Chairman Buffum: The treatment of the patient with asthma is often a difficult and complicated problem. In this discussion we are concerning ourselves only with "hyposensitization," which is only a part and sometimes a very small part of the treatment.

Probably it is best to treat with all the inhalant allergens that are causing or seem likely to be causing symptoms. From the history and the tests it is decided which substances are important in a given case, and extracts of these allergens are injected regularly.

House dust is almost always given in perennial asthma. It seems to be the commonest trouble maker in the patients, and is usually used in treatment, unless the dust skin tests are negative and also something else is clearly indicated. Animal danders, for instance, are also used, when they seem to be a likely source of trouble, and when they cannot be completely avoided.

The pollens are used which by history and by skin test seem to be indicated. For instance, if a patient is worse in June and gives a positive skin test to grass pollen, grass pollen is given as part of the treatment. If, in addition he gives a good positive test to ragweed, and is not worse in September, ragweed should not be included in the treatment.

Molds undoubtedly play a part in some cases. Patients who have trouble in the summer may be sensitive to molds. Not uncommonly pollen patients whose treatment is not successful are found to be sensitive to molds also. Alternaria is much the most important of these, with hormodendron a poor second. There are several other molds which may be important in a given case. A patient who has trouble in the summer, and who has positive tests to one of these molds, should have that mold included in his treatment.

If the patient has had symptoms limited to the ragweed season, and if our treatment is started well before the season, our problem is relatively simple. We start treatment with a dilution of ragweed that we know by experience will be safe with this patient, and give injections once or twice a week increasing the size of the dose each time.

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