Biological drugs are pharmaceuticals made from natural materials. These would seem, at first glance, to be safe for chemically susceptible patients. Yet in some cases they are as bad as synthetic substances.

Susceptibility to biological drugs is a problem which allergists see fairly often but frequently do not know how to interpret. The patient gradually develops strange symptoms, months or even years after beginning a course of antiallergy injections with biologically derived drugs. These reactions continue or get worse following each injection, even when the doctor reduces the potency of the dose. Quite commonly the physician concludes that the patient is a hypochondriac, complaining about the alleged side effects for psychological reasons. The problem is usually chemical, however.

In the early 1950s, several patients became ill each time I tried to give them provocative skin tests with food extracts. One patient had no skin reaction to this test but suffered rapidly progressing headaches, nausea, dizziness, and faintness immediately after four injections.

Suspecting some sort of chemical susceptibility, I found that the food extracts which I was using in the tests were preserved with phenol, a coal-tar derived chemical, otherwise known as carbolic acid. (This is the same common chemical also found in the lining of food cans.) Some food extracts without phenol were therefore prepared. The same patients had no adverse reactions to these samples. This test was performed blind, as well; in other words, patients were alternately given phenol-containing and phenol-free injections of the same substance, without knowing which was which. Invariably they became ill from the phenol-containing solution, but not from the phenol-free one. Dr. Jerome Glaser of Rochester, New York, made similar observations, independently, at about the same time.

For many years I maintained a set of phenol-free food extracts for the diagnosis of patients susceptible to this form of the chemical problem. In recent years, far-advanced and complicated cases have been better handled in a hospital setting.

Reactions to other biological drugs, such as insulin, liver extract, epinephrine, and so forth, can also be traced in many cases to the preservatives in the drug. This can be troublesome indeed, for drugs such as epinephrine, a hormone of the adrenal gland, will rapidly disintegrate without a preservative.

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