Ecology centers are controversial clinics or hospital units usually run by doctors who call themselves "clinical sociolo­gists." According to their theories, many mysterious diseases involving a wide range of symptoms are attributable to allergic-type reactions to chemicals, pollutants, or to a long list of other substances found in minute quantities in the air, water, food, or general environment. Patients are often treated with exotic diets or in isolation rooms with specially filtered air and water and from which many synthetic ma­terials have been removed. There is no proof available from well-controlled double-blind studies to prove or disprove the benefit of treatment at these clinical ecology centers.

See Challenge Test.

Rheumatoid arthritis is a disease characterized by chronic inflammation of the joints. It may also affect other organs and tissues of the body. Immunological factors are important in the origination and development of the disease. A specific antibody against denatured, or altered, gamma globulins—called rheumatoid factor— is often found in the serum of patients with rheumatoid arthritis.

Epinephrine hydrochloride (Adrenalin) and terbutaline sulfate (administered by injection) are often used in emergency rooms, but they have little value in the prolonged treatment of asthma patients. A patient overusing medications is an indication that the patient’s medication program must be changed. The side effects of such medi­cations are similar to those mentioned for other bronchodilators; they should be used cautiously in adults with cardiac problems or over­active thyroid glands.

Clearly, grasses are the major source of pollen allergy, regardless of the time of year. Also, significant levels of fungus spores, accom­panied by allergic symptoms, occur in all the seasons. It is suspected, too, that insect-derived material plays a role in allergies. One source ; of insect debris is the droppings of bats, which often live in the roofs of private homes. It is not clear, though, whether the droppings con­tain bat dander. Respiratory irritation from the smoke of burning sugar cane is widely recognized, but a true allergy to the smoke has not been proved.

Mucus is a glutinous secretion of the mucous membranes; it is produced by glands to protect and moisten the membranes.

When an allergen is absorbed into the bloodstream, it stimulates certain small white blood cells called lymphocytes to produce special substances known as allergic antibodies. These antibodies react with the allergen and produce allergic inflammation and irritation in par­ticularly sensitive areas of the body, such as the nose, eyes, lungs, or digestive system. This sensitivity is not present at first contact with the allergen; instead, it may develop after repeated exposure. For exam­ple, a new cat may not cause allergy until it has been living in a house for many months. Eventually, a susceptible person becomes sensitized and develops a stuffy nose and sneezing or wheezing on further con­tact with the cat.

A thorough explanation of the benefits and side effects of all medi­cation helps the patient develop a positive attitude and improves cooperation between patient and physician. Various techniques may be used, such as teaching displays of drugs commonly used, along with the primary function of each. The patient may, for example, be told the potential hazards of the medicines involved, and asked to memorize their names. Discussion groups monitored by nurses, physi­cians, and/or other personnel help patients understand their diseases and increase their knowledge of drug therapy.

Anaphylaxis is a sudden condition resembling shock that follows within minutes an allergic reaction to a foregn sub stance. It is potentially the most immediately life-threatening allergy emergency, ff the allergen is ingested, as is the case with food or medication, the first symptom may be numbness or tingling in the mouth. This sensation may occur even before the food is completely chewed and swallowed, or it may begin within fifteen minutes after swallowing. The tongue swells, and the throat, or windpipe, feels constricted (from the ensuing edema, or swelling, of the soft tissues). In more severe reactions, the skin, cardiovascular, pulmonary, and gastrointestinal systems can, in rapid sequence, be affected. Hives, rapid heartbeat, lightheadedness, wheezing, nausea, and vomiting can be expected. If the allergen is injected, either by the stinger of an insect or by a physician’s needle, a red swelling at the site is likely to be the first sign. Then, except for a numbness and tingling in the mouth, symptoms similar to those when allergen is ingested may occur. The original site of contact with the allergen is thus involved initially, only to be followed rapidly by general symptoms. Fortunately, spontaneous recovery is the rule; a person recovers within thirty minutes to several hours, and the recovery is nearly always complete. In rare cases, the patient may faint from abnormally low blood pressure, experience seizures, or suffer cardiac damage. Fatal anaphylaxis is rare. A Canadian study has uncovered seven such deaths per year in a population of 6 million. Although penicillin causes some reaction in about 10 percent of the people injected, the death rate is believed to be 1 in 7.5 million injections. Stinging insects inflict large, local (or nonfatal) anaphylactic reactions in slightly less than 1 percent of people stung. The death rate is about 1 per 3.5 million persons per year. In studies called urograms, radiologists and urologists inject radiocontrast dyes to better visualize the kid­neys; it has been estimated that one death has occurred for every 116,000 such examinations. Reaction to an injected dye is called an anaphylactoid reaction. This type of reaction is similar to that of anaphylaxis, although no immunological basis has been discovered. X-ray dyes can release histamine and other chemical agents from cells in the body. For reasons that are poorly understood, in some people these drugs have an exaggerated capacity to act. Why some people have these reactions and others do not has been attributed to a combination of the degree and type of exposure to the provoking agent, and to the immune system. Some individuals have inherited hyper-responding immune systems that produce more immunoglobulin E, as well as other antibodies. Repeated contact with small amounts of the allergen may have produced greater sensi­tization. Injections are more likely to cause general reactions than oral or skin contact. Death is more likely in people over forty or in those with chronic,, severe health problems. Variant Diagnosis Sometimes a person reacts to an injection by fainting. Before doing so, the individual becomes pale, light­headed, and possibly nauseous. Although the person may not suffer from hives or any respiratory difficulty, the pulse is apt to be slow. The individual revives after lying down. The cause is a nervous reaction (in medical terms, a vasovagal reaction) transmitted via the vagus nerve to the heart and blood vessels.

A shock organ is the tissue or organ in which an aller­gic reaction occurs.