Clinical history and autopsy findings on six cases of death from asthma were reviewed. The autopsy findings of these cases are characterized by a formation of mucous plugs in the smaller and middle-sized bronchi throughout the whole lungs. Asphyxia due to this mucous plugging, and over-inflation of the lungs and disturbance of pulmonary circulation due to severe airway obstruction are presumed to be the causes of death. Severe ventilatory disturbances which show an association with emphysema, and a history of severe asthma attacks accompanied by marked derangements of blood gas values and/or mental disturbances such as unconsciousness or coma are suggested as the signs which possibly indicate a danger of death. Such signs as disappearance of wheezing accompanied by increasing dyspnoea, and diminished breath sounds on auscultation which were proposed as a prognostic triad, seemingly indicate a stage which is late for a patient to be saved. In all cases which are or have been treated with steroid, enough doses of steroid must be given to counter-attack exacerbation, because of a possible insufficiency of adrenal cortex. And every caution must be paid to this insufficiency in the course of reduction of steroid therapy.

View full abstract

For the purpose of clarifying the pathophysiology of allergic reactions the role of serotonin was investigated in anaphylaxis. Furthermore, the release of serotonin from platelets were observed. Results obtained were as follows. 1) The average serotonin levels of normal rabbits without sensitization were 4.13±1.65μg./109-in the platelets, 0.67±0.31μg./ml. In the plasma, 9.46±0.70μg./ml. In the serum, 1.49±0.55μg./g. in the lung tissue and 1.18±0.03μg./g. in the liver tissue. 2) After sensitization of the rabbit was bovine serum albumin, serotonin levels were 2.09±0.64μg./g. in the lung tissue, 1.03±0.14μg./g. in the lever tissue. Comparing these serotonin levels with those of normal rabbits, there were no significant increase in the serotonin levels of the sensitized rabbits. 3) Determing the serotonin levels in plasma and platelet after administration of the antigen to the sensitized rabbits in an attempt to induce anaphylactic shock, The both serotonin levels were noted to be as follows. The plasma serotonin level increased to the maximum from fifteen to thirty seconds after injection of the an tigen and thereafter decreased gradually. On the other hand, the platelet serotonin level decreased to the minumum from fifteen to thirty seconds after injection of the antigen in 3 cases and at 2 minutes in other 2 cases. 4) The average serotonin levels of the lung tissue and liver tissue 10 minutes after injection of the antigen were 10.76±4.32μg./g. and 2.31±0.41μg./g. respectively. The lung serotonin level was significantly higher than those of normal as well as sensitized rabbits, but the liver serotonin level demonstrated no significant difference. 5) The average lung serotonin levels were 0.32±0.02μg./g. in normal guinea pig and 0.39±0.04μg./g. in guinea pig sensitized with serum of the sensitized rabbits. Five minutes after the provocation of anaphylaxis, the averagelung serotonin level was 0.58±0.17μg./g. This results indicated a significant increase comparing with that of normal guinea pig and a considerable increase comparing with that of sensitized subjects. From the results mentioned, above serotonin is thought to be released from platelets by antigen-antibody reaction and to be one of the chemical mediators playing a part in the occurrence of anaphylactic shock.

