Swelling of the salivary glands may be a manifestation of an aller­gic reaction to a food. Once you have identified the food or foods responsible for this reaction, the only recourse is to avoid them. Other causes of salivary-gland swelling —for example, stenosis, or narrow­ing, of the salivary duct and infection—should be ruled out. Your doctor will help determine the exact cause.

Saute beef, mushrooms, green pepper, and celery in oil. Add tomatoes, onion soup mix, Worcestershire sauce, salt, and thyme. Cook until excess moisture is gone. Cook rice noodles or vermicelli, drain well, and add to meat mixture. Put in casserole, adding grated cheese if allowed. Heat in 350° F oven for 1.2 to 3.4 hour. If desired, omit mushrooms, celery, and tomatoes and substitute stuffed olives, canned corn niblets, and your favorite soup. Serves 12.

Your doctor, in addition to taking a thorough history of your ill­ness, may make a study of your home and work environment, your diet, and your living habits. The doctor will also give you a physical examination and run some laboratory tests. Using extracts of common allergens, the doctor may perform various skin tests to ascertain aller­gies to specific allergens. After reviewing the family history, giving an examination, and running skin tests, the physician will be able to determine whether you have an allergy or allergies and, if so, what allergens are involved. This requires planning, skill, and patience. An accurate diagnosis cannot be obtained simply by performing allergy tests alone, as is done in some testing laboratories.

Urine immunotherapy is another controversial area of allergy research. Clinics that use it as a treatment have sprung up around the United States. In the therapy, patients bring their own urine to the clinic, where it is filtered and injected back into them. This procedure is purportedly beneficial, but to trained allergists, it is a sham, for which gullible people pay large sums of money despite the lack of evidence supporting the therapy. Belief in such treatment indicates that people have chosen a form of medical treatment without regard for research —the scientific procedures by which medical practices are substantiated and theories verified.

Allergic conjunctivitis is a common allergic reaction of the eyes. The most prominent symptom is itchy, watery eyes and a red lining on the whites of the eyes. Allergic conjunctivitis is often associated with other allergic symptoms such as hay fever, but sometimes it is the only complaint. Symptomatic treatment with antihistaminics produces significant improvement in most cases. In severe cases, allergic evaluation and treatment is carried out in the usual manner, that is, by skin testing and eosinophil and IgE quanti-fication.

The relationship between allergies and hyperactivity, or hyper-kinesis, remains to be proved. Although controlled studies are not available, most allergists believe that no relationship exists.

For certain patients, an extract of dust from your house would be more useful in treatment than the commercially produced extracts formulated to be like those that originate in most households. Usu­ally, however, there must be a peculiar condition in your home for the dust to differ. There are no new, significant developments in the treatment of allergic rhinitis that your doctor would not be likely to know about, considering today’s communications and the dissemination of scien­tific information. Ornade, CoPyronil, and Actifed, for example, are considered effective antihistamines and decongestants, but they cause drowsiness in some allergic people. You should discuss any questions about treatment with antihistamines with your physician.

Serum sickness was originally described as an aller­gic illness that occurs six to eight days after administration of large amounts of an animal antiserum. The patient develops fever; skin lesions, particularly urticaria (hives); pain and swelling in the joints; and swelling in the lymph nodes. Symptoms may be mild, lasting only a few days, or they may be severe, involving numerous organs, including the heart and kidneys. The mechanism responsible for serum sickness consists of deposits of antigen-antibody complexes (animal serum protein being the antigen, combined with human antibodies) in various organs and tissues. These antigen-antibody complexes activate the complement system and subsequently induce the process of inflammation responsible for the tissue damage and symptoms. In the past, horse antitoxin, or antiserum (that is, a foreign, animal serum protein) was widely used in treating bacterial infection, but its use was often complicated by serum sickness. Recently, the primary use of horse serum has been against powerful toxins such as snake and spider venom and as a preparation of antilymphocyte serum used in organ transplants. Both drugs and serums can cause serum sick­ness, with penicillin currently the most frequent cause. Treatment is symptomatic; the choice of therapy depends on the clinical symptoms. Mild cases may require rest and the administration of such anti­inflammatory drugs as aspirin and antihistamines over a period of a few days. More severe cases may require the administration of a short course of corticosteroids such as prednisone. In the long run, how­ever, the best way to prevent serum sickness is to avoid using animal serum and any drug unless the drug is absolutely necessary.