Late Skin Reactions Research Articles

Immunologic responses to an adrenocorticotropic hormone preparation in bronchial asthma and rheumatoid arthritis

Thirty-three patients with bronchial asthma, including 15 atopic patients, 24 patients with rheumatoid arthritis, and 18 control subjects received intramuscular injections of a porcine ACTH preparation as antigen at weekly intervals. Intradermal testing was performed prior to each intramuscular injection with 1:10, 1:100, and 1:1,000 dilutions of ACTH preparation. In addition to immediate wheal and flare skin reactivity, another skin reactivity which we tentatively called “late skin reaction” appeared during the course of immunization. The immediate reaction developed in 75 per cent of the subjects within 8 weeks. Positive immediate reactions to 1:1,000 ACTH were observed more frequently in atopic asthma patients (in 13 of 15) than in the other subjects (p < 0.05). Follow-up observation revealed that 7 of 8 atopic patients and 7 of 21 nonatopic patients still retained immediate skin reactivity even after 4 years. The “late skin reactivity” appeared in 4 of 24 asthmatic patients, 6 of 19 rheumatoid arthritis patients, and 1 of 16 control subjects. Group differences in this reactivity were not significant.

Occupational asthma and rhinitis due to Western red cedar (Thuja plicata), with special reference to bronchial reactivity.

Gandevia, B., and Milne, J. (1970). Brit. J. industr. Med., 27, 235-244. Occupational asthma and rhinitis due to Western red cedar ( Thuja plicata ), with special reference to bronchial reactivity. With the increasing use of Western, or Canadian, red cedar ( Thuja plicata ) in the timber industry, a distinctive respiratory syndrome of rhinitis and asthma has been observed with increasing frequency in clinical and industrial practice. Six cases of asthma and four of rhinitis are described in some detail; the onset of symptoms some hours after exposure, the nocturnal predominance of symptoms, especially of cough, and their persistence for days or weeks after cessation of exposure may conspire to make diagnosis difficult if the occupational hazard is not appreciated. Both immediate and late skin reactions to extracts of Western red cedar were mild or absent, and serum precipitins were absent in the two cases in which they were sought. Positive bronchial reactions, reflected in serial estimations of ventilatory capacity, occurred in response to provocative inhalations of extracts of the cedar dust, commonly at four to six hours and at night, rarely within the first hour. In some instances, a single provocative exposure to the nebulized extract over 90 seconds was shown to produce exacerbations of asthma for two or three successive nights, with normal or reduced ventilatory capacity during the intervening days. Regularly recurring asthma after an isolated exposure has not previously been documented, and is perhaps of fundamental importance to the understanding of non-occupational asthma. Bronchial reactions were not observed to house dust extract, to which patients consistently showed dermal sensitivity. Symptoms subsided gradually when exposure was avoided, but there was considerable individual variation as to how much exposure could be tolerated without relapse; symptomatic therapy, with or without specific hyposensitization, did not adequately control the symptoms.

Late consequences of early skin reactions.

Abstract Re-evaluation of 29 of 85 patients originally categorized quantitatively as to the extent of skin reaction following a standardized 250-kVp irradiation treatment regimen was carried out approximately ten years later, using essentially the same objective criteria. No apparent relationship between the severity of the initial skin reaction and the late changes was noted. Early and late adverse skin reactions appear to be independently variable. This was true for all skin colors and complexions. Thus, the degree of early reactions to irradiation does not predict later consequences.

