Allergy as a factor for consideration in the treatment of tuberculosis

Abstract

Summary o (1) Man, in his responses to tuberculous infection, may exhibit successively three main constitutional states: Indifference, Intolerance and Tolerance. (2) The state of “Indifference” is pre-allergic. First Infection encounters no immediate response except that of natural immunity. The states of Intolerance and Tolerance depend on the acquired character of “Allergy,” and re-infections, whether autogenous or exogenous, excite reaction. (3) Allergy, “altered reactivity,” manifests itself, in tuberculosis, in a series of states which, although they tend to overlap and interact, may be roughly subdivided as follows:— (a) Allergic Hypersensitivity .—Toxic and inflammatory processes excited by products of the action of antibodies on tuberculo-proteids, and resulting in exudative phenomena. (b) Immuno-allergy , an anti-toxic stage, evoked, in part at least, by reaction to the toxic products of the hypersensitive state, and resulting in a diminution or cessation of inflammatory and exudative phenomena. (c) Augmentation of natural immunity , stimulated, in all probability, by the phosphatide and other lipoid constituents of the tubercle bacillus and resulting in productive phenomena around infective foci, viz., the cellular proliferation, fibrosis and calcification of spontaneous healing. (4) There seems reason to think that the toxic and inflammatory effects of allergic hypersensitivity are inimical to the initiation of the “productive” changes of the immune phase. The latter can only become established if and when the toxic process has been suppressed or neutralised by the onset of the intermediate processes of immuno-allergy. (5) Underlying the relative preponderance of one or the other of these phases are differences in size and frequency of infective doses, age of first exposure to severe infection, intercurrent illnesses, social and environmental factors, accidental circumstances and racial characters. (6) In human tuberculosis, the quantitative permutations and combinations of these three phases are expressed in varying clinical states. Extreme instances are: the tuberculosis of African natives, illustrating the toxic phase; the tuberculosis of “sputum positive” sanatorium patients on “Grade VI” of work and exercise, illustrating the anti-toxic phase; healthy but deformed persons with healed Pott's curvature, in which the once active lesion has been overcome and the spinal column reconstituted by fibrous and bony union, illustrating the productive phase. (7) The aim of treatment should be: the prevention or diminution of auto-inoculations by rest, local and general, especially collapse therapy where indicated; control of hypersensitivity by desensitisation, and attempts at “immunisation,” by appropriate auto-inoculations (grading), or, in suitable cases, by tuberculin therapy.