Manifestations Of Anaphylaxis Research Articles

Serious Drug Induced Hypersensitivity Reactions among Hospitalized Infants and Children

Background There are very limited data concerning the epidemiology of drug hypersensitivity in Egypt. Aim We sought to investigate the magnitude of serious drug hypersensitivity reactions among hospitalized infants and children in a tertiary hospital over a period of one year. Patients and Methods This study is a cross sectional one that was conducted over a period of one year from the middle of October 2020 to the middle of October 2021. The study was carried out in Children’s Hospital, Ain Shams University. We screened for patients with serious drug hypersensitivity reactions among a total of 10440 hospital admissions over a period of 12 months. Positive cases were further assessed with complete clinical and laboratory assessment. Results Out of total admissions of 10440 patients over the study period, 35 (0.335%) patients had clinical manifestations of serious drug hypersensitivity reactions. Concerning those 35 patients, they were 21 (60%) males and 14 (40%) females with age ranging between 3 to 193 months with median (IQR) = 50 (24-96) months. Four patients (11.4%) were known to be allergic; with 1(2.9%) having allergic rhinitis, 1 (2.9%) having urticaria, and 2 (5.7%) having cow milk protein allergy. Ten patients (28.6%) had family history of allergic disorders. Eleven patients (31.4%) had manifestations of anaphylaxis, 18 (51.4%) severe urticaria/angioedema, while the remaining 6 (17.1%) had manifestations of Stevens-Johnson syndrome. Concerning results of laboratory investigations, anemia was found in 29 (82.9%) patients, leukocytosis in 9 (25.7%) patients, leukopenia in 8 (22.9%) patients and thrombocytosis in 4 (11.4%) patients, while none of them had eosinophilia. CRP and ESR were elevated in 24 (68.6%) and 15 (42.9%) patients respectively. All of the 35 patients could overcome the drug hypersensitivity reaction with proper management Conclusions Although rare, drug hypersensitivity reactions represent an important health issue that should be clearly well reported, registered, and properly managed. Further wider scale and multicenter studies are warranted to gather more data and investigate the prevalence of each type of drug hypersensitivity reactions among children including those which are not reported in our study.

IL6-inhibitors in treatment of SARS COVID19

The aim of this study was to evaluate the clinical efficacy and safety of a two-dose approach in the administration of tocilizumab in patients with SARS COVID19
 Material and methods. The study was carried out on the basis of the Odrex Medical House in 2000-2021. The total sample included 4,112 patients hospitalized in a specialized department with coronavirus pneumonia. Of this sample, 150 patients were prescribed tocilizumab at a dose of 8 mg/kg of patient weight, including 36 (24.0 %) cases when tocilizumab was administered in a two-dose regimen. In the case of a two-dose regimen, the second dose was administered no earlier than 24 hours after the first one.
 All patients were examined according to the current clinical protocols. The hemogram, the content of CRP, ferritin, interleukin-6 were assessed. All patients received dexamethasone intramuscularly at a dose of at least 6 mg per day.
 Statistical processing was carried out by methods of analysis of variance using the software Statistica 13.0.
 Results. After the use of tocilizumab, the patients had a decrease in body temperature and a decrease in the need for oxygen support. At the same time, the normalization of indicators of the activity of the systemic inflammatory response was observed.
 Mortality after the use of tocilizumab was 29.3 %; in all cases, the deaths had an extremely severe course of coronavirus infection and a significant comorbid background. There were no manifestations of anaphylaxis and cases of secondary infection after the appointment of tocilizumab.
 Conclusions. The use of tocilizumab could significantly improve the condition of patients with SARS COVID19. There were no signs of anaphylaxis and cases of secondary infection after the administration of tocilizumab. In the absence of a pronounced clinical effect within 24 hours after the first dose of tocilizumab in patients with severe SARS COVID19, it is advisable to re-administer the drug (two-dose regimen)

Eosinophilic Esophagitis: Latent Disease in Patients with Anaphylactic Reaction to Cow's Milk

