Uric Acid as a Factor in the 
Production of Hay Fever. 
BT 
NORTON L. WILSON, M. D., 
ELIZABETH, N. J., 
Ex-President of Union County, N. J., Medical Society ; 
Laryngologist, Rhinologist, and Otologist, Elizabeth General 
Hospital, etc. 
REPRINTED FROM THE 
Neto ¥orft jftacHfcal Journal 
for December 26, 1S96. Reprinted from the New York Medical Journal 
for December 26, 1896. 
URIC ACID AS A FACTOR 
IN TIIE PRODUCTION OF HAY FEVER.* 
By NORTON L. WILSON, M. D., 
ELIZABETH, N. J. 
EX-PRESIDENT OF UNION COUNTY, N. J., MEDICAL SOCIETY ; 
LARYNGOLOGIST, RHINOLOGIST, AND OTOLOGIST, ELIZABETH GENERAL HOSPITALf 
ETC. 
In 1885 it was my privilege to present for your 
consideration the subject of tonsillitis, at which time 
I pointed out what appeared to me to be the cause of 
certain forms of this disease—viz., uric acid. The paper 
was thoroughly discussed, and some of the gentlemen 
present expressed themselves as never having heard of 
the theory before. To-day, I believe, this is a generally 
accepted theory. I further wish to present for your 
consideration the effect of uric acid not only upon the 
mucous membrane of the throat but upon the entire 
respiratory tract. Especially would I call your attention 
to uric acid as a very important factor in the pro- 
duction of hay fever and asthma. In 1892, while in 
conversation with a medical friend, I was induced to 
* Read before the meeting of the District Medical Society of the 
County of Union, held in Plainfield, N. J., October 14, 1896. 
Copyright, 1896, by D. Appleton and Compan^ 2 
URIC ACID AS A FACTOR IN HAY FEVER. 
purchase a book entitled the Relation of Alimentation 
and Disease. This book contains a chapter on asthma, 
its cause, pathology, and treatment. The chapter begins 
thus: 
“ All heavy horses are hogs. Heavy horses do not 
know when they have eaten enough. Heaves in horses 
corresponds to or is the same kind of disease in them 
that asthma is in man. All asthmatic people are un- 
healthy feeders and overeaters. They have a craving 
to keep the stomach full.” 
This and many other similar expressions I read to my 
asthmatic patients, and almost without exception they 
expressed themselves in very forcible language as to the 
idiocy of the author of that chapter. Some of them 
admitted, however, that their attacks came on shortly 
after eating, and others said they were small eaters; and 
in some instances I knew this to be true. The author of 
that book goes on to say that “ asthmatics are all dys- 
peptics of an especial type. They are all flatulent with 
carbonic-acid gas. Their stomachs are full of ferment' 
ing products. This special type of dyspepsia always de- 
velops a ‘ gravelly diathesis.’ ” 
Although I do not accept the teaching of this au- 
thor or agree with him in his mode of treatment, I must, 
however, acknowledge that my first insight as to the 
cause of the disease, or rather one of the important 
factors in the production of hay fever and asthma, came 
from the perusal of that book. I have constantly kept 
in mind the thought that the respiratory mucous mem- 
brane was in some way or other irritated by uric acid. 
I not infrequently see a peculiar reddened and glazed 
appearance of the mucous membrane of the pharynx, URIC ACID AS A FACTOR IN HAY FEVER. 
3 
and often an oedematous soft palate and pillars of the 
fauces, with dilated and tortuous blood-vessels, which, 
after exhausting all other methods of treatment without 
success, will immediately clear up under salicylate of 
sodium. 
The exact mode of production of uric acid in the 
body is still a matter of uncertainty, but, according to 
the majority of workers in this field, it is undoubtedly 
associated with nitrogenous metabolism, and the acid 
represents an imperfectly oxidized form of nitrogenous 
material. The final destination of uric acid is its con- 
version into urea, but from lack of perfect oxidation 
in the tissues this process is checked. 
I determined to examine the urine, the blood, and 
the sputum of these patients and see if it was not due 
to excess of uric acid within the system. From the spu- 
tum I gained but little knowledge, because it was some- 
times the secretion from the upper pharynx, sometimes 
from the bronchial tubes, and always more or less mixed 
with saliva. From the blood I gained this fact, that 
when the patients suffered most the blood was the most 
strongly alkaline (at which time it is richest in uric 
acid). I found the urine in some cases loaded with 
uric acid or urates, and in others it contained but little. 
