To the Editor.\p=m-\We would like to comment on the statement that 53% of 249 patients with Hymenoptera allergy were atopic. A history of hives, drug rash, and infantile colic are included as evidence of atopy, and these diagnoses are not accepted as indicating atopy by most authorities. The frequency of hives was the same in atopic and nonatopic individuals.The Insect Allergy Committee of the American Academy of Allergy reported that 27% of 2,606 patients with Hymenoptera allergy had a personal history of hay fever, asthma, or other specific evidence of atopy (193:115, 1965). In addition, they stated that of the severe reactors, 19% had a personal history of atopy.In two different studies done by different authors on college students, a personal history of asthma and allergic rhinitis was found in 25% of 1,836 students in one study (J Allergy 44:323, 1969) and 19.1% out of 434 students in the other study (J Allergy 33:130,1962). It seems, therefore, that the frequency of atopy is similar in a segment of the general population (college students) and in a population made up of Hymenoptera-allergy pa¬ tients. In addition, no significant dif¬ ference was found in the frequency of Hymenoptera allergy in the normal and atopic segments of a population made up of 2,964 Boy Scouts (J Al¬ lergy Clin Immunol 50: 146, 1972). On subdividing his data, Dr. Barr also reveals that 25.7% (64 of 249) of his Hymenoptera-allergy patients have a history of hay fever. This fre¬ quency of hay fever is about what one would expect in the general population. use of morphine in the treatment of acute pulmonary edema is not mentioned. While Dr. Walker does state that the patient's anxiety should be controlled, he relegates this to No. 8 in a list of ten measures to be taken in the treatment of acute pulmonary edema.It is generally recognized that the first step in treating a patient with acute pulmonary edema is an adequate dose of morphine. This not only relieves anxiety but also ameliorates his dyspnea and fear of impending death.I shall always remember a young man with kyphoscoliosis and heart failure who was admitted for the first time to the ward service of a large teaching hospital where I was the attending physician. The house staff informed me the next morning that he had been given phenobarbital intravenously by the resident and had died during the night. It should be stressed over and over that parenterally administered mor¬ phine is the first measure to use in treating this disorder. Harry F. Klinefelter, MD BaltimoreTo the Editor.\p=m-\Except in those patients with severe chronic pulmonary disease, morphine sulfate has been a time-honored, and an unusually effective, drug. While its precise mode of action is not clear, it certainly does allay anxiety and produce venous pooling. Rotating tourniquets to all four extremities is another quick means to reduce venous return by pooling blood in the extremities. One other useful agent not mentioned in the treatment of acute pulmonary edema is intermittent positive pressure breathin...
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