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At the surrender of Singapore on 15 February 1942, over 100,000 men became prisoners of the Japanese. This included many medical officers who, over the ensuing years, treated men (and some women) suffering the ravaging effects of disease, worsened by the inhumane conditions of captivity. Many medical officers stand out for their work. One in particular, Jacob Markowitz, developed a blood transfusion service, under the most extreme conditions, for the sick working as slave labour on the Burma Railway. Although he qualified 20 years before the outbreak of war, little has been written of Markowitz's early life, or of the impact of this on his war-time contributions. [ABSTRACT FROM AUTHOR]

Introduction: 'Burning Feet Syndrome' affected up to one third of Far Eastern Prisoners of War in World War 2. Recently discovered medical records, produced by RAF Medical Officer Nowell Peach whilst in captivity, are the first to detail neurological examinations of patients with this condition., Methods: The 54 sets of case notes produced at the time were analysed using modern diagnostic criteria to determine if the syndrome can be retrospectively classed as neuropathic pain., Results: With a history of severe malnutrition raising the possibility of a peripheral polyneuropathy, and a neuroanatomically plausible pain distribution, this analysis showed that Burning Feet Syndrome can now be described as a 'possible' neuropathic pain syndrome., Conclusion: After 70 years, the data painstakingly gathered under the worst of circumstances have proved to be of interest and value in modern diagnostics of neuropathic pain., (© The Author 2016. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com)

Background: Over the last 100 years, several persistent misconceptions or 'false beliefs' have built up around allergen immunotherapy and its use in allergic rhinitis. This is perhaps because enthusiastic physicians administered complex allergen extracts to a diverse population of patients suffering from heterogeneous atopic conditions. Here, we review evidence that counters seven of these 'false beliefs.', Discussion: 1. The symptoms of allergic rhinitis can be more heterogeneous, more severe and more troublesome in everyday life than many physicians believe. Large-scale epidemiological surveys show that the majority of allergic rhinitis patients have at least one symptom severe enough to interfere with sleep quality, productivity and/or well-being. 2. Allergen immunotherapy is not necessarily suitable for all allergic rhinitis patients (notably those with mild symptoms). Recent evidence from double-blind, placebo-controlled, randomized clinical trials suggests that the more severe the disease, the greater the treatment effect. 3. Allergen immunotherapy is often accused of lack of efficacy (relative to pharmacotherapy, for example). However, there are now many meta-analyses, systematic reviews and high-quality clinical trials that find overwhelmingly in favor of the efficacy of allergen immunotherapy (including sublingual formulations) in allergic rhinitis induced by pollen and, increasingly, other allergens. 4. Natural-exposure and challenge-chamber trials have shown that symptom relief may become apparent within months or even weeks of the initiation of allergen immunotherapy. 5. In pollen-induced allergic rhinitis, several years of subcutaneous or sublingual allergen immunotherapy are associated with sustained clinical efficacy after subsequent treatment cessation - confirming the disease-modifying nature of this therapy. 6. Most patients seeking treatment for allergic rhinitis are polysensitized, and allergen immunotherapy has proven efficacy in large, robust clinical trials in these groups. Polysensitization is not a contraindication to allergen immunotherapy. 7. Sublingual allergen immunotherapy is safe for home administration. A recent review calculated that 1 billion doses were administered worldwide between 2000 and 2010 and found that the 11 case reports of anaphylaxis (all non-fatal) corresponded to non-standard practice., Summary: Modern, evidence-based medicine has generated more than enough robust evidence to remove misconceptions about allergen immunotherapy and allergic rhinitis.

Fifteen children, 6-14 years old, who were heavily exposed to pigeon droppings, presented with cough, chills and breathlessnes on mild exertion. Twelve gave immediate positive skin test reactions to pigeon droppings. Ten of the fifteen also gave a late (Arthus) reaction, and seven gave a positive delayed reaction which was maximal at 24--72 hr. Nine children had precipitins against avian droppings. In ten patients who were tested for lymphocyte transformation, five gave positive responses to both serum and pigeon droppings. Radiological findings of the chest showed parenchymatous infiltrations and diffuse interstitial reticulations, suggestive of extrinsic allergic alveolitis. In a control group of fifteen heavily-exposed children who had no symptoms, immediate and late skin reactions occurred respectively in five and two. One only had a positive precipitin test, and one of five tested had a positive lymphoblastic transformation. In a non-exposed comparable group of children, all tests were negative except for one immediate positive skin response. Children heavily exposed to the inhalation of avian antigens can develop extrinsic allergic bronchiolo-alveolitis.

Eighteen patients with a history of urticaria or asthma, or both, induced by aspirin were studied before and after provocation of symptoms with aspirin. The plasma prostaglandin F2 alpha concentration, which was characteristically raised before challenge, fell significantly at the time of adverse reactions. Repeated administration of aspirin up to a dose of 650 mg daily induced tolerance in most of the patients, and several developed bronchodilator responses to aspirin. Although median total IgE concentrations may be raised in patients with aspirin sensitivity, it appears likely that pharmacological rather than immunological mechanisms are chiefly responsible for the phenomena of aspirin sensitivity and desensitisation.