I worked along this line, and it was uphill work, for many 
times when I supposed I had established this theory to 
my entire satisfaction I was met by some obstacle which 
almost annihilated my pet theory. Occasionally, how- 
ever, I would see something which would give me fresh 
courage, and to-day I feel confident that uric acid is 
a potent factor in the production of hay fever and 
asthma. Of course, I allude to the asthma following hay 
fever. In reading Dr. Haig’s book on uric acid I was 4 
URIC ACID AS A FACTOR IN HAY FEYER. 
led to see why so many of my cases did badly on salicyl- 
ate of sodium. He does not mention asthma as being 
due to uric-acid diathesis, but I think I can establish 
that fact, and he will help me do it by showing me 
errors in the administration of certain drugs. He has 
shown that quinine, in small doses, squeezes uric acid 
out of the spleen, thus producing uric acidaamia, while 
a larger dose—six to fifteen grains of the sulphate—will 
have the action of a sulphate, which clears the blood of 
uric acid and thus benefits these cases. I have fre- 
quently benefited asthmatics by ten grains of quinine, 
and I know this to be the basis of a popular “ quack 
cure.” 
He has shown that opium, cocaine, antipyrine, caf- 
feine, strychnine, acids, iron, lead, lithia, manganese, 
calcium chloride, acid phosphate of sodium, some sul- 
phates, chlorides, mercury, the nitrites, and some hypo- 
sulphites, either directly or indirectly raise the acidity 
of the blood or form insoluble compounds with uric 
acid. All these substances diminish the excretion of 
uric acid and bring about its retention and accumula- 
tion in the body. They drive the urates out of the 
circulation into the joints and fibrous tissues, also into 
the liver, spleen, and other organs. 
Acidity of urine bears a fairly constant relation to 
urea, both tending to rise and fall together, and the 
relation given by Haig (one of acidity to 6.6 of urea) is 
very constant. “ Whatever raises urea raises acidity, and 
vice versa. On the other hand, the alkalies (except lithia), 
phosphate of sodium, and compounds of salicylic acid, in- 
crease the excretion of uric acid in the urine, and for 
a time also increase the amount of it in the blood by 
raising the alkalinity of that fluid.” If these state- URIC ACID AS A FACTOR IN HAY FEVER. 
5 
ments are correct—and I have no reason to doubt them, 
as they agree with some observations made by myself—I 
should at least he able to make some impression upon 
my hay-fever patients, if, as I have stated, uric acid is 
a factor in its production. Since Bostock first de- 
scribed the affection, in 1819, it has been written upon 
largely by English and American authors, and I think it 
is pretty well established that three important factors 
are essential for the production of the disease: 
1. The predisposing constitutional condition. 
2. An external irritant. 
3. A pathological condition of the nasal mucous 
membrane. 
The predisposing constitutional condition is a neu- 
rosis, and who can say that this condition of the nervous 
system is not due to irritation by uric acid? It is a 
recognized fact that neurasthenia and lithaemia go hand 
in hand. 
The second factor is an external irritant. I care 
not whether this be the emanation from certain plants, 
dust, odors, pollen, or any other mechanical irritant, 
my experience with mucous membranes has shown me 
that uric acid is a very important irritant, and I can 
see no reason why it should not act as such in autumnal 
catarrh. 
The third factor is a pathological condition of the 
nasal mucous membrane. This may or may not he the 
result of irritation, and, so far as I can see, the uric- 
acid theory combines all three of these factors, for it not 
only induces a neurosis, hut acts as a local irritant, 
which brings about pathological changes of the nasal 
mucous membrane. It is not necessary for me to say 
anything about the symptoms of this peculiar disease, 6 
URIC ACID AS A FACTOR IN HAY FEVER. 
as you are all familiar with them, but I can not but 
allude to the paroxysmal sneezing, which is very apt to 
be worse about 4 a. m., or just as the patient arises in 
the morning. In most of the text-books it is set down 
that the sneezing is due to irritating dust or pollen 
grains. This I must deny, inasmuch as there is no 
dust or pollen grains in the bedchamber at that hour in 
the morning. In my opinion it is due to the neurotic 
tendency, and until I found that it occurred on dark 
or rainy days I ascribed it to the action of sunlight. 
I am now of the opinion that it is due to uric acid, since 
you will remember the blood at this hour is strongly 
alkaline, and there is more uric acid circulating in this 
fluid. 
