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It is important to remember that allergy has two aspects, the one clinical, the other immunologic. It is perhaps unfortunate that some allergists in turning from the one to the other aspect appear to insist that treatment of patients shall be carried exclusively along immunologic lines although the diagnosis may have been made entirely on the basis of a practical clinical empiricism. The allergist in his quality of immunologist has broadened our understanding of physiologic mechanisms that have to do with the organism's intolerance to interference from without. The immunologist in assuming the character of clinical allergist, however, often has seemed to be too rigidly insistent on the immunologic dogma that all the clinical manifestations that have become known as the allergies must have an antigenantibody mechanism as a background of etiology and as a basis for treatment. Relatively recently the value of a clinical approach to many of the problems of allergy has received attention. Study of those factors that alter the threshold beyond which manifestation of allergy occurs, as Carryer'" stated, has proved more fruitful in the care of many patients than has sole dependence on an antigenantibody type of treatment. Nevertheless, most allergists insist on including an immunologic mechanism in the definition of allergy, although it seems probable that few of them insist on the demonstration of an antigen-antibody mechanism in making a clinical diagnosis of the condition.I believe that this attempt to play the dual role of scientist and physician without separating the two parts sufficiently has caused some of the confusion in regard to the management of allergy. It seems to have been forgotten that the immunologic hypothesis was developed to explain certain syndromes whose confines had previously been laid out not by controlled experiment but on the basis of knowledge gained through observation and experience.Read at the meeting of the American Academy of Ophthalmology and Otolaryngology, Chicago, Illinois, October 8 to 13, 1950.

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