Carl Prausnitz: a personal memoir.
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Biomedical subjects
Publications and source records attributed to A W Frankland.
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Conjuvac, a new generation of allergen extracts, has been developed to meet the need for improved characterization, purification, and standardization. Conjuvac consists of a dialyzed, standardized aqueous allergen extract chemically conjugated to a sodium alginate carrier and lyophilized in single-dose vials, thus ensuring stability until reconstituted with sterile water just before each injection. A preliminary study of Conjuvac 2 Grass by Pegelow (1984) involving a small number of patients showed this extract to have potential advantages. Accordingly, a study involving more patients was undertaken: two different maintenance dose levels of Conjuvac 2 Grass were investigated and compared to a pyridine-extracted, alum-precipitated two-grass extract called Allpyral, which in previous double-blind trials has been shown to be effective. The trial, which included 125 patients with hay fever and which extended over 2 years, involved ten allergists from seven European countries. Overall, the Conjuvac high-dose regimen proved slightly superior to Allpyral without any increased incidence of side effects, and all treatments stimulated marked increases in specific IgG levels without raising IgE levels.
Eighteen patients with a history of urticaria or asthma, or both, induced by aspirin were studied before and after provocation of symptoms with aspirin. The plasma prostaglandin F2 alpha concentration, which was characteristically raised before challenge, fell significantly at the time of adverse reactions. Repeated administration of aspirin up to a dose of 650 mg daily induced tolerance in most of the patients, and several developed bronchodilator responses to aspirin. Although median total IgE concentrations may be raised in patients with aspirin sensitivity, it appears likely that pharmacological rather than immunological mechanisms are chiefly responsible for the phenomena of aspirin sensitivity and desensitisation.
Allergic rhinitis is often trivialised but accurate diagnosis and institution of therapy greatly alleviate its symptoms. Diagnosis requires a careful history and nasal mucosal examination. Nasal smear eosinophil staining and skin tests can be helpful, but skin and nasal provocation testing should be controlled and related specifically to a patient's history. Recent advances in symptomatic treatment, particularly antihistamines and most cell stabilising drugs, and immunotherapy are considered.