This brings me to the important part of this paper, 
Can we do anything to relieve our hay-fever patients? 
and before giving you my experience 1 want to 
quote Dr. Bishop, of Chicago, who has recently pub- 
lished a very interesting article on this very subject, and 
I may say truthfully that I was not aware when I wrote 
my previous remarks that others were working in the 
same field. This, however, encourages me to continue 
my observations, for I now feel that I am not alone 
in my belief. 
Dr. Bishop says (in the July number of the Laryngo- 
scope): “ An excess of uric acid in the blood causes 
hay fever, or nervous catarrh. Attacks can be stopped 
by precipitating the excess of uric acid from the blood 
by rendering the latter less alkaline with an acid treat- 
ment.” He, too, refers to Haig, and has evidently 
absorbed some of the ideas which caught me. He goes 
on to say: “ While pursuing the study of gout and allied 
diseases dependent upon lithaemia, I was struck with URIC ACID AS A FACTOR IN IIAY FEVER. 
7 
the close analogy between the conditions present, with 
their local manifestations, and the various phenomena 
of hay fever. The theory that the paroxysms of hay 
fever are due to a uric-acid toxaemia is not antagonistic 
to the present status of medical opinion or surgical 
treatment; but, on the contrary, explains questions that 
were inexplicable before. The uric-acid hypothesis ex- 
plains why some persons suffer from attacks under cer- 
tain conditions in winter as well as during the warm 
months.” 
The periodicity of hay fever has a counterpart in 
migraine, which comes once in every seven, ten, four- 
teen, or thirty days, for years or for life. But enough 
has been said to lay the base line of a treatment that has 
proved vastly more successful than any other thus far 
devised. 
I must admit that I am not so sanguine as Dr. 
Bishop, and yet I want to lay before you, in an im- 
partial manner, the results of my labors in this direc- 
tion. You will remember a few years ago several emi- 
nent rhinologists, chief among whom was Dr. Daly, of 
Pittsburgh, and Dr. Roe, of Rochester, advocated the 
theory that it was “ a local chronic disease, upon which 
the exciting cause acts with effect.” They had in their 
minds, however, that the exciting cause came from 
without and not from within. I have cured some cases 
by removal of hypertrophies, spurs, polypi, etc., but I 
am satisfied they would still have their hay fever had 
I not made some change in their diet. This is the age 
when the medical profession at large is recognizing 
lithsemia, not only by swollen and painful joints, but by 
disease of the eye, the ear, the throat, the heart, the 
spleen, the liver, the gastro-intestinal tract, and, in 8 
URIC ACID.AS A FACTOR IN IIAY FEVER. 
fact, almost every organ in the body will show evi- 
dences of uric-acid poisoning. 
Just as the dermatologist often recognizes eczema 
as an expression of uric acid, so do I recognize hay 
fever as a lithaemic condition. If you will consult the 
appended table you will see that ten out of the eighteen 
cases had eczema in some form or other. If uric acid 
is the important factor in the production of hay fever 
and asthma, why is it that it usually makes its appear- 
ance about the middle of August, especially when most 
people eat but little meat during the summer? In 
health about five to eight grains of uric acid are secreted 
every twenty-four hours, and it is readily soluble in 
the blood, which is slightly alkaline. If there is in- 
creased formation of this acid no harm results so long 
as it is promptly eliminated and the ratio between it 
and the urea is not disturbed. Anything which will 
produce a low nutrition will produce uric acidEemia. 
About the middle of August you will find a marked 
change in the weather, when it is usually cooler and often 
damp for a day or two. Invariably, as soon as this change 
comes you will find the hay-fever symptoms begin. 
I have records of the weather for the past six years, and 
you can almost to a certainty pick out the date of at- 
tack by the drop in temperature. This year it was about 
the 8th of August, and again on the 14th, when the 
highest temperature was 74° and the weather cloudy. 
The table shows that my first cases this year began on 
the 10th, and six of them on the 15th. 
The sudden drop in temperature diminishes per- 
spiration, raises acidity, freeing the blood from uric 
acid and driving it into the tissues. In two days the tem- 
perature suddenly goes up, and then you have a uric URIC ACID AS A FACTOR IN IIAY FEVER. 
9 
acidaemia which irritates the already exhausted nervous 
system and mucous membranes. Nutritive disturbances 
are brought about by overdrinking, especially when 
combined with deficient muscular exercise. Once irri- 
tated, the respiratory tract is kept in a constant state of 
irritation until the uric acid is driven from the blood 
by the onset of cold weather. 
