Optimum Injection Volume for Intramuscular Streptomycin Sulphate
Authors: P. Stradling, L. C. Kreeger
Journal: BMJ (1954)

BDICALJouRNAL Asthma Induced by AntihistaminesThe phenomenon of rapid alternation of clinical syndromes among allergic individuals has long been recognized-for instance, asthma and eczema in young children.It would appear that the antihistamines are capable of provoking such an alternation.Tomlinson (1948) and Harris (1948) cite cases in which eczema supervened when hay-fever was treated with diphenhydramine hvdrochloride.Frankland (1949) refers to the onset of asthma towards the end of the pollen season in patients who have been treated with anti- histamines.The records of nine patients who exhibited this pheno- menon are given below.They were seen during the course of investigation and treatment of 3,000 cases of allergic rhinopathy (including hay-fever) in the past four years.In each case cited antihistamine therapy produced relief of the symptom treated, coincidentally with the appcarance of asthma.In most cases this effect was reversible, and cessa- tion of this therapy restored the status quo ante.Pollen was usually but not invariably a major aetiological factor.CASE REPORTS Case 1.-A woman aged 37 had had intermittent vaso- motor rhinitis for 13 years; it was perennial, but worse in the summer months.Skin sensitivity to house dust and pollens was demonstrated.A first and only attack of asthma occurred with great severity immediately after taking antazo- line tablets.This has not recurred, and the patient has re- fused to take further antihistamines.Case 2.-A girl aged 8 had had atopic eczema since infancy and seasonal hay-fever for the last three summers, but no asthma.In the summer of 1950 she took mepyramine maleate on two or three occasions, and each time an attack of asthma supervened.When the drug was discontinued no further asthma occurred.Skin sensitivity was demonstrated to pollens only.Case 3.-A woman aged 29 had had vasomotor rhinitis and asthma for five years.After a course of hyposensitization treatment in 1948 and 1949 the asthma had practically disappeared, but the vasomotor rhinitis persisted though improved.In April, 1950, she took promethazine hydro- chloride for the first time, with immediate improvement of the tnasal condition, but severe asthma occurred within three days.Cessation of the drug brought about complete relief of asthma but recurrence of vasomotor rhinitis.She has repeated the test on four further occasions (using different antihistamines) with identical results each time-on the third night of treatment she develops asthma.Case 4.-A woman aged 30 had had morning rhinorrhoea for many years which cleared completely during pregnancy three years ago but recurred with increased severity and fre- quency a year later.Mepyramine maleate relieved the nasal condition, but within a day or two produced moderately severe asthma for the first time.The as.hma has persisted in a mild form though antihistamines have been discon- tinued.Pollen sensitivity was demonstrated.Case 5.-A woman aged 50 had seasonal hay-fever at age 21 which was treated and relieved by cauterization.A severe recurrence in the summer of 1949 was treated with diphenhydramine hydrochloride.Her first attack of asthma occurred immediately thereafter and has persisted in spite of cessation of antihistamines.Although pollen sensitivity can be demonstrated the asthma is not purely of allergic origin, as there is an infective element superimposed.Case 6.-A woman aged 40 had a ten-years history of vasomotor rhinitis.In 1950 she was given promethazine hydrochloride, which afforded relief.Asthma then appeared for the first time-possibly coincidental.Sensitivity to house dust was demonstrated but not to pollens.Case 7.-A woman aged 39 had had seasonal hay-fever for seven years, increasing in severity each year.It was twice aggravated by pregnancy.Three years ago a course of