The allergy clinic is recently set up in university hospitals, in national hospitals, and in others, for the purpose of examining and treating systematically the patients with allergic diseases by allergological means. During the period of 5 years since the start of our Allergy Centre, the patients who visited our clinic were 1183 cases: asthma bronchiale 653 cases, rhinitis allergica 126 cases, urticaria 306 cases and the others 98 cases. The number of patients is on the increase every year, the greater part of them visiting from Shizuoka City and its suburbs. The patients with bronchial asthma, however, came not only from a short distance, but also from a great distance, so far from the shore of Hamana Lake or the Izu' Peninsula, and even outside the prefecture. From these facts, it is conjectured that the patients suffering from bronchial asthma itinerate in search of any more effective treatment. The author investigated on the present state of allergy clinic, sending out opinionaires (enquetes) to almost every department of internal medicine, pediatrics, oto-rhino-pharyngo-laryngology and dermatology in universities in the whole country. As to the 69 departments in which the allergy clinic is established, in some of them the proper examining room is alloted for allergy clinic, while in a large majority the general consultation room is diverted to allergy clinic, merely applying after the general examinations. The consultation days, in the greater part of allergy clinic, are one to three a week. In half the allergy clinics, the allergist is posted in full-time, but in another half doctors interested in studies of allergy are in charge of consultation. Henceforth the establishment of allergy clinic seems to have some connection with the course of research and investigation in the very department concerned. The same investigations as to the university hospitals were also carried out to the national hospitals and others. And it was noticeable that in the greater part of these hospitals, allergy clinic is co-operating tehnically with that of a university hospital. Here the author concludes that, since allergy clinic is now contributing so much to the examination and treatment of allergic diseases in the surrounding areas of each hospital, this drift of the medical world ought to be propelled to the development of allergy clinic proper, cultivating able allergists and giving independence to allergology in the Medical Treatment Law.

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In March, 1968 the authors found a patient with bronchial asthma among the workers dealt with "Bei-Sugi" in Ichinoseki City, Iwate Prefecture. This finding led to the attempt to find asthmatic patients among the wood workers in the saw-mills in Ichinoseki City and Noshiro City, Akita Prefecture. Furthermore, some clinical examinations were performed to elucidate the etiology of this type of asthma on 15 asthmatic cases of woodworkers in both cities and 9 cases found in the out-patient clinic of our hospital. Results obtained were as follows. 1) The incidence of the asthma was 7.0% of 86 woodworkers in Ichinoseki City and 1.1% of 828 woodworkers in Noshiro City. The difference between both cities was thought to be due to the difference of the installation of their saw-mills. 2) Most patients above-mentioned had their own history or family history for allergic diseases. The majority developed the disease within 1 to 5 months after engaging in their work. 3) The "Beisugi" sawed in the saw-mills in both cities was proved histologically to be western red cedar. 4) The skin test, the inhalation test and Prausnitz-Kustner reaction were performed with the extract obtained from western red cedar. A positive reaction was found in 17 of 20 cases in the skin test, 15 of 18 cases in the inhalation test and 9 of 17 cases in Prausnitz-Kustner reaction. From the results above-mentioned the asthma occured in the workers dealt with "Beisugi" was considered to be an allergic inhalative one due to "Beisugi" (western red cedar) as an antigen.

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The clinical investigation of the Bronchial Asthma caused by the pollen of Nerium indicum Mill, which is distributed widely in west Japan, is described. The pollination of the tree of Nerium is from June to October in Amagasaki district. The results are as follows. 1. Among 61 cases of Bronchial Asthma, who visited my allergic clinic in this autumn, 16 cases of the pollen asthma of Nerium were demonstrated, the intradermal test with Nerium pollen extract. 2. Of these 16 cases of Nerium Pollen Asthma, 3 cases were negative to the intradermal test with other allergen extract. 3. By the anamnesis, these 16 cases of Nerium Pollen Asthma were sick enough during the pollination of Nerium indicum, mostly in June, July, August and September. 4. Most of the patients with Nerium Pollen Asthma are living in the suberb of Amagasaki city where preater part of the tree is planted. 5. When P-K reaction with the pollen extract of Nerium was examined for 2 cases of these Nerium Pollen Asthma, one was positive and the threshold of the reaction was 1 : 2^3.

