ADRENAL FUNCTION IN ALLERGY

An evaluation of a schedule of intermittent prednisolone therapy in the treatment of 42 children with severe allergic disorders, who had failed to respond to ordinary allergic management, is presented. In 11 subjects the response was excellent; in 28, good; and in 3, poor. No serious complications were observed as a consequence of the method of treatment. Appraisal of adrenal function, as measured by a standardized test of response to adrenocorticotropin, was undertaken before and after the institution of therapy in the majority of the subjects. The mean urinary excretion of 17-hydroxycorticosteroids in the test observed after the introduction of therapy was significantly less than that prior to treatment. This suggests that the regimen of therapy employed impairs the adrenals' response to exogenous ACTH. The unresponsiveness of the adrenals was at least partly dependent upon the dosage of hormone administered. The effect of intermittent steroid therapy on the urinary excretion of adrenocortical steroids in 16 subjects is also reported. Some hypofunction of the adrenals, which is overcome only partially during the days hormones are withheld, is suggested by the data on 17-OHCS. There was no discernible effect on the urinary excretion of 17-KS. The indications for use of steroid therapy in allergic children and the implications of the findings in this study are discussed. Although a schedule of intermittent steroid therapy was found to be useful as an adjunct in the treatment of intractable asthma and atopic dermatitis, it should not be used as a substitute for conventional methods of treating allergic patients. The criteria for selection of patients and the precautions required in the administration of continuous hormone therapy, should also be applied in the use of intermittent hormone therapy.