Glues and gums can occasionally cause allergies. Chicle, gum arabic, acacia, and other vegetable gums have been re­ported as causing allergy by inhalation or ingestion. They are present in many common foods and medications.

Fungi are plants that, unlike green plants, have no chlorophyll and must depend on plant or animal material for nourish­ment. About 100,000 species of fungi have been identified. Many species can be the cause of disease in humans, animals, and plants. Molds, however, may be beneficial by increasing in the decay of vege­tation or as a source of antibiotics and enzymes. The greatest number of fungi are produced by the soil. Tempera­ture, humidity, and air circulation are some of the meteorological fac­tors that determine fungal growth and distribution. In warm, humid climates, molds are present in large quantities almost all year round. They grow best at temperatures between 70 and 90 degrees Fahrenheit (21 and 32 degrees Celsius) and stop growing below 40 degrees Fahrenheit (4 degrees Celsius). Indoor molds are essentially similar to outdoor molds; their growth depends on the same factors that enable them to grow outdoors. The most common sites of mold growth are vegetable containers; house plants; furniture; refrigerator and air-conditioner drip trays; most organic substances such as wool, carpets, and wallpaper; and damp cellars and closets. Molds reproduce by spores that, like pollen, are shed in large quan­tities into the air. Fungal spores are present in the air in concentrations that significantly exceed the concentration of pollen grains. World­wide, cladosporium is probably the most widely distributed mold. Among the fungal classes, families of the Fungi Imperfecti class, such as cladosporium, alternaria, aspergillus, and penicillium, are known to produce allergic symptoms in humans. Information about the role of fungi spores in allergic diseases, however, has been limited to a few members of the Fungi Imperfecti class, and little is known about the role of other fungi classes such as mushrooms in causing allergic diseases. See also Molds.

Antiserum is serum that contains antibodies. It may be prepared in animals by immunization with a specific antigen, or it may be isolated from humans previously exposed to the antigen. Animal antiserums were often used in the past for treating infections; today, their use is limited to antisera against snake venom and other potent toxins and antilymphocyte serum, which is used in organ transplants. Human antiserum is frequently used for the prevention of certain infections such as infectious hepatitis. Antiserums prepared for use against toxins are called antitoxins.

Bronchiectasis is a disease in which dilations occur in the air passages of the lungs, often as a result of a long-standing infection.

Common side effects of the adrenergic drugs are fear, anxiety, tenseness, restlessness, headache, weakness, tremor, dizziness, pallor, and awareness of heartbeat. They are usually tem­porary and subside with rest and reassurance. Respiratory difficulty rarely occurs in neurotic patients. Existing symptoms can be aggra­vated. The most common negative effect of metaproterenol, salbu­tamol, or terbutaline is tremor. Aggravation of high blood pressure is more likely with drugs that affect the blood vessels and heart, but blood pressure may increase with use of any drug in this group. Meta­proterenol, salbutamol, or terbutaline rarely cause low blood pressure. They can also induce nausea, vomiting, and difficulty urinating. Patients suffering from high blood pressure, thyroid disease, or heart disease should exercise care in using these drags. Some drugs — those known as cyclopropane or halogenated hydrocarbon anesthetics, which are used to anesthetize patients before surgery—increase the effect of adrenergic agonists on both blood pressure and the heart. Internal cranial bleeding (bleeding inside the head) or abnormal heart rhythm may also occur. Adrenergic agonists are also capable of aggravating diabetes in some patients.

See Arachidonic Acid.

Antibiotics may be effective in treating some patients, while in others they may have no effect. In general, antibiotic therapy should be reserved for asthmatic patients with bacterial infections believed to contribute to bronchial obstruction. Antibiotics frequently are given empirically and before recurring data which report the identity of the organism that caused the infection. Asthmatics and bronchitics who chronically produce sputum may benefit from antibiotic therapy even though no specific causative bacteria have been identified. In such cases, broad-action spectrum antibiotics such as ampicillin or tetra­cycline can be prescribed along with a therapy that promotes good bronchial hygiene. Under these circumstances, antibiotics sometimes work because they decrease the total number of bacteria. Mucolytics and Expectorants The administration of fluids is the best way to thin secretions. Sometimes the fluids are given intravenously. Some fluids may be given with a nebulizer which, when combined with postural drainage and aerosolized bronchodilators, can be useful. Expectorants such as a saturated solution of potassium iodide (SSKI) or guanefesin have limited usefulness. Less Commonly Used Medications Atropine sulfate has been used as an aerosol and is helpful to some patients. Antihistamines also may provide relief of asthma in certain patients, but, because of their drying properties, they should be dis­continued if it becomes difficult for the patient to bring up sputum. Other medications—for example, the antibiotic troleandomycin and such alpha adrenergic blocking agents as phentolamine—have specific but limited uses and should be given only under the supervision of a physician.

