HYPERSENSITIVENESS, PROTEIN INTOXICATION 229 



Observations dealing with the metabolism of these patients are most 

 striking by their absence. It is a perfectly familiar observation that pa- 

 tients with asthma or urticaria are prone to lose weight and that when 

 their symptoms cease, they rapidly increase in weight. Exactly what this 

 loss of weight is due to, however, is not known and there are so many 

 factors, such as improper feeding or even the abstinence from food by the 

 patient, loss of sleep and constant anxiety or distress which many of these 

 patients suffer, that it is impossible to determine what factor is responsi- 

 ble or how important the various factors are in bringing about this fre- 

 quent loss in weight. 



In a few cases of urticaria, known to occur in naturally hypersensi- 

 tive individuals, the chemistry of .the blood and the function of the kid- 

 neys have been studied before and during attacks. Thus, in six cases of 

 urticaria which were made a subject of study by Longcope and Racke- 

 mann, it was found that two showed very marked temporary renal in- 

 sufficiency during the attack of urticaria. In one patient, who was sensi- 

 tive to beef and sheep protein, the attack of urticaria was associated with 

 a rise in blood urea, a decrease in the phthalein output, suppression of 

 urine and almost complete suppression of chlorid and nitrogen excretion. 

 During the period immediately after recovery, the nitrogen excretion 

 and chlorid excretion were excessive, when the blood urea, the phthalein 

 output and the water exchange returned to normal. During this same 

 period, there was a loss of almost eight pounds in weight. The second 

 case which was not shown to be hypersensitive to any of the proteins with 

 which tests were made, belongs perhaps more properly in another group 

 which will be discussed in a later section. It must be admitted, how- 

 ever, that there is almost complete lack of information and of study con- 

 cerning the finer chemical and metabolic changes which take place during 

 the crises of intoxication in these naturally hypersensitive individuals, and 

 there is further no definite evidence that such crises result in any per- 

 manent injury to the organism. 



Despite the fact that in the literature there are numerous reports upon 

 the alteration in metabolism caused by dyspnoea, little attention has 

 been paid to the metabolism of patients with bronchial asthma either 

 in the interval between the attacks or during the paroxysm. Zugsmith and 

 Kahn(a) studied the nitrogen partition and the mineral excretion in the 

 urine of two patients with bronchial asthma. Presumably the studies were 

 carried out in the intervals between attacks, although it is not so stated 

 in their paper. The findings seem to agree very well with the results 

 obtained in experimental animals. Apparently there is a condition of tis- 

 sue suboxidation which results in an increase in the non-oxidized "neu- 

 tral" sulphur and a lowered excretion of creatinin. Since the amount of 

 the latter in the urine is dependent only on endogenous katabolism it 



