ECZEMA OF THE HANDS DUE TO FOOD AND POLLEN ALLERGY.
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Biomedical subjects
Publications and source records attributed to A ROWE.
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Observation of 100 patients with atopic dermatitis due to hypersensitivity to pollen over a period of 12 years emphasized certain important diagnostic and therapeutic features. The incidence was higher in females than in males and higher in middle and old age than in the earlier years. Pollen dermatitis may be the sole or major manifestation of allergy; 43 patients gave no history of other allergic symptoms. It may involve any or all areas of the body. The site or the distribution of lesions or the nature of the lesions gave no clue as to the diagnosis of pollen sensitivity. The character of the eruption varied widely from patient to patient and in given patients from week to week at times. Atopic dermatitis due to pollen sensitivity may be purely seasonal, perennial with seasonal exacerbations or perennial without seasonal variation. Reactions to skin testing with pollens suspected as allergens may be positive, equivocal or negative. In 58 patients there were positive correlative skin reactions to pollens. The diagnosis of atopic dermatitis due to pollen sensitivity, and the composition of the desensitizing antigen or antigens, must be based primarily on the clinical history and the area of residence. Most patients could tolerate only very weak dilutions at the beginning of desensitization therapy. Strong dilutions caused exacerbation of the dermatitis. Good or excellent results were obtained with perennial pollen desensitization therapy administered over long periods. In 13 patients good results took four to eight years of desensitization therapy. Fifty required less than two years. Tolerance of the patient for a given dose of antigen should determine the maximum dilution used in therapy.
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The authors consider sensitivity to foods and sensitivity to inhalants about equal in importance in bronchial asthma, allergic rhinitis and allergic bronchitis. Food allergens are the sole cause of bronchial and nasal allergic disease in 20 to 40 per cent of cases throughout life, including old age; inhalants are the sole cause in approximately an equal number; and sensitivity to foods and to inhalants are often associated. THEIR FREQUENT RECOGNITION OF SENSITIVITY TO FOODS AS A CAUSE OF DISEASE, THE AUTHORS BELIEVE, DEPENDS ON: (1) The recognition of the fallibility of skin testing and the usual negative skin reactions to allergenic foods in chronic and recurrent bronchial asthma and allergic rhinitis. (2) The adequate use of trial diets, especially cereal-free elimination diet. (3) The realization that ingested foods remain in the body usually for two to four weeks and that the diet must be continued until symptoms have been relieved for two to three times as long as preceding relief between attacks.
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Strained meat formulas containing approximately the protein, carbohydrate, fat and mineral content of cow's milk have proven valuable in the study of animal milk allergy in infants and children. Strained meat formulas have been given to over one hundred infants and children with bronchial asthma, eczema and gastrointestinal allergic disease. There were no instances of weight loss or anemia. Clinical improvement was evident in most cases.
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Cortisone and corticotropin (ACTH) in adequate doses usually promptly relieve allergic rhinitis, bronchial asthma, atopic eczema, urticaria, drug reactions and poison oak and ivy dermatitis. However, as the symptoms recur upon discontinuance of the hormones, and longcontinued use entails certain hazards, it is necessary to determine the underlying allergic cause of the symptoms and to institute measures to overcome it. However, when adequate antiallergic treatment does not control symptoms, the continued use of small doses of these steroids or of larger doses for weeks or months in severe or intractable cases is justified. In the few cases in which prolonged use of these hormones is necessary, the patient ought to be told of the possible complications, of the expense of laboratory studies that must be carried out, and of the cost of the hormones.
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ACTH and cortisone are highly nonspecific in their action. A fundamental portion of the mechanism of action is the interposition of a blockade between toxin and end organ. This effect can be of great benefit in the management of a variety of acute and chronic diseases.A major hazard constantly to be kept in mind is the potential masking of advancing disease. This consideration makes concomitant chemotherapy mandatory in the presence of specific infections. In chronic diseased states it should be assumed that prolonged therapy will be necessary. Treatment should not be instituted unless such continued therapy is physiologically and economically feasible.
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