Hyposensitization Treatment of Bronchial Asthma

Abstract

Chinical result of specific hyposensitization treatment by aqueous house dust extract was compared with the results of unspecific treatment by aurothioglucose and combined treatment. 149 patients were selected whose clinical course was regularly checked at least for over one year. In general, favorable effects were observed in 83%, 86%, and 92% respectively. But marked effect was more often seen by specific hyposensitization in atopic type of asthma and by aurothioglucose therapy in intrinsic asthma. Endpoint of positive intracutaneous reaction (greatest antigen dilution) was diminished in the cases reacted favorable to the specific hyposensitization, suggesting a decrease in reagin titer. Blocking antibody titer increased mostly by the specific treatment. But as there were inconsistent cases concerning clinical result and antibody titer change, both factors (reagin and blocking antibody) might were considered to be taken into account simultaneously to explain the result of the specific hyposensitization treatment. Decrease in one second forced expiratory volume (FEV) by the inhalation of antigen extract was gradually alleviated by the specific treatment but bronchial threshold of acetylcholine did not change significantly either by specific hyposensitization or by gold treatment. Namely increased bronchial sensitivity to acetylcholine in bronchial asthma could not be improved by the specific treatment for 1-3 years, even in clinically ameliorated cases. As threshold of intracutaneous reaction (greatest antigen dilution) should be used as a basic criterion to estimate initial dosis of hyposensitization treatment, an objective statistical method to analyze frequency curve of skin reaction was proposed in order to determine limit of positive reaction. The frequency curve of really measured skin reaction was analyzed by assuming that it consists of 2 normal populations with different means and same variance. Thus errors (α and β) to mistake 1. popuation (negative group) for 2. population (positive group) and 2. population for 1. population were calculated and the criteria to differentiate positive reaction from negative reaction were shown in the table at 5% level of risk. Skin sensitizing antibody (reagin) was checked by Prausnitz-Kustner's method and patient's sera were fractionated by D.E.A.E. cellulose and Sephadex G 200 column chromatography. Serum protein fractions were checked by immunoelectrophoresis. Reagin in the sera of an egg allergy patient and of 3 caces of house dust allergy (asthma) were proved chiefly in the fraction corresponding to _<δ/1>A. But in some cases of house dust allergy skin sensitizing activity was proved also in the first fraction of D.E.A.E. cellulose column chromatography which consists mainly of _<δ/2> globulin as revealed by immunoelectrophoresis. β and _<δ/> globulins (filter paper electrophoresis), _<δ/1>M, _<δ/2>A, and _<δ/2> fractions (immunoassay) were measured in the sera during the course of hyposensitization. Total _<δ/> and _<δ/2> fractions showed no definite change. β-fraction showed a tendency to decrease in with aurothioglucose treated patients. Significant changes (α=0.05) were shown in _<δ/1>A and _<δ/1>M fractions. _<δ/1>M content proved higher in untreated asthmatic patients than in hyposensitized patients. _<δ/1>A fraction proved increased in house dust positive asthmatic patients than in skin reaction negative patients and control subjects. A marked low values of _<δ/1>A were found in some patients who received hyposensitization treatment. But no significant difference was proved on an average between the _<δ/1>A values in the asthmatic patients and in control subjects. The clinical significance of these changes in protein fractions was discussed. Anti A and anti B isohemagglutinins were also measured and the titer was low in the with aurothioglucose treated cases tha