Roll lamb in mixture of flour and salt. Brown in hot drippings. Add water, cover, and simmer for 1 hour. Add potatoes, cover, and cook for 25 minutes or longer, or until tender. Prepare gravy with liquid and 1 tablespoon flour. Serves 3.

Anyone prone to allergy spends a lot of time asking —and trying to answer—such questions as, Are allergies all in my head? Does my child deliberately make himself wheeze? Why does my nose always get stuffy when I’m nervous? Allergic diseases are not figments of the imagination. Once a person becomes disposed to allergic disease, however, many factors may be involved in aggravating the individual’s physical problem. People with asthma have overly sensitive and reactive muscles in the bronchial tree, just as patients with allergic rhinitis have overly sensitive blood vessels and mucous-secreting cells in the nose. When these individuals are faced with such stresses as exposure to allergens, irritating fumes, or viral infections, their allergic problems may well increase. This is not a deliberate turning on of reactivity, but rather a manifestation of increased reactivity to various stimuli by the allergic end-organ. Just as a man with an ulcer can aggravate his difficulties by eating spicy foods or allowing the pressure of work to upset him, an asthmatic who breathes in pollen or who has a stressful work situation can suffer bronchospasm. The physical raw material re­sponsible for the ulcer or the asthma, however, existed before the stressful situation and determined the course the stress would take. The extent to which an allergic individual can control reactions to external factors has a lot to do with the individual’s coping mechanism —how secure the person is, whether he enjoys his job, how much pleasure he derives from daily chores, and so on. It is important that the physician explain this interaction of physical disease and environment (both psychological and physical) to the allergic person. That way, the link between what the person thinks and feels, and his or her physical problems, is less likely to be mis­construed as a psychosomatic, attention-getting mechanism. The allergy sufferer should not lose sight of the tremendous psy­chological impact a person with a significant allergy problem has on the people around him. Someone with severe eczema may be viewed as ugly and unfortunate, as someone to be avoided. People may misunderstand the medical problem and consider it infectious and dangerous to their health if they associate too closely with the allergy sufferer. A person with asthma may be considered an invalid who cannot participate in normal activities. The person’s family or spouse may be annoyed, or even angry, because of coughing fits that disturb sleep, physical limitations that force daily lives to be altered, medical costs that prohibit other spending. Allergic individuals undoubtedly can encourage negative feelings in people around them if these people remain ignorant of allergy problems. With education comes understanding that can help the allergic patient, as well as the patient’s friends and family, cope with allergy problems. Knowledge of allergies helps them understand that allergic disease is not a will-o’-the-wisp but a physical ailment that can be affected either positively or negatively by the environment. For example, exposure to cigarette smoke, paint fumes, or freshly mowed grass can exacerbate an individual’s control, and avoidance of compounds known to be noxious or threatening can subdue al­lergic reactivity. There are several ways of correcting negative ways of coping with difficulties (for example, a bad experience always provokes wheez­ing). One is to observe the cause-and-effect relationship between an event and a negative result. Sometimes a friend or a physician merely has to suggest such a relationship to someone for them to understand their behavior and correct it. In the case of a complex allergy prob­lem the allergy victim may not admit a problem or may not be able to correct an annoying reaction pattern. Counselling by a professional psychiatrist, a psychologist, or a primary-care physician can some­times correct the behavioral pattern. Behavioral modification and biofeedback methods can also alter reaction patterns in some situa­tions.

A hospital is the best environment in which to treat severe cases of asthma. The ideal environment is a respiratory intensive care unit operated by specialists and equipped with continuous monitoring equipment. Repetitive blood-gas tests (which measure the levels of oxygen and carbon dioxide, as well as acid-base relationships) are necessary for the physician to decide whether breathing assistance is needed. Whether oxygen and so­dium bicarbonate are used depends on the patient’s clinical con­dition.