Drug Withdrawal Shock (Cataphylactic Shock) Compared with Anaphylactic Shock

Abstract

Although death by anaphylactic shock is usually caused by protein antigens in animal experimentation, clinical deaths in man are often due to small molecules like penicillin. The molecular weight of potassium penicillin G is about 372. The molecular weight of heroin is close to 369, almost identical to that of the penicillin compound. Penicillin is an allergen that not only produces (according to Stewart and McGovcrn) 300 deaths annually, but it also can produce tolerance to itself in certain organisms, e.g. staphylococcus. In a previous report’ I have pointed out that there are certain clear resemblances between the symptoms of acute anaphylactic shock and those of acute drug withdrawal shock in man. On the theoretical side of the allergic state, drug addiction is in one sense the converse of hypersensitivity. The individual is markedly less sensitive to the drug. Sudden withdrawal of the drug leads to the violent symptoms of “cold turkey.” In a sense, the acute symptoms of withdrawal are a type of “withdrawal shock” analogous to anaphylactic shock. Both anaphylactic shock and the symptoms of anxiety, frothing at the mouth, difficulty in breathing, feeling of body on fire, cyanosis, generalized itching, spasms, and swelling of the skin of anaphylactic shock are to some extent matched by the symptoms of withdrawal shock (barbiturates, alcohol, etc.) like vomiting, tremor, restlessness, muscle twitching, anxiety, ataxia and psychic aberrations. Perhaps the allergist should examine more closely the mechanisms of addiction and tolerance to drugs, if new ideas are to develop in untangling the complexities of hypersensitivity and, perhaps, of tolerance to drugs. It is the purpose of this communication to examine by paradigm the similarities between these two types of shock hitherto considered quite distinct.