Food allergy and eosinophilic esophagitis are a substantial and evolving public health issue. Clinicians should know the relationship between these diseases and how one may predispose to the other. This can help minimize misdiagnosis. The objective of this study was to assess esophageal eosinophilia and eosinophilic esophagitis frequency in patients with persistent cow's milk allergy and anaphylaxis manifestations. Patients with persistent cow's milk allergy with anaphylaxis manifestations were enrolled from 2012 through 2016 at the São Paulo University Hospital, Brazil. All of them were submitted to endoscopy despite the presence or absence of gastrointestinal symptoms. Demographics data, atopic comorbidities, medication use, endoscopic findings, and esophageal eosinophilia frequency were evaluated. Eighty-nine patients were selected. The median age was 8 years. It was observed that 34 of 89 patients (38.2%; 95% confidence interval [CI]: 28.14%-49.16%) presented with esophageal eosinophilia. Five patients (7.1%) presented proton pump inhibitor-responsive esophageal eosinophilia, and 10 patients (14.2%) presented eosinophilic esophagitis. We found that 29.4% were asymptomatic patients, 23.5% had nonspecific symptoms, 23.5% had persistent typical symptoms, and 23.5% had intermittent typical symptoms. There was an association with inflammatory endoscopy findings in 21 patients (61.7%). This description demands scientific attention because it is the highest frequency of esophageal eosinophilia yet described in a group of patients with cow's milk allergy presenting with anaphylaxis. Eosinophilic esophagitis is a condition that can coexist "silently" with an IgE-mediated food allergy and is most often underestimated and underdiagnosed.

A Male Patient with Syncope, Anaphylaxis, and ST-Elevation: Hepatic and Cardiac Echinococcosis Presenting with Kounis Syndrome

BackgroundApproximately 1% of emergency department (ED) visits are due to anaphylaxis. Symptoms can include skin rash, facial and laryngeal edema, dyspnea, vomiting, hypotension, and shock. A transient loss of consciousness can also be a manifestation of anaphylaxis. A variety of electrocardiographic changes due to anaphylaxis have been described for Kounis syndrome, also known as allergic angina. Case ReportHere we describe the case of a male patient presenting at an ED with syncope, anaphylactic shock, and ST-segment elevation on electrocardiogram (ECG). The diagnostic workup led to the diagnosis of ruptured hepatic echinococcal cyst complicated by anaphylactic shock and syncope. ECG alterations were a manifestation of anaphylaxis, as defined by the type I Kounis syndrome. Why Should an Emergency Physician Be Aware of This?Kounis syndrome represents an underestimated disease. Its prompt diagnosis in an ED has important clinical and therapeutic implications, such as modifications in the anaphylaxis treatment protocol, that is, adrenaline should be avoided because it could worsen vasospasm and myocardial ischemia.

The modern aspects of anaphylaxis therapy

Introduction: Anaphylactic reaction is a most serious allergy where the symptoms may occur shortly after contact with an allergen and can get worse quickly. Therefore, timely and appropriate treatment is of crucial importance. Methods: In this article, we draw on evidence from publications on the subject of anaphylaxis treatment that we got by searching Google Scholar and PubMed databases. Used articles included: systematic reviews, case reports and randomised controlled trials. We also used World Allergy Organization guidelines for the management and the assessment of anaphylaxis. A literature search with the keywords 'anaphylaxis treatment', 'anaphylactic shock', and 'allergy' identified a number of potentially eligible studies, of which 42 satisfied our eligibility criteria and were therefore included in this review. Topic: There was evidence regarding the optimum route, dose and site of adrenaline administration ,with the latest recommendations indicating the intramuscular route (i.m.) in the mid-outer thigh as the optimum treatment. We found studies suggesting the purpose of applying H1 and H2 antihistamines, systemic glucocorticosteroids, calcium and methylxantines to manage anaphylactic shock, recommended doses and mode of administration. With regard to treatment, we focused on acute rather than on long-term management. Further, we have taken into consideration the mechanisms, common triggers and clinical manifestations of anaphylaxis. Conclusion: Adrenaline represents the first choice drug and it is necessary to be applied as soon as possible. However, there is a controversy regarding the application of the other specified medications in this life-threatening condition.

Takotsubo cardiomyopathy due to cephalosporin anaphylaxis under general anaesthesia.

