In attempting to elicit the enhanced immunological response in hay-fever patients, it was found that a primary series of injections with ragweed-extract so educated its recipients that they responded to later doses more quickly and vigorously, providing an adequate period of freedom from treatment had been allowed. In general, longer periods of rest and lower resting titers were followed by better immune responses than were shorter periods and higher titers. Secondary stimuli given rapidly proved to be more effective than the same-sized doses administered over a longer treatment-period. A primary course of 50,000 units produced higher antibody-concentrations and better clinical results than did an initial series of only 3500 units. Patients receiving the larger dosage their first year appeared to respond more favorably to secondary stimuli than did the other group.

These findings suggest that the average patient will fare better if he is treated intensively for several months his first year. An extensive primary course will offer a good opportunity for protective amounts of thermostable antibody to be acquired by his blood and shock-tissues previous to the season of pollination. Periodical tests for immunity, performed at intervals during treatment and at the peak of the pollinating season, will indicate the patient's responsiveness and approximately at what level of immunity he will be clinically comfortable when there is pollen in the air. The goal of secondary stimulation can then be this degree of antibody-formation. As previously suggested, the serum, skin, or shock-tissue may be tested for immunity, the conjunctival test being the simplest.

A subsequent publication will show that this approach to the management of hay fever will often make it possible to give a satisfactory degree of clinical immunity in a few days or weeks, once the patient has been “educated” by an initial series of injections and a rest-period.

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Presented before the Eighteenth Meeting of the Society for the Study of Asthma and Allied Conditions, in New York City on December 5, 1942.

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