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Repository Immunization in Pollen Allergy

From The New York Hospital and Department of Medicine, Cornell University Medical College, New York, New York

Abstract

1. In a longitudinal study extending over 17 years and associated with statistical analysis, 117 ragweed-allergic individuals have been given 749 annual courses which alternated between conventional, multi-visit injections and single-visit repositories of the Freund type.

2. In comparing the effectiveness of these two methods of immunization, three criteria were applied: the customary clinical estimate obtained from the patient at the end of each pollinating season, his daily diary of hay fever hours, and a controlled variety of conjunctival test which gaged the acquisition of blocking antibody by the tissues. Whereas these served as yardsticks of clinical and immunologic effectiveness, the incidence of untoward reactions afforded the clue to the relative safety of the new and old procedures.

3. The two procedures were found to be comparable in effect by all the criteria except that based on the conjunctival test. Here, the older method proved to be more effective by an amount that carried statistical—but not, however, practical—significance. The repository technique offers, therefore, a great saving in time without decreasing the practical advantages of therapy or increasing the risk of overdose reactions.

4. It is possible that our schedules of dosage, which have depended on conjunctival classification of each patient, can be utilized by allergists who employ only the endermal or scratch methods of classification.

5. A sizable minority of our ragweed-allergic group appeared to respond as well to placebo repositories as to active emulsions, according to their clinical reports and recorded hay fever hours. At the same time, no acquisition of blocking antibody was indicated by eye-test. Obviously, such placebo-responsive subjects should be excluded from experiments which compare the clinical efficacy of two therapeutic procedures. These patients stood in contrast with other individuals whose clinical reports promptly reflected any change from specific to placebo management. Such subjects should be responsible for the ultimate clinical opinion on repository therapy.

6. No abscesses, cysts, or malignant growths have resulted from 1200 repositories used during the past 9 years.

7. When either isopropyl myristate or corn oil was substituted for petrolatum in the repository, the number of overdose reactions was increased owing to a more rapid release of antigen. Clinical results were somewhat inferior with the substitutes. However, fewer nodules persisted beyond the season of pollination. This minor cosmetic problem surrounding the standard emulsion can probably be met by reducing the volume of mineral oil in repositories.