Whenever allergens in a patient’s environment can be isolated, they should. This is fairly easy when a feather pillow or dust-catching furniture is the problem. When a person is sensitive to a cat, dog, or bird, however, removing the allergen source may not be easy because of an emotional attachment. It can be done, though, by using patience and compassion and by explaining the risk of keeping the pet. If foods are the cause of the difficulty, they must be eliminated from the diet. The timing and proper use of medications are important in treating allergic disease. A medical doctor must prescribe the medications and their dosages. Numerous medications are now available that are helpful both in preventing symptoms and in providing relief from them. They may be all that is needed in cases of mild allergy. If symp­toms persist despite the proper use of medications and the removal of allergens from the environment, immunizing injections may be neces­sary to control the disease.

Commonly known as hay feyer,allergic rhinitis is a complex of symptoms characterized by attacks of sneezing actymny


stuffy nose and postnasal drip, frequent eye irritation, and ear con­gestion resulting from specific allergic reactions. These symptoms may be limited to one season of the year or they may be perennial, de­pending on the presence of a specific allergen in the local environ­ment. Severe nasal obstruction may occur, which can interfere with normal sinus drainage and with the openings of the Eustachian tubes, producing headaches, impaired hearing, and secondary sinus and ear infections. During the allergy season, it is not unusual for a person to complain of fatigue, irritability, and a loss of well-being. Not every­one who has nasal symptoms, however, is suffering from allergic rhinitis.

Patch tests are used to identify substances responsible for contact allergy. The test consists of applying a small amount of a suspected substance to the skin. The area is then covered with tape and left for forty-eight hours. If a small area where the substar was applied swells and turns red, the test result is said to be positr

Certain methods of testing for and treating food allergies have failed to receive adequate scientific scrutiny. One example is the leukocytotoxic test, which involves putting antigen and serum from an allergic person on a slide with white blood cells. Killed white cells are thought to indicate allergy, but this has not been proved. Other inadequately documented methods are subcutaneous provocation testing and sublingual (under the tongue) provocation testing. In both tests, small amounts of antigen are administered and such side effects as respiratory problems, gastrointestinal problems, irritability, and drowsiness are noted. Because these responses are difficult to relate immunologically to the initial challenge, their validity is questionable. End-point intracutaneous test titration is an immunotherapy method for determining proper dosage on the basis of the lowest concentration of antigen that produces a specific wheal. Essentially, the technique is low-dose immunotherapy. It differs from conven­tional immunotherapy only in that, instead of giving as large an antigen load as is feasible to produce immunologic protection, the smallest feasible dose is given. This method was recently compared with conventional immunotherapy for ragweed hay fever, and was found less effective.

by Manuel Lopez, M.D., and John E. Salvaggio, M.D.

(wheat-free, milk-free, egg-free, corn-free)

For gluten-free diets, use a cereal-free baking powder and substitute for barley flour, 2 1/4 cups rice flour less 1 tablespoon.) Cream together sugar and milk-free margarine. Beat in remaining in­gredients. Chill briefly. Roll into 1-inch balls and roll balls in sugar. Place on lightly greased and floured (with barley flour) sheet. Bake for 5 min­utes in 375° F oven. Remove from oven and make a thumbprint in each cookie. Continue baking for about 8 more minutes. When cool, fill each thumbprint with a dab of jelly. Makes 42 cookies.

Angioedema is a localized swelling of the deeper layers of the skin. In contrast, an urticarial reaction occurs in the superficial areas of the skin. In angioedema, the swelling often involves the eye­lids, lips, hands, or feet. Swelling usually lasts a few hours and seldom more than twenty-four. Because they appear to have similar mecha­nisms, angioedema and urticaria are ordinarily studied together.

(wheat-free, milk-free, egg-free, corn-fret

(For gluten-free diets, use a cereal-free baking powder; instead of barley flour, use 2 1/2 cups less 1% tablespoons rice flour.) Cream together the milk-free margarine and brown sugar. Beat in egg substitute, water, and vanilla. Mix together the flour and baking powder and gradually add to the creamed mixture. Mix until smooth. Force dough through cookie press onto ungreased cookie sheet. Bake in 400° F oven for 8 minutes. Makes 60 cookies.

House dust is a heterogeneous, firm gray powdery ma­terial that accumulates indoors. This category includes mold, pollen, animal danders, food particles, kapok, cotton linters, insects, and bacteria. Aggravation of respiratory symptoms by exposure to dust is common. Symptoms may be due to an irritant, or they may have an allergic basis. Allergy to dust is regarded by many allergists as one of the most common causes of perennial rhinitis. The allergenicity of house dust cannot be explained by the presence of pollen, molds, or animal danders. The identification of allergenic material in house dust has been the subject of many scientific investigations. Some researchers believe that the main allergen in house dust is degenera­tive cellulose. Although it is not known whether there is a specific allergen in house dust, there is no doubt that house dust contains allergens capable of producing symptoms in allergenic patients. These allergens play an important role in numerous cases of rhinitis and asthma. Recently, several investigators have demonstrated that house dust mites (dermatophagoides) may be a primary source of house dust allergens. Mites are common contaminants of house dust; certain conditions such as high humidity and the presence of danders increase the number of mites. Available data suggests that mites are a major source of dust allergen, but tiiat they are not the only causative agent in dust.

A challenge test is a medical procedure, also known as provocative testing, used to identify substances to which a person is sensitive by deliberately exposing the person to diluted amounts of the substance; a positive bronchial challenge is one in which pul­monary function decreases. See Inhalation Challenge.