.4 9.5 9.8 8.6 11.2 10.4 9.8 8.2 of calcium. of calcium.
_
RAMIREZ
:
CALcIuM
IN
ASTHMA.
HAY
FEVER
~SD
UKTICARIA
2x5
cium values below 10 milligrams were chosen for this report. As a whole, the hay fever cases showed a higher init,ial calcium figure than the asthma and urticaria cases, and the urticaria cases lower on an average than the asthma cases. The general response to calcium preparat’ions was similar to that shown in the ast,hma series, and the clinical result was the same. It is my conviction that calcium is of very little clinical value in the treatment of asthma, hay fever, and urticaria. These conclusions agree with those of Criep and McElroy,1 but are at variance with the opinion of many ot,hers, notably Sterling,” Brown and IIunter,” PottengerT4 Novak and Hollender,“, 6 Patterson.? The work recently published by Blyers” regarding so-called vagotonia and sympat,heticot,onia is well wort,h careful consideration by those interested in this phase of the asthma problem. In stating that I have not seen clinical improvement following t,hr raising of blood calcium in allergic conditions, I do not mean t,o imply that some cases have not shown temporary improvement. This is particularly true in urticaria, but the improvement does not last long and may have been occasioned by many other factors unrelat,ed to calcium a,dministration. Calcium has been used in this series in the form of vigantol, calcium lactate, and afenil. We have also observed the effect on the blood calcium of the quartz lamp and of the combined administration of calcium and phosphorous and also of calcium, phosphorous, and parathyroid and thyroid ext,ract ; and, again, not desiring to fill pages with unnecessary lists of figures and graphs, I repeat that there is no change in my stat,ed opinion of the ~-alue of these drugs and combinations, in the treatment of allergic conditions. IIEl?ERENCES 1. Criep, 2. 3. 1.
.?. 6. 7. 8.
Leo H., and McElroy, William S.: Atop? : Blood Calcium and Gastric Analysis, Arch. Int. Med. 42: 863, 1928. Sterling, Alexander : The Value of Phosphorus and Calcium in Asthma, H:c! Fever. and Allied Diseases. J. Lab. & Clin. Med. 13: 997. 1928. Brown, G: T., and Hunter, 0. B:: Calcium Deficiency in Asthma: Hay Fever,, and Allied Conditions, Ann. Clin. Med. 4: 299, 1925. Pottenger, F. M.: A Discussion of the Etiology of Asthma in Its Relation to the Various Systems Composing the Pulmonary Neurocellular Mechanism With the Physiological Basis for the Employment of Calcium in Its Treatment, Am. J. Med. SC. 167: 203, 1924. Novak, F. J. Jr., and Hollender, A. K.: (‘alcium and I’arathyroid Glands in Relation to Hyperesthetie Rhinitis, J. A. M. A. 84: ,534, 1925. Novak, F. J. Jr., and Hollendrr, A. K.: Influence of Ultraviolet Irradiation on Calcium Cont,ent of Blood Serum, J. A. M. A. 81: 2003, 1923. Pa,tterson. Harold A.: Asthma and the Calcium Ion, N. 1’. State .I. Med. 26: 661, i926. Myers, Kurt: Zur pharmakologischen Analyse der Anaphylaktischen Ncaktion, Ztschr. f. Immunitiitsforsch. n. axper. Therap. 62: 270, 1929.
383
P,uni
AVENUE.