Sir, Cephalosporin anaphylaxis is a known but rare entity with an incidence of 0.0001-0.1%[1] We report an unusual case of anaphylaxis during general anaesthesia which resulted in transient stress-induced cardiomyopathy in the absence of coronary disease. A 27-year-old female was posted for limb-salvage surgery for osteosarcoma of the left proximal tibia. She had received three cycles of chemotherapy containing Adriamycin. She was active pre-operatively and did not have any comorbidity. All her laboratory investigations were normal including echocardiography which showed an ejection fraction of 62%. On arrival in the operation theatre, she was provided general anaesthesia with standard monitoring. After an intravenous dose of injection cefuroxime, the patient developed bradycardia followed by multifocal ventricular extrasystoles and ventricular tachycardia. The arrhythmia resolved spontaneously but the patient became haemodynamically unstable. All anaesthetic agents were discontinued and 100% oxygen was administered. Patient's radial artery was catheterized and arterial blood gas analysis was done. The patient was administered injection hydrocortisone and an infusion of noradrenaline was started. Trans-oesophageal echocardiography showed global left ventricular hypokinesia, dyskinesia and regional wall abnormality beyond the territory of the single epicardial vessel with an ejection fraction of 35%. Cardiac enzymes (creatine kinase-MB and TROP-T) were mildly raised. She was shifted to Intensive Care Unit for monitoring and further management. A 12 lead electrocardiogram (ECG) showed diffuse ST segment elevation in leads I, II, aVL and V3–V 6. She was extubated the following day and follow-up echocardiography on the 3rd post-operative day showed an ejection fraction of 45% with improved left ventricular contractility. She was posted for incision and drainage of pus 6 weeks later but this time, she had an uneventful perioperative period. A skin prick test performed during pre-anaesthetic check-up was positive for cefuroxime and negative for other drugs, including atracurium, propofol and midazolam. Echocardiography showed an ejection fraction of 60%. The temporal relationship between drug administration and cardiovascular collapse and positive results in the skin prick test in the present case suggest that cefuroxime, a second-generation cephalosporin, was the most likely cause of the reaction. The negative results of pre-operative intradermal tests can be explained by the lower sensitivity of the tests. We did not obtain serum tryptase levels as it is not routinely done in our hospital. Serial mast cell tryptase[2] levels as early as feasible may be useful for diagnosis. During anaphylaxis, compensatory release of catecholamines by renin-angiotensin system and histamine results in excessive activation of catecholamine receptors in the left ventricle; catecholamine-induced transient left ventricular dysfunction is known as takotsubo cardiomyopathy.[3,4,5] Our patient fulfilled all the criteria (Mayo clinic) of takotsubo cardiomyopathy, which are; left ventricular hypokinesia, dyskinesia extending beyond a single epicardial distribution; absence of chronic obstructive pulmonary disease and coronary disease; new ECG changes with elevated cardiac enzymes and absence of pheochromocytoma and myocarditis. Kurisu et al.[6] suggested multivessel coronary spasm at microscopic level as a cause of cardiomyopathy. Lymphodepletion and profound suppression and alteration of antigen-specific IgG antibody response by the chemotherapeutic agents and the pre-operative dexamethasone were possibly the factors due to which our patient did not have any other respiratory and cutaneous manifestation of anaphylaxis. Treatment of stress-induced cardiomyopathy relies on standard supportive measures. The prognosis is generally favourable, provided the patient survives the initial complications. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

English

Anaphylaxis during pregnancy can be catastrophic for both mother and her fetus. Ant bites are a rare cause of anaphylaxis in pregnant females. The manifestations of anaphylaxis in pregnant females have unusual features making diagnosis challenging. The pathophysiology could be explained by low levels of blood histamines in second and third trimester. Rapid identification and prompt treatment is a prerequisite for survival of both mother and her fetus.

Antibiotics Are an Important Identifiable Cause of Perioperative Anaphylaxis in the United States

The diagnosis of perioperative anaphylaxis (PA) remains challenging, given its clinical setting, exposure to multiple medications, and rarity. Previous reports have found that PA is most frequently caused by neuromuscular-blocking agents. To determine characteristics and causes of PA at our center. We performed a retrospective medical record review to identify patients with anaphylaxis. Cases were further categorized by manifestations of anaphylaxis, age, sex, atopy, timing, tryptase level, and previous PA events. Cases with a cause identified by skin or in vitro tests were classified as IgE-mediated anaphylaxis. Thirty cases were identified. Seventeen (57%) had an identifiable cause: antibiotics in 10 (59%)-β-lactams in and metronidazole in 1; latex in 3 (18%); and neuromuscular blockers in 4 (23%). There was no identifiable cause in 13 cases. The most frequent presenting sign of PA was hypotension (97%). Seven patients (23%) presented with cardiac arrest. A minority (17%) exhibited urticaria. Only four had a history of atopy. Most of the reactions occurred during the anesthesia induction phase. Elevated serum tryptase level was found in 10 of 10 (100%) cases of IgE-mediated anaphylaxis compared with 4 of 10 (40%) cases without an identifiable cause. We found that antibiotics were the most common identifiable cause of PA. Our findings imply that antibiotic exposure warrants careful attention in the evaluation and management of patients with PA, particularly for those who require repeat and/or future surgeries.

