Seven of twelve autologous sera from patients with chronic idiopathic urticaria re-injected intradermally produced a weal at the site of injection. There was no response in 19 control subjects. Patients showing a positive response had a shorter duration of disease and shorter duration of spontaneous weals, and their urticaria was less likely to be exacerbated by pressure. There was some serological evidence of circulating immune complexes in both positive and negative responders to autologous serum, but only two showed complement abnormalities. When six of the serum-positive patients were re-tested after one year, five still showed a positive response with their original stored serum, but only two, whose disease remained active, were positive when challenged with freshly drawn serum, suggesting that a serum mediator is only present when the urticaria is active. A marked neutrophil infiltrate was seen within and around small dermal blood vessels at the injection site in the majority of urticaria patients but this appearance did not correlate with weal formation. In control subjects the cellular response was mild and mainly mononuclear.

Summary and conclusions Twenty-five patients taking part in a controlled trial to compare azathioprine plus prednisone with prednisone alone in the treatment of pemphigoid were followed up for three years. Results showed that the addition of azathioprine 2 5 mg/kg body weight daily reduced the total maintenance dose of prednisone needed by about 45%, with no increase in serious side effects or mortality.The suggestion that azathioprine might increase the risk of disseminated malignancy in elderly patients was not supported.We conclude that in future trials the combination of azathioprine with prednisone should be used as the standard treatment for comparison.

Clinical observations are made on a series of 22 patients with cholinergic urticaria, representing 02",, of total referrals to dermatological out-patients and 7"., of patients with urticarial eruptions. The average age of onset was 16 and the average duration 7-5 years.The weals are widely scattered and although some coincide with follicles, others arise between them.The precipitating factors are discussed, particularly in relation to water contact; it is concluded that this acts only when heat or exercise are coincident.The fact that the same precipitating factors can play a part in other physical urticarias often leads to confusion in diagnosis.Treatment is briefly discussed and a double blind comparison of hydroxyzine with antibistamine therapy in 14 patients is described; hydroxyzine was preferred in 8 patients.

Visuo-motor Disability-Brenner et al. CJouM performance was so deficient as to suggest a specific developmental failure. Fourteen of these children were matched for age, sex, handedness, verbal I.Q., and home and school background with an equal number of children drawn from the same sample who had shown no evidence of selective visuo-motor impairment. Both groups were followed up for a three-year period.The children with visuo-motor defect were found to be significantly inferior to the controls on a series of tests of spatial judgement and manual skill, to present a variety of educational problems, especially in regard to spelling and arithmetic, and to give evidence of a relatively high incidence of maladjustment. There was also evidence of a relatively high incidence of perinatal abnormality in this group, raising the possibility of minimal early brain damage.This study supports the contention that agnosic-apraxic disabilities in otherwise normal children are by no means rare and warrant wider recognition. Brit. med. J., 1967, 4, 262-264 The ingestion of aspirin often seems to be responsible for attacks of urticaria and it has been assumed that there is an immunological basis for this effect. However, in the past few years it has been realized that in some patients with chronic urticaria which is apparently unrelated to food or drug allergy an exacerbation may be caused by taking aspirin (Calnan, 1957;Warin, 1960). The purpose of this investigation was to determine the incidence of this phenomenon and whether there are any clinical differences between patients with chronic urticaria who react in this way to aspirin and those who do not. In addition, we wished to discover which part of the aspirin molecule was responsible and whether the effect extends to the physical urticarias and weals induced by intradermal injections of histamine. Subjects and Methods UsedPatients included in the study were drawn from those routinely seen in the outpatient department at the Bristol General Hospital. Others were referred to us by colleagues and in answer to a circular sent to general practitioners in the area. For the purpose of this study we have defined chronic urticaria as urticaria without an obvious cause which had been present for at least six weeks. All the patients had dermal weals, most of them also had attacks of angioedema. A few who presented with angioedema had had at some time a phase of dermal wealing. A total of 228 patients have been studied. The proportion of males to females was 1: 1.7, and ages ranged from 3 to 71 years.As part of a detailed interview patients were questioned regarding the ingestion of aspirin or aspirin-containing compounds, and any association with an increase in weals. If there was any possibility of exacerbations from this cause an aspirin test was carried out. This was done on a patientblind basis, and consisted of control inert tablets identical in size, colour, and taste to aspirin labelled "A" and aspirin tablets labelled "B." The inert tablet was always taken first, as it...

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