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Studies on Intradermal Sensitization, II: Intradermal Reaction to Agar and an interpretation of Intradermal Reactions

John H. Stokes
The Journal of Infectious Diseases
Vol. 18, No. 4 (Apr., 1916), pp. 415-436
Published by: Oxford University Press
Stable URL: http://www.jstor.org/stable/30080298
Page Count: 22
Subjects: Health Sciences
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Studies on Intradermal Sensitization, II: Intradermal Reaction to Agar and an interpretation of Intradermal Reactions
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Abstract

Recent conceptions in regard to the physical mechanism of anaphylaxis can be applied to advantage in clearing up the confusion incident to conflicting reports on the specificity o f certain intradermal tests. Such reactions, including those to luetin and pallidin, that to agar observed by the author, to iodid (Sherrick), to placental substrates, and to skin emulsions, may be conceived as at least in part due to the parenteral introduction of antiferment-adsorbents, the activity of which uncovers ferments normally present in the subject. These proteases split up the proteins o f the subject, with the formation o f anaphylatoxins the action of which in turn produces focal necrosis and inflammation. On the possibility for a focal character o f such a process, this statement by Jobling, Eggstein and Petersen13 a is apropos : "Indeed it seems probable that the protease action can take place in what might be termed local areas of antiferment deficiency such as must occur at the point o f contact o f the serum and adsorbing substance." The course of the reaction is determined by the success or failure of the body cells in their effort to restore the anti-enzyme-protease balance at the site of injection of the adsorbent. The escape of locally formed toxins into the lymphatic or vascular circulation, in spite of the walling off by leukocytes characteristic of such reactions, might account for systemic symptoms. Whether the matrix of the locally formed anaphylatoxin is blood, lymph, or cellular elements of either blood or tissues, cannot be stated as yet. In general such reactions may be considered as non-specific, in opposition to the term specific as used in the antigenamboceptor theory. They are conceivably due to the action of the patient's own enzymes on his own proteins, made possible by the inhibition of his antif erments, and not to a specific interaction between the injected substance and a specific amboceptor in the blood. The problem of why some persons react while others do not, is thus transferred, tho to a degree as yet undetermined, to an investigation of the changes which may occur in ferment balance locally in organs and tissues and in the body as a whole, within the limits of normal and pathologic processes. Experimental evidence is accumulating toward a substantial basis for such work. Future studies may well contribute a new method of approaching obscure problems in etiology and pathogenesis, especially in cutaneous diseases.

Notes and References

This item contains 47 references.

[Footnotes]
  • 1
    Jour. Am. Med. Assn., 1915, 65, p. 404.
  • 2
    Jour. Exper. Med., 1911, 14, p. 557.
  • 3
    Bull. Soc. franc, de dermat. et de syph., 1914, 25, p. 27.
  • 4
    Compt. rend. Soc. de biol., 1911, 71, p. 413.
  • 5
    Ibid., 1913, 74, p. 225.
  • 6
    Berl. klin. Wchnschr., 1911, 48, p. 987.
  • 7
    Ztschr. f. Hyg. u. Infektionskrankh., 1911, 68, p. 535.
  • 8
    Ztschr. f. Immunitätsf., 1914, 22, p. 539.
  • 9
    This reference contains 2 citations:
    • Wien. klin. Wchnschr., 1912, 25, p. 331.
    • Kolle and Wassermann, Handb. d. pathogenen Microorganismen, 1913, 2, p. 947
  • 10
    Ztschr. f. Immunitätsf., 1914, 22, p.42; p. 49
  • 11
    Ibid., p. 59.
  • 12
    This reference contains 4 citations:
    • Ztschr. f. Immunitätsf., 1912, 15, p. 171
    • 16, p. 475
    • 1913, 18, p. 207
    • Berl. klin. Wchnschr., 1912, 49, p. 2310
  • 13
    This reference contains 3 citations:
    • Jour. Exper. Med., (a) 1915, 21, p. 239
    • (b) 1914, 20, p. 37
    • (c) Arch. Int. Med., 1915, 15, p. 286
  • 14
    This reference contains 3 citations:
    • Ztschr. f. Immunitätsf., (a) 1913-14, 20, p. 405
    • (b) 1913, 17, p. 506
    • (c) 1912, 12, p. 241
  • 15
    München. med. Wchnschr., 1914, 61, p. 238.
  • 16
    Deutsch. med. Wchnschr., 1914, 40, p. 1467.
  • 17
    Berl. klin. Wchnschr., 1914, 51, p. 348.
  • 18
    Ztschr. f. Immunitatsf., 1913, 18, p. 636.
  • 19
    Arch. f. Dermat. u. Syph., 1914, 120, p. 240.
  • 20
    Jour. Cutan. Dis., 1914, 32, pp. 751, 830.
  • 21
    Arch. f. Dermat. u. Syph., 1913, 116, p. 281.
  • 22
    Arch. f. Dermat. u. Syph., 1913, 116, p. 852.
  • 23
    Bull. Soc. franc. de dermat. et de syph., 1914, 25, p. 31.
  • 24
    Finske läk.-sällsk., handl., Helsingfors, 1913, 1, p. 407.
  • 25
    N. Y. Med. Jour., 1913, 98, p. 24.
  • 26
    Jour. Cutan. Dis., 1913, 31, p. 549.
  • 27
    Bull. Soc. franc. de dermat. et de syph., 1913, 24, p. 507.
  • 28
    Versamml. deutsch. Naturforsch. u. Aertze in Wien, 1913.
  • 29
    München. med. Wchnschr., 1913, 60, p. 1537.
  • 30
    Ibid., p. 2033.
  • 31
    Ztschr. f. Imimmitätsf., 1914, 22, p. 229.
  • 32
    Compt. rend. Soc. de biol., 1910, 68, p. 257.
  • 33
    Lyon médical, 1910, 114, p. 621.
  • 34
    Dermat. Wchnschr., 1912, 54, p. 109.
  • 35
    Arch. f. Dermat. u. Syph., 1914, 120, p. 444.
  • 36
    Wien. klin. Wchnschr., 1913, 26, p. 49.
  • 37
    Arch. f. Dermat. u. Syph., 1914, 120, p. 730.
  • 38
    München. med. Wchnschr., 1914, 61, p. 689.
  • 39
    Ibid., p. 1115.
  • 40
    Ibid., p. 1502.
  • 41
    Chicago Path. Soc, 1915, 9, p. 249.
  • 42
    Berl. klin. Wchnschr., 1910, 47, p. 1836.
  • 43
    Wien. klin. Wchnschr., 1913, 26, p. 1546.
  • 44
    Arch. f. Dermat. u. Syph., 1915, 121, p. 7.
  • 45
    Die Ophtalmo- und Kutan -Diagnosc der Tueberculose, 1908
  • 46
    Ztschr. f. Immunitätsf., 1913, 17, p. 506.
  • 47
    München. med. Wchnschr., 1913, 60, p. 2608.