Favism in London.

Favism is an acute haemolytic anaemia caused by an acquired allergy to a protein of the broad bean (Viciafava). Reports of the disease date from before the fifth century B.C. and in a good review of the literature Luisada (1941) points out that favism used to have a very wide distribution in the Mediterranean basin. It now occurs particularly in the Sardinians, who seem to have retained the more typical characteristics of the original Mediterranean race. In Sardinia many thousands of cases occur every year in a population of one million. The disease is found also in Sicily, on the mainland in parts of Italy, Greece and Turkey, in the Greek islands, in Cyprus and in north Africa. A few sporadic cases have been described in France and in Spain, and since 1933 nine cases have been described in Americans of Italian descent. I have been unable to find any reported cases in Britain. There are now about 25,000 Cypriots living in London, and this number will probably increase. Many more examples of favism may be discovered in the future if this diagnosis is considered in Mediterranean patients presenting with acute haemolytic anaemia. As well as being racial the condition is often familial. There must be some constitutional peculiarity in the people who develop allergy to the fava bean, for it has been shown that the susceptible subjects are sensitive to fava beans from any country, whereas people who are not susceptible can consume broad beans grown in Sardinia or elsewhere without ill effect. The disease may arise by inhalation of the bean flower pollen (usually in April and May) and in this case the symptoms begin within a few seconds, sometimes with startling suddenness. The commoner cause is eating broad beans. The incidence is known to be less when the beans are well cooked. The symptoms begin in from five to 48 hours after ingestion of the beans. Favism principally affects small children and is commoner in males. The severity of the condition generally decreases as age advances. The mortality rate in untreated cases is stated to be 8 %, the deaths occurring almost entirely in children. On first eating the beans or inhaling the pollen the child suffers no ill effects, but a second contact with the antigen can produce an illness which is very variable in degree. At one end of the scale is a mild attack of diarrhoea and vomiting and at the other end a rapid haemolytic anaemia with jaundice and haemoglobinuria. The following cases illustrate this difference in degree.