As I sat in my office, perusing the latest June issue of the Journal of Allergy and Clinical Immunology, I was intrigued by the article by Sheldon G. Cohen, in "The Allergy Archives--Pioneers and Milestones" discusing "Food Allergens:  Landmarks along a historic trail.  As noted in the article, Dr. Warren T. Vaughan was the author of Practice of Allergy, 1939, and editor of the Journal of Laboratory and Clinical Medicine.  In his article, Dr. Cohen notes:

"In 1930, Vaughan, in collaboration with Frances Wilson, an academic botanist, initiated studies of shared characters of plant-derived foods as the first stage in the development of a classification intended to serve as a rational and workable basis for selecting test allergens representative of members of a group.  ...Of special interest is a 75-year-retrospective review of Vaughan's contribution, noting that with few exceptions his compilation was valid and met the test of time"  

 As a Renaissance Allergist, I have an interest in classical (medical) literature, and an overwhelming sense of curiosity--basically, what else did Vaughan write--and what might it tell us in addition to Cohen's article? 

Here's some things not pointed out in the article by Cohen:  

First, Vaughan wrote on a wide range of topics he felt were related to the allergy field:  check these out:

1.  Vaughan, WT.  Allergic Migraine.  JAMA 88:1383, 1927.

2.  Vaughan WT.  Role of specific and nonspecific factors in allergy and allergic equilibrium.  J Lab & Clin Med 13:633, 1928.  

3.  Vaughan WT.  Allergic factor in mucous colitis.  South M J 21:894, 1928.

4.  Vaughan WT.  Atypical and borderline allergic manifestations as important factors in general medicine.  South Med & Surg 95:15, 1933.  

5.  Vaughan WT.  Food allergy as a common problem.  J Lab & Clin Med 19:53, 1933.

6.  Vaughan WT.  Food idiosyncrasy as a factor of importance in gastroenterology and in allergy.  Rev Gastroenterol 5:1, 1938.  

7.  Vaughan WT.  Palindromic rheumatism among allergic persons.  J Allergy 14:256, 1943.

Secondly, we know Vaughan was a brilliant physician.  ( For anybody to get their picture in the JACI, you've got to be brilliant).  Even his son was a brilliant doctor--John Heath Vaughan, was an internationally recognized authority on allergy and autoimmune diseases and a former member of the University of Rochester School of Medicine and Dentistry, who recently passed away at the age of 85 on Nov 11, 2007.  So why was  a brilliant physician like Vaughan writing about palindromic rheumatism and it's relation to allergy?  What does his "classical" writing tell us?  Are you curious? I was. 

In his article, Vaughan described 27 cases with recurrent or chronic joint symptoms among a large group of allergic patients, in whom the arthritic symptoms were attributed to food sensitivity.  He called this syndrome "palindromic rheumatism", a term used by Hench and Rosenberg 2 years earlier to imply recurring joint disease without articular residue.  Vaughan would note that about half of his patients seemed to have abnormal joint changes at the time of exam.  His original discription of this group of patients is repeated here for its remarkable accuracy:

"The second consideration was a small group of allergic persons with intermittent attacks resembling subacute rheumatoid arthritis in whom we have demonstrated specific food incitants.   The evolution of the attacks resembled those of intermittent hydroarthrosis, but multiple small joints were involved; often just one hand or foot was affected.  Sometimes the reaction occurred in more than one extremity, and at times one or two large joints became inflammed either simultaneously or independelty.  The local picture was of swelling, redness, paind, and tenderness.  The attacks would last from several days to a week, rarely longer.  In some, the joints were objectively normal between attacks.  In others, there were low grade arthritic changes..."

Now--be honest--how many allergists take rheumatic histories on our patients?  I do.  For example, I can remember the patient with a strong dust sensitivity who suffered an acute attack of palindromic rheumatism after sweeping out her basement.  In truth, being curious and delving into the older "classical" allergic literature---which was devoid of the built-in constraints of IgE-mediation, may offer us new insights.  Remember what I wrote last month about the mast cells and the synovium?  

Warren T. Vaughan was a Renaissance Allergist.  A brilliant clinician.  And he believed that palindromic rheumatism could be triggered by food incitants.  Renaissance Allergists in today's world need to follow-up on his meticulous & compelling observations. ...

Later, Dude.