I do not mean to say that every case of uric-acid 
diathesis is a hay-fever subject, any more than I would 
say every such case had eczema, hut I do mean to say 
that there is a very close relationship between uric acid 
and hay fever, and I do say that every patient having 
a neurasthenic tendency, if you please, and a pathologi- 
cal mucous membrane of the respiratory tract is irri- 
tated by uric acid, and thus far my observations have 
led me to suspect it in every case of periodic hyperaes- 
thetic rhinitis. In the treatment of these cases the 
greatest care must be exercised. You must ever keep in 
mind that alkalies, salicylate, etc., produce a uric acidae- 
mia so long as there is an increase of uric acid within 
the system. During the attack they must be used with 
care and in small doses. I have certainly increased the 
severity of an attack by giving ten grains of salicylate 
of sodium three times a day. During the attack it is 
better to free the blood from uric acid by the adminis- 
tration of an acid. Aromatic sulphuric acid or phos- 
phoric acid acts very well. After freeing the blood, 
gradually extract the uric acid from the tissues by 
two- or three-grain doses of salicylate of sodium (given 
three times a day), cut off the acid-producing foods, 
such as meat, beer, wine, cider, lemonade, etc. Keep 
your patient’s nervous system in the best possible con- 
dition by proper feeding, hygienic measures, and nerve 10 
URIC ACID AS A FACTOR IN HAY FEVER. 
tonics, if necessary. See that no polypi, spurs, or hyper- 
trophies exist in the nostrils. Begin a crusade against 
uric acid six weeks or even two months before the time 
of attack. 
For the local relief, I have found menthol and cam- 
phor in liquid albolene, very gently sprayed into the 
nostrils, effectual in some cases. There are cases, how- 
ever, which are apparently irritated by this solution, 
and for these I have found, if I would contract the tis- 
sue with a six- or ten-per-cent, solution of cocaine, and 
then gently coat the turbinate with a thin film of flexible 
collodion, they would experience relief. For the itch- 
ing and irritation of the conjunctiva, hot water or yel- 
low ointment rubbed into the conjunctiva will afford 
relief. 
I can not close this paper without expressing my 
belief of the use of lithia. For the past three years I 
have failed to see a case of uric-acid diathesis benefited 
which I could ascribe to the action of lithia. In other 
words, the amount of water which these patients are 
obliged to take is, in my opinion, the factor for good, 
and not the. lithia. Haig goes so far as to say that 
“ lithia is a good solvent of uric acid in the test-tube, 
but in the body not only is it a poor solvent of that 
acid, but it actually combines with the phosphates in 
the blood and prevents its action on uric acid, so that 
the fact is lithia retards rather than increases its ex- 
cretion.” 
I have hinted at rather than given any definite plan 
of treatment, and hope you will next season be able tn 
give me the benefit of your experience. I think I can 
truthfully say that every patient on the list has received 
some benefit so far as the hay fever goes. This can not Name. 
Asthmatic. 
Acute articular rheu- 
matism. 
Rheumatic pains in 
| joints or muscles. 
Eczema. 
Time of sneezing. 
Pathological condi- 
tions in nose. 
Do you have attacks 
in summer only ? 
Date of attack this 
year. 
Date of asthma this 
year. 
Are you immune at 
sea or on the water ? 
Where are yon free 
from hay fever f 
Age when first at- 
tacked. 
Are you much of a 
meat eater ? 
Do you have rose 
cold ? 
lias my treatm’t bene- 
fited your hay fever f 
Has my treatm’t bene- 
fited your asthma f 
Mr. C. E 
Yes. 
No. 
Yes. 
Yes. 
11 A. M. 
Yes. 
No. 
Aug. 14. 
Aug. 14. 
No. 
Don’t know. 
20 yrs. 
Yes. 
Yes. 
Yes. 
Yes. 
Mr. H. S ... 
Yes. 
No. 
Yes. 
Yes. 
7 A. M. 
Yes. 
Yes. 
Aug. 10. 
Aug. 31. 
No. 
Don’t know. 
22 vrs. 
Yes. 
No. 
Yes. 
Yes. 
Mr. A. M 
Yes. 
7 yrs. 
old. 
Yes. 
Yes. 
Yes. 
7 A. M. 
Yes. 
