Clinical and therapeutical aspects of cold urticaria (urticaria a frigore).

A new drug with inhibitory properties on the Mast Cell degranulation, Ketotifen, was administered in 87 patients suffering from idiopathic urticaria a frigore (iUF). The first group (A), with 52 patients effectuated prophylactic management for 4 months with Ketotifen (K) (2 mg/day) and Clemastine (C) (2 mg/day) according to the double blind crossover method. Both the drugs were administrated in stages of 2 months each. The second group (B), with 35 patients (having previously failed a prophylactic attempt with Cyproheptadine) received only K, for two months. The results of group. A were favourable (clinical improvements over 50%) in 86.6% of the patients treated with K and in 50% of the patients treated with C. The mention is made that 36.6% from favourable results obtained with C in the second stage, appeared as a continuation of the improvements determined by K in the first stage. The lowering of the skin response to Cold Test (CT) was obtained in 55.8% of the patients treated with K and only in 7.6% of them who received C. Group B obtained favourable clinical results in 62% cases and the diminution of CT in 42% cases. Finally a few lesser known clinical and aetiopathogenic aspects of iUF resulting from the analysis of the patients investigated are presented.

Imminent shock; a useful diagnosis in drug pathology.

A research has been carried out on a total of 121 persons with survival post-drug shock (DS), which registered 192 DS. Mention should be made of their predominance in the feminine sex (85 per cent) and their maximum frequency between the ages of 21-50 (average age 34). DS was the first adverse reaction to drugs in 71 per cent of the cases. Therefore DS unpredictability is very frequent. A retrospective study suggested the role of risk factors which should help the doctor to prevent DS (personal allergic antecedents, antecedents of adverse reactions to drugs, neuroses, disorders of endocrine glands, feminine sex, etc.). In 1970, the clinical concept of shock imminence (SI) was formulated and it is applied to various etiologies (drugs, insect stings, food). The existence of SI was identified in the case history of 14 per cent of the persons with DS. SI is a syndrome which includes all clinical manifestations with imminent potential of transformation into shock condition, and represents the stage precursory to the setting up of shock. The utility of SI diagnosis is maximum if it also includes the causal factor (e.g. SI by penicillin or aspirin). The clinical image of SI may vary from the monosymptomatic aspect (urticaria, vomiting, diarrhoea, headaches, etc.) to the one with complex symptomatology (mixed form). Usually the symptoms are dramatic and depend on the administration of a certain drug (often in SI of allergic origin) or of various drugs (mainly on non-immunologic form). The absence of vascular collapse differentiates SI from shock. Differential diagnosis is more difficult in border cases with a slight diminution of blood pressure. SI can be diagnosed especially in several circumstances: when the first adverse drug reaction is dramatic; when the first allergic-type reaction to a drug occurs; when the repetition of drug reactions is amplified in intensity or frequency; when it occurs in persons with risk factors. The differential diagnosis of SI is made with a crude or minimum shock and with pre-shock condition. The advantages of SI diagnosis are the institution of efficient treatment with rapid recoverability and the prevention of subsequent shock to the respective drug.

[Experience in the field of microbial allergic asthma]. / O experienta in domeniul astmului alergic microbian

The present paper reports on the effect of prolonged microbial hyposensitization applied in 206 cases of microbial allergic asthma in comparison to 95 asthmatic patients of the same category in which this treatment was not applied; improvement was obtained in 78% of the former lot as against 17% in the latter. The quanlity of the improvement obtained and the dependence of the results upon the various diagnostic criteria used are discussed. Microbial hyposensitization has proved efficient in asthmatic patients although its mechanism of action is not yet known, nor the difference that exists from this point of view with the current microbial vaccination. The data obtained suggest that microbial hyposensitization acts by the mechanism of microbial vaccination in all the variants of infectious asthma.

The criterion of the inhalation test to allergens at establishing specific hyposensitizing in allergic asthma.

The experience we had in our casuistics as regards 1,000 asthmatics, demonstrates the positive inhalation test (IT) to allergens, only in about 40% of the asthmatics having positive cutaneous test (CT). The technic for determination has used the FEV1 criterion. We correlated the data of the anamnesis (A), CT and IT. The indications of allergenic etiology concerning A, have been divided into three categories: certain anamnesis (CA), suggestive anamnesis (SA) and unconclusive anamnesis (UA). At asthmatics having + CT, CA was associated to + IT in 92%, to SA in 49% and to UA in 11% of the cases. At asthmatics having --CT, CA is possibly associated to + IT, much more rarely associated to SA and not at all associated to UA. From these correlations we deduce the value of A and the fact that --IT is sometimes a false negative test. It further results that IT is not absolutely necessary in cases having CA and + CT. However, IT becomes useful in cases having CA/SA and --CT, as well as in cases having SA/UA and +CT. In 611 persons having allergic asthma lasting cures (1-6 years) of SH have been obtained successfuly in 92% and unsuccessfuly in 8% of the cases. From this total, lot 1 (437 cases) has been selected according to criterion CA/SA and +CT; lot II (130 cases) has associated in addition to criterion of selection by +IT; lot III (44 Cases) was selected with CA/SA, +CT and --IT. Although the selection has been different, the SH results have been identical. From this we infer the spheres of SH efficacy exceed the limit of every selection criterion mentioned before. Further it is to be inferred that the routine IT brings a satisfactory selection for the SH decision only in the mentioned conditions.