Summary Eighty highly atopic patients were selected for study because they had either atopic eczema (fifty cases) or atopic reactivity to foods, as judged by a positive skin‐prick test (thirty cases). In all, sixty‐five out of eighty subjects (81%) described symptoms of some kind provoked by foods, but correspondingly positive skin tests were found in only half of these, thirty‐three out of eighty (41%). The symptoms experienced by thirty‐one of the thirty‐three patients with positive skin tests were immediate in onset (within 1 hr) and were at first confined to the upper gastrointestinal tract, the most frequent symptoms being oral irritation and throat tightness. In a proportion of these patients, further symptoms such as urticaria, asthma or anaphylaxis developed following the initial oral symptoms, which suggested the term‘oral allergy syndrome’. In the absence of the oral allergy, symptoms such as asthma, urticaria, migraine or eczema starting later than 1 hr after food were seldom associated with positive skin tests. In the oral allergy syndrome, the characteristic symptoms (strong association with positive skin tests and RAST, time of onset and sites at which symptoms are expressed) suggest a causative relationship between exposure to food antigens and specific IgE‐induced release of mediators. In cases of food intolerance that lack a characteristic symptom pattern and a positive skin test or radio‐allergo‐sorbent test, it seems appropriate to consider non‐IgE‐mediated causes.

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Systemic lupus erythematosus was originally described by a dermatologist (Kaposi, 1872). The cardiac manifestations of this disease were first noticed by Libman in 1911 and published with Sacks in 1924 (4 cases). Recognition of the full clinical picture and of the interrelationship of the various aspects of the disease was achieved by the Mt. Sinai group in the years 1923-1935 (see Baehr et al., 1935). The first account of the pathology of the cardiac lesions was based on 11 cases (Gross, 1932). Systemic lupus erythematosus appears to be less common in the British Isles than in the U.S.A., but it has received more attention here in recent years. With wider recognition of the disease the incidence of heart damage has been found to be greater: Humphreys (1948) found cardiac abnormalities in most of 21 cases studied at necropsy, and Harvey et al. (1954) found that 55 per cent of 138 patients had cardiac abnormalities at some stage of their illness, the commonest finding being pericarditis. Our own observations also show a high incidence of cardiac abnormalities in systemic lupus erythematosus. Heart lesions develop in nearly all patients at some time during the course of their disease when life is prolonged by modern antibiotic and steroid therapy. MATERIAL AND METHODS Sixty patients have been studied in hospital* in the past ten years. Their ages range from 10 to 54. Only four were female. The diagnosis was based on a combination of features such as polyarthritis, lupus rash, fever, and renal, cardiac, or pulmonary involvement, and a raised sedimentation rate. The incidence of the important systemic manifestations is shown in Table 1. In 50 patients TABLE I INCIDENCE OF NON-CARDIAC MANIFESTATIONS IN 60 PATIENTS WITH

An abnormal metabolism of histamine has been suspected in urticaria and the role of diamine oxidase (DAO: histaminase) is therefore of interest. We have studied DAO activity in plasma and jejunal biopsy material and have measured the post-heparin DAO release in 11 control subjects and nine with recurrent urticaria, three of whom had had concurrent episodes of abdominal pain. Two of the nine urticaria subjects had only a minimal rise in plasma DAO activity after heparin, three had a response which was at the lower end of the normal range, and four were normal. In four out of five cases in which jejunal biopsy activity was obtained, there was concordance between mucosal DAO activity and the post-heparin plasma DAO response. Those with abdominal symptoms had abnormally low mucosal DAO activity and the subject who was most severely affected had proven episodes of small bowel oedema.

In an attempt to understand the role of the different IgG subclasses in allergic disease, we have studied the subclass of IgG antibody to dust mite (HDM) and grass pollen (GP) produced as a result of natural exposure. Studies were carried out on 40 atopic children and 100 atopic adults who had never received immunotherapy. Thirty-two non-atopic adult controls were also studied. The specificity of the assay for IgG antibodies to dust mite was confirmed by inhibition with the homologous extract but not mite culture medium or fetal calf serum. IgG1 antibodies to HDM could be detected in most atopics (94%) and non-atopics (97%), and similar results were obtained for GP (81% and 100%, respectively). IgG4 antibodies to HDM were detected in more atopics (66%) than non-atopics (53%) and the difference was more marked for GP (72% vs. 19%). While the levels of IgG1 antibodies were not significantly different in the two groups, the levels of IgG4 antibodies were much lower in the non-atopics (P less than 0.001, Mann-Whitney U-test). These data show that all subjects were capable of recognizing and mounting an IgG1 antibody response to these inhaled antigens. Atopic individuals differed from normal subjects in the frequency with which they made IgG4 antibodies in response to natural exposure to both dust mites and pollen.