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The fluorimetrical determination of histamine by Shore et al. in 1959, containes many probrems in Japan. This method is not practically suitable for measurment of histamine. Authors have previously been investigated the Shore's method in detail from the point of view as purification of OPT, reaction time and temperature of OPT, the wave's length of fluorescence, the influences of histidine for measurement of histamine etc. Moreover, it is clearly observed the high value in reappearance (means 103%) under our fixed condition. In our method, the determination of histamine in whole blood, shows the value as 0.037-0.075 mcg/ml in normal children. This value was similar in normal adult. The dynamic changes of plasma histamine value may contain many meanings for analysis of biogenic reaction in the body. From these reasons, authors must investigate or discuss above these mentioned problems.

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It has been shown in our previous report that polysaccharide fraction (PS) from extracts of Candida albicans elicited immediate reaction, and protein fraction (Prot.) provoked immediate, delayed or both reactions on human skin sensitive to the organism. When fractions of the extracts were inhaled to the patients with bronchial asthma, their bronchus also reacted like their skin. The aim of this study was to confirm the antigenicity of the fractions on respiratory tract of guinea pigs immunized with the organism. Extracts were made from organisms of Candida albicans, fractionated and purified with zone electrophoresis, DEAE-cellulose chromatography or Sephadex gel filtration to obtain purified PS and prot. as reported elsewhere. Twelve guinea pigs were immunized with intraperitoneal injections of Candida albicans and exposed to the aerosol of PS, Prot. or crude extracts of the organism. the oscillation method was used to measure respiratory resistance and respiratory nates of the animals. A definite decrease in respiratory conductance was seen immediately after the inhalation of 10 to 30 mg PS and this lasted for approximately 30 minutes. When the pigs were exposed to 7 to 15 mg of Prot. or crude extracts, two types of reactions in the respiratory tract were observed in each The first wasan immediate reaction with a decrease in conductance following inhalation, as was seen with exposure to PS, and the second was a delayed response with marked tachypnea occurring at 24 hours after exposure. This delayed response was not accompanied with any remarkable change in conductance. Little change in conductance or respiratory frequency was noted following exposure to these antigens s to three control animals. It has been shown in our previous study on guinea pigs immunized with egg albumin or tuberclie bacilli and exposed to the antigens, that allergic reactions in respiratory tract of immediate type and of Arthus type provoked a decrease in respiratory conductance and that reactions of delayed type caused an increase in respiratory frequence. Histologically the former reactions corresponded to the broncho-spasm and the latter represented exudation, edema and cell infiltration in the interstitium as well as in the alveolar space and peripheral airways. Taking the above results into consideration, it is likely that polysaccharide fraction from extracts of Candida albicans has an antigenic activity to provoke immediate type reaction, and the protein fraction has the activity to elicit immediate and delayed type allergic reactions in the respiratory tract as well as in the skin of guinea pigs immunized with the prganism. Histological studies support this view.

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Relationships between viral infections and asthmatic attacks were studied. About 80 cases were investigated. Serological tests were carried out with the following antigens: respiratory syncytial virus; parainfluenza virus; influenza viruses type A, B; adenovirus group; M. pneumoniae; and coxsackie B group type 1. On the same time CRP, ESR, nasal smear, and throat swab culture were examined. Viral infections were detected in approximately 30% of the cases with asthmatic attacks in December and February, and about 15% in April and July. Following up 6 patients of perennial asthma for half a year, viral infections were demonstrated in 5 of them. In retrospective study the inset of first attack was involved in measles in about 4%. Partially fluorescent antibody technique was applied in the nasal smear. After immunizing the pigeon with parainfluenza virus, the serum having a high antibody titer was obtained. In conclusion, viral infections suggested to play a role in the attacks of asthma.

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The functional status of adrenal cortex and the pituitary gland in asthmatic children who had received or had never received adrenal steroids, was assessed by the indirect determination of blood cortisol using 3H-prednisolone resin uptake. No apparent abnormalities were noted in asthmatic children who had never received adrenal steroids. During periods of asthmatic attacks, the blood cortisol levels showed an increase over their corresponding base line value, but a normal pattern of diurnal variation was maintained. The patients were receiving prednisolone in total dose from 60 to 4645 mg and in average monthly dose within about 150 mg, showed normal blood cortisol levels and normal response to ACTH. Only three patients who had received daily steroids, they had low blood cortisol levels, no diurnal variations and no response to ACTH. According to the administered preparations, they showed different recovery of pituitary adrenal function. Adrenocortical function was monthly assessed in four patients who receiving frequently corticosteroid therapy. Adrenocortical function was not so depressed in them by intermittent use of adrenal steroids.

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