Allergy to castor bean was diagnosed in thirty-nine dockworkers from Port Sudan, on the basis of rhinitis and/or asthma provoked by castor bean dust, together with a positive prick test to a high dilution of castor bean extract. These were compared to twelve non-allergic dockworkers from Port Sudan and forty-three other Port Sudan residents. The castor bean allergic group had significantly higher IgE levels (mean 902 iu/ml) than the non-allergic dock workers (mean 245 iu/ml) or the Port Sudan residents (mean 404 iu/ml) P less than 0.01. IgE antibody to castor bean was detected in all the castor bean-allergic group, and also in 25-35% of the Port Sudan resident group, but at a much lower level. No evidence was found to support the view that parasitic infestation (evidenced by IgE antibodies to Ascaris lumbricoides) prevented sensitization to castor bean or any other allergen. There was a higher incidence of IgE antibodies to Dermatophagoides pteronyssinus in the castor bean-allergic dockworkers (18/36) than in the non-allergic Port Sudan residents (5/43), although we were unable to show that sensitivity to other inhalant allergens pre-disposed to castor bean allergy.

Two preliminary trials in which patients with respiratory allergy to the house dust mite were treated with pyridine-extracted alum-precipitated extracts of house dust mites are described. In the first, using an extract of D. farinae, twenty-two of twenty-eight asthmatic patients improved. In the second, using an extract of D. pteronyssinus, fifteen of eighteen asthmatic patients improved.

Allergic rhinitis is often trivialised but accurate diagnosis and institution of therapy greatly alleviate its symptoms. Diagnosis requires a careful history and nasal mucosal examination. Nasal smear eosinophil staining and skin tests can be helpful, but skin and nasal provocation testing should be controlled and related specifically to a patient's history. Recent advances in symptomatic treatment, particularly antihistamines and most cell stabilising drugs, and immunotherapy are considered.

Conjuvac, a new generation of allergen extracts, has been developed to meet the need for improved characterization, purification, and standardization. Conjuvac consists of a dialyzed, standardized aqueous allergen extract chemically conjugated to a sodium alginate carrier and lyophilized in single-dose vials, thus ensuring stability until reconstituted with sterile water just before each injection. A preliminary study of Conjuvac 2 Grass by Pegelow (1984) involving a small number of patients showed this extract to have potential advantages. Accordingly, a study involving more patients was undertaken: two different maintenance dose levels of Conjuvac 2 Grass were investigated and compared to a pyridine-extracted, alum-precipitated two-grass extract called Allpyral, which in previous double-blind trials has been shown to be effective. The trial, which included 125 patients with hay fever and which extended over 2 years, involved ten allergists from seven European countries. Overall, the Conjuvac high-dose regimen proved slightly superior to Allpyral without any increased incidence of side effects, and all treatments stimulated marked increases in specific IgG levels without raising IgE levels.

Aspergillus fumigatus is being increasingly recognised as causing various pathological conditions in man, animals and birds. In man the use of antibiotics has increased the importance of fungi in various clinical situations as opportunistic infective agents. In man, cavities in the lung are often (20 per cent) colonised by Aspergillus species, nearly always A. fumigatus. The mycetoma so formed can be specifically diagnosed by finding precipitating antibodies to A. fumigatus in the serum. In an asthma clinic, the findings of an immediate positive prick skin test to A. fumigatus, with or without precipitating antibodies to the fungus, confirms the diagnosis of pulmonary aspergillosis. These asthmatic patients develop transient lung infiltrations and proximal bronchiectasis, so that they eventually develop some degree of irreversible airways obstruction. Except for a small number of old patients, there are usually multiple positive type I skin responses to other inhalant allergens which will include other aspergilli species. Basically the complaint is a complication of allergic asthma. When first seen the patients often have treated with repeated courses of antibiotics for presumed infective asthma. Some of the findings in 86 asthmatic patients suffering from pulmonary aspergillosis will be presented.

Clobetasone butyrate (0.1%), a new topical corticosteroid eye preparation for the treatment of ocular inflammation, has been compared with sodium cromoglycate (2%) eye drops in thirty-nine patients experiencing allergic conjunctivitis during the hay fever season. In this double-blind, within-patient comparative study both preparations were effective in relieving the patients' symptoms of conjunctivitis. However, clobetasone butyrate was clinically more effective than sodium cromoglycate as determined by symptom score card analysis (P less than 0.01) and the patients' overall assessment of treatment (P less than 0.05). Patients' preference for the treatment of seasonal allergic conjunctivitis was markedly in favour of clobetasone butyrate (P less than 0.001).

A double-blind comparison of betamethasone valerate and sodium cromoglycate both given by the nasal route was carried out in forty patients with seasonal rhinitis caused by grass pollen. All patients kept daily symptom score cards, and half of them measured both oral and nasal peak expiratory flow rates twice daily. Adrenal function was monitored in thirty-one patients and found to be normal throughout. Sixteen of those patients receiving the steroid aerosol recorded success and two failure of treatment. By contrast, of those receiving sodium cromoglycate there were only two treatment successes and twelve failures. The total symptom score recorded in the group receiving betamethasone valerate was about half that recorded by the sodium cromoglycate group (P less than 0.01). No difference was observed between the two treatments in respect of nasal peak flow rate; specific IgE blood levels and weal sizes following prick tests were not significantly altered throughout the period of the trial, although total IgE was significantly increased. These results suggest that nasal betamethasone valerate offers patients with allergic rhinitis marked symptomatic benefit without the disadvantages previously associated with steroids.