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To the Editor:—
The two points raised by Dr. Naterman should perhaps have received more attention than they did in the article referred to.It has always been assumed, as Dr. Naterman states, that infection is the common offender in severe asthmatic relapse with purulent sputum, with or without slight fever. The sedimentation rate is rarely measured under such circumstances, but we have made many such measurements and have often observed elevations not only in the colder months but also in patients having what seemed to be polleninduced relapses occurring in the appropriate season. Attempts to isolate a bacterial pathogen in the sputum of these and many other instances of asthmatic relapse were so unsuccessful that we concluded that either infection was absent or that a virus infection was present. The suppression of manifestations of infection by steroids is well recognized, and we were naturally concerned that this explained the
Lowell FC. Eosinophilia In Atopic Disease. JAMA. 1968;203(11):991. doi:10.1001/jama.1968.03140110083031