View full abstract

The house dust is one of the important allergens for the cause of bronchial asthma. It consists of various substances, such as detritus of furniture, bedding and clothes, danders of human and animals, as well as bacterias, mycobacterias and mites. Besides, there is intimate relationship between infection and asthma which attack is frequently caused by common cold or bronchitis etc. Although etiological significance of bacterial infection for the asthmatic attack is still discussing, it seems to be sure that sometimes bacterias affect on the human bodies as one of the exogenous allergens. In some cases, sufficient therapeutic effect of the hyposensitization with only house dust was observed on the patients whose asthmatic attack was connected closely with episodes of bacterial infection. Consequently, it was suggested that these patients have some common antigenicity against both house dust and bacteria. In this paper the cross-reactivity between house dust and the cell components of bacterial body obtained from homogenized Staphylococcus aureus was studied. In view of several investigations, this bacteria was chosen because it was characterized by relative high incidence of positive skin reaction among common bacterias in upper air way. 1) In 52 patients with bronchial asthma, the positive rate of immediate skin reaction for house dust was 78.8%, and the positive rate of same reaction for bacterial cell components of Staphylococcus aureus was 63.5%. Some relationship between both skin reactions was recognized. 2) In non asthmatic control subjects, the positive rate of immediate skin reaction with cell components of Staphylococcus aureus as well as with house dust was low. In addition, the positive rate of delayed skin reaction with both antigens was also low in the patients with asthma and without asthma. 3) In the rabbit anti-sera against house dust, hemagglutinin titer was elevated not only for house dust, but also for the cell components of Staphylococcus aureus. Similarly, rabbit anti-sera against cell components of Staphylococcus aureus in which high value of hemagglutinin titer was shown, presented also some elevation of antibody titer to house dust. Also in inhibition tests, there was shown cross reactivity between both antigens. 4) In gel diffusion test, house dust showed several precipitation lines against anti-house dust sera, and cell components of Staphylococcus aureus showed one precipitation line which was overlaped with a line presented by house dust. 5) In the patients who were under hyposensitization treatment with house dust, increased titers of hemagglutinin and blocking antibody against both house dust and components of Staphylococcus aureus were recognized. From these results, it was concluded that there is immunological cross reactivity between both antigens of house dust and cell components of Staphylococcus aureus. In addition, these results might be contribute the evaluation of etiological role of infection for the oncet of asthma and the application of vaccine therapy for this disease.

View full abstract

Inhalation of disodium cromoglicate (DC) was tried on children with bronchial asthma in the Pediatric Allergy Clinic, University Hospital, University of Tokyo. There were 30 patients, 21 boys and 9 girls, aged from 6 to 15 years old (mean age 9.6 years old). The effectiveness was evaluated by a double-blind cross-over method, using doctor's assessment, parents' assessment, counting and scoring the symptoms (wheeze and stridor and/or cough) and treatments recorded in asthma diary by parents. Statistical analysis was made by the Wilcoxon's singed rank test. The results were as follows. 1. The doctor's assessment of effectiveness is statistically significant, while the parent's assessment is not considered to be significant. 2. Number of the episodes of wheeze-stridor and wheeze-stridor-cough is significantly decreased during the treatment with DC than with placebo. Number of the episodes of cough is not significantly decreased. 3. Number of p.r.n. medication (bronchodilator-antihistaminics complex) for asthmatic attack is significantly decreased during the treatment with DC than with placebo. 4. By the score method of the Department of Pediatrics University of Tokyo (Table 2) for asthma, the total count of symptoms and treatments and the asthma index, which indicates severity of asthma, are significantly decreased during the treatment with DC than with placebo. Inhalation of disodium cromoglicate is considered to be effective for bronchial asthma in children.

View full abstract

A single-blind trial, in a "trapdoor" type design, of disodium cromoglicate (Intal) was carried out for a period of 7 months in 22 asthmatics suffering from seasonal or perennial attacks, which were not satisfactorily controlled on conventional bronchodilators and low corticosteroid therapy. A definite symptomatic improvement was achieved, described below, in most of the patients throughout the trial period except for a randomly chosen 1 month placebo period in which inactive capsules were substitutioned for Intal: The results showed a complete remission of attacks in 11 cases: marked improvement in a further 6. In addition it was found, that the corticosteroid dose, in 9 patients was reduced and the aerosol bronchodilator requirments decreased in 3 patients during the period on active drug. Of the 22 allergic patients a significant clinical improvement was observed during Intal therapy in 17 patients (77.3%), the eosinophil count in 7 patients during treatment showed values of less than 50% of either that of pretreatment or placebo periods. Five of the 17 patients demonstrated spirometric improvement in the period of Intal therapy. Their maximal mid-expiratory flow (MMF) increased more than 20% as compared with the control period. The corticosteroid requirement was significantly reduced in 9 patients, with complete discontinuation in 4 of these and useful reduction in the remaining 5. In parallel with these objective findings there was symptomatic improvement as shown by daily record cards.

View full abstract