Delayed Skin Sensitivity in Schistosomiasis

An evaluation of delayed skin reactivity to a schistosome skin test antigen was made in a group of 49 adult male Puerto Ricans and 20 adult male controls from the continental United States. The immediate 15-min histaminic response and the 24-hr, 48-hr, and 72-hr skin induration reaction were recorded. In a second study, 23 normal controls were skin tested with similar adult worm antigens at higher concentrations. A wheal area of 120 mm2 or greater was considered a positive reaction for the immediate 15-min skin response. Induration of 60 mm2 or greater at 24 or 48 hr was selected as a positive delayed reaction. Of the 49 test subjects, 22 (45%) had positive immediate responses and 15 (31%) had positive delayed responses. The 20 normal controls had no positive immediate and only one had a positive delayed reaction at 24 hr. Using stronger antigens in control subjects, 3 of 23 individuals reacted to a 50 ug N/ml antigen, whereas 2 reacted to the 100 ,ug N and 200 A/g N/ml antigens. Evaluation of circulating antibody by serologic tests of all the individuals indicates some correlation with the immediate skin reaction but none with the delayed response. Seven of 22 subjects with positive immediate skin reactions had one or more positive serologic tests for antibodies. Only one of the six subjects with negative immediate and positive delayed responses had a positive serology. Three test subjects had positive complement fixation tests. These three individuals were passing eggs of S. mansoni. The remaining test subjects were negative for eggs by one stool examination. This study indicates that there may be a delayed skin response to schistosomiasis but its clinical and immunologic significance requires further study. Skin tests employed in clinical practice are of two types: immediate and delayed. The immediate intradermal reaction is associated with humoral or immediate hypersensitivity, whereas the delayed skin test is associated with cellular or delayed hypersensitivity. The role of delayed hypersensitivity in schistosomiasis is not well understood, and has not been extensively investigated. Khalil and Hassan (1932), using a 0.4% carbol saline extract of adult Schistosoma bovis and Schistosoma spindale, skin tested 136 parasitologically proven cases of schistosomiasis and 42 negative controls. Using these heterologous antigens, they noted four delayed skin reactions among the 136 infected individuals tested. Pellegrino and Memoria (1960) reported late skin reactions in 24.2% of the children and 29.4% of the adults tested with an extract of adult Schistosoma mansoni. Sadun and Biocca (1962) observed delayed skin reactions in a study made in Sardinia with Received for publication 6 June 1969. * Requests for reprints should be addressed to I.G.K., Parasitology Section, National Communicable Disease Center, Atlanta, Georgia, USA 30333. t U. S. Public Health Service, U. S. Penitentiary, Atlanta, Georgia. + U. S. Public Health Service, National Communicable Disease Center, Parasitology Section, Atlanta, Georgia 30333. individuals sensitized to S. bovis cercariae and tested with antigens of S. mansoni. Because of the paucity of information on delayed skin sensitivity in schistosomiasis, this study was undertaken to delineate further its presence in an unselected population from an endemic area. It was also attempted to determine the characteristics of response to different concentrations of antigens and to present a standard method of application. Using an extract of adult worms of S. mansoni, 49 adult male Puerto Ricans and 20 adult male controls were skin tested; both immediate and late skin reactions were recorded. In addition, sera from the Puerto Rican subjects skin tested were evaluated for schistosome antibody by a bentonite flocculation test, a cholesterol-lecithin flocculation test, and the complement fixation test. Stools from 20 individuals were evaluated for the presence or absence of eggs of S. mansoni. Analysis of the skin tests indicates that infection with S. mansoni can, in fact, cause delayed skin reactions in man and, in addition, this reactivity can be elicited with a standard dose of adult worm extract utilized widely for testing of immediate hypersensitivity by intradermal injection. MATERIALS AND METHODS Two investigations were carried out. The first study involved 49 Puerto Rican inmates of the U. S. Penitentiary, Atlanta, Georgia, and 20 na-

Antigenicity of Polypeptides (Poly-α-Amino Acids)

Summary It has been demonstrated that although the response in guinea pigs is variable, the polymers GLA5, GLT, GLPhe, GLA30, GLAT and GAT are antigenic. Both early (immediate) and late (delayed) skin reactions were noted. GLA30 and GLAT produced the most extensive reactions. From cross PCA reactions, it was determined that most of the specificity in GLA5, GLPhe and GLT is the same as in GL but that GLT also has a GT specificity. In GLA30 and GLAT, in addition to the above specificity, there is also a GA specificity.

The late vaccine skin reaction

The late vaccine skin reaction