Yes. 
Aug. 20. 
Aug. 27. 
No. 
Adirondack; 
White Mts. 
18 yrs. 
Yes. 
No 
Yes. 
No. 
Miss S 
No. 
No. 
Yes. 
No. 
6 A. M. 
No. 
Yes. 
Aug. 25. 
No. 
Don’t know. 
7 vrs. 
Yes. 
No. 
Yes. 
Miss M 
Yes. 
No. 
Yes. 
No. 
4 A. M. 
Yes. 
Yes. 
Aug. 16. 
Aug. 20. 
No. 
Don’t know. 
10 yrs. 
Yes. 
No 
Yes. 
Yes. 
Mr. F 
No. 
No. 
Yes. 
Yes. 
7 A. M. 
Yes. 
Yes. 
Aug. 14. 
No. 
Don’t know. 
10 yrs. 
Yes. 
No. 
No. 
* 
Master B.... 
No. 
No. 
Yes. 
Yes. 
9 a. m. and p. m. 
No. 
Yes. 
Aug. 10. 
No. 
Don’t know. 
7 yrs. 
Yes. 
Yes 
Yes. 
Miss P 
Yes. 
No. 
Yes. 
No. 
7 a. m. and p. m. 
Yes. 
No. 
Aug. 15. 
Aug. 25. 
Don’t know. 
Don’t know. 
11 yrs. 
No. 
Yes. 
Yes. 
Yes. 
Mrs. D 
Yes. 
No. 
Yes. 
Yes. 
5.30 a. m. 
Yes. 
Yes. 
Aug. 15. 
Aug. 22. 
Don’t know. 
Don’t know. 
22 yrs. 
Yes. 
No. 
Yes. 
Yes. 
Mrs. G. P ... 
Yes. 
No. 
Yes. 
Yes. 
4 and 7 a. m. 
Yes. 
No. 
Aug. 15. 
Sept.,’95. 
Don’t know. 
Don’t know. 
20 yrs. 
Yes. 
No. 
Yes. 
No. 
Master D.... 
No. 
No. 
Yes. 
No. 
4 A. M. 
Yes. 
Yes. 
Aug. 16. 
No. 
Don’t know. 
4 yrs. 
Yes. 
Yes. 
Yes. 
Mr. W. D ... 
Yes. 
No. 
Yes. 
Yes. 
Early morning. 
Yes. 
Yes. 
None. 
None. 
No. 
Don’t know. 
20 vrs. 
Yes. 
Yes. 
Yes. 
Yes. 
W. T. (negro). 
No. 
No. 
Yes. 
No. 
Early morning. 
Yes. 
Yes. 
None. 
None. 
No. 
Don’t know. 
5 yrs. 
Yes. 
No. 
Yes. 
Mrs. E. M. W. 
No. 
No. 
Yes. 
Hives. 
8 A. M. 
Yes. 
Yes. 
Aug. 13. 
No. 
Don’t know. 
30 yrs. 
Yes. 
No. 
Yes. 
Mr. W. D ... 
No. 
No. 
Yes. 
Yes. 
7 A. M. 
Yes. 
Yes. 
Aug. 14. 
Don’t know. 
Don’t know. 
20 yrs. 
Twice 
daily. 
No. 
Yes. 
Mrs. W. S. .. 
Yes. 
No. 
Yes. 
No. 
4 A. M. 
Yes. 
Yes. 
Aug. 25. 
Aug. 25. 
Don’t know. 
Don’t know. 
48 yrs. 
Once 
daily. 
No. 
Yes. 
No. 
W. A. C 
Yes. 
No. 
Yes. 
Yes. 
7 A. M. 
Yes. 
No. 
Aug. 15. 
June 20. 
Don’t know. 
Don’t know. 
1 yr. 
Yes. 
No. 
Yes. 
Yes. 
W. M. A 
No. 
No. 
Yes. 
No. 
8 A. M. 
Yes. 
No. 
Aug. 20. 
No. 
White Mts.; 
not free in 
Adirondack. 
14 yrs. 
Yes. 
Yes. 
Yes. 
* Did not carry out treatment. 12 
URIC ACID AS A FACTOR IN HAY FEVER. 
be said of their asthmatic symptoms, however, as three 
of them suffered quite as much as in previous years, 
but I have seen enough of the treatment to encourage 
me to begin early next season, and I feel confident I can 
at least mitigate their symptoms. The New York Medical Journal. 
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