Mastocytosis presenting as cardiac emergency

Mastocytosis is characterised by clonal proliferation of mast cells in the skin and in various internal organs, and by symptoms related to an acute release of mast cell-derived mediators. In 20-30% of patients, mastocytosis occurs without the typical skin lesions of urticaria pigmentosa that are usually the first clinical sign of the disease. In these patients, anaphylaxis is often the presenting sign of the disease. We report three cases in which a cardiac emergency (cardiac arrest or ventricular fibrillation) was the first clinical manifestation of anaphylaxis associated with systemic mastocytosis. All patients were men, none of them had previous episodes of anaphylaxis or other mediator-related symptoms, and none had major pre-existing cardiovascular condition. An eliciting factor was identified in one case (a wasp sting), but one was found in the other two. Elevation of the serum tryptase suggested a mastocytosis, which was confirmed by bone marrow biopsy. This case series demonstrates that cardiovascular emergencies may be presenting signs of mastocytosis, and that elevation of serum tryptase after an acute cardiac event, if confirmed under basal conditions, may be useful for diagnosing this disease.

Les acariens, de nouveaux allergènes alimentaires masqués

In atopic individuals with respiratory sensitization to house dust mites, ingestion of food contaminated with Dermatophagoides farinae, Dermatophagoides pteronyssinus, and/or storage mites can cause acute anaphylaxis. Erben et al. reported the first case in 1993. We found 55 reported cases. The 33 women and 22 men (sex ratio, 1:5) were 5 to 45 years of age (mean, 22 to 23 years); half the patients were 18 or younger. Time to symptom onset after food ingestion was only 5 minutes to 2 h. The patients had rhinoconjunctivitis, asthma or atopic dermatitis and had been previously sensitized to airborne mites. Manifestations of anaphylaxis were as follows, in order of decreasing frequency: asthma, angioedema, rhinitis, urticaria, gastrointestinal disorders, and anaphylactic shock, which was life-threatening in two of ten cases. In some patients, the diagnosis was missed at the first episode. The many incriminated foods include pancakes, cakes, breaded foods, pizzas, polenta, and various Japanese dishes such as okonomi-yaki. The mites proliferate during storage under improper conditions. Growth of mites is particularly fast at temperatures higher than 25° C and relative humidity higher than 70%, which explains that most reported cases occurred in hot climates. However, cases that occur during the hot season in temperate climates are probably underdiagnosed. In patients with food anaphylaxis and negative tests for food allergens, contamination by mites should be considered. In reported cases, D. farinae was the most commonly implicated mite, followed by D. pteronyssinus, Acarus siro, Tyrophagus putrescentiae, Thyreophagus entomophagus, Suidisia nesbitti, Aleuroglyplus and Ascidae spp. Examination under the microscope can show a large amount of mites: in one estimation the range was 4,900 to 52,200 mites per gram of flour! The 60% rate of sensitivity to aspirin or nonsteroidal anti-inflammatory drugs among these patients is generating considerable interest but remains unexplained. This new risk of food-related disease requires that patients with sensitivity to mites take a number of basic precautions: they should be aware of the potential risk associated with foods such as pancakes, cakes, and pizzas; store flours in airtight containers; keep these containers in the refrigerator to prevent mite growth; and inform the catering industry of this new risk.

Condoms as primary prevention in sexually active women.

The origin of the word condom is the subject of some debate, but the use of a linen sheath as a preventive measure for venereal disease was noted in the writings of Fallopius in 1564. In recent years condom sales have increased, and in a sample of San Francisco male homosexuals consistent condom use was reported to have increased from 26% to 79% between 1984 and 1987. Condom sales in drugstores increased by over 20% from 1986 to 1987, with women being responsible for an estimated 40-50% of US purchases. Studies suggest a failure rate of 2-15/100 couples using condoms. Failure rates for 1st-year users average about 12%, but consistent and correct condom use theoretically results in approximately a 2% failure rate. Mean breakage rates ranging from 0% to 13% have been reported. Both epidemiological and laboratory studies have demonstrated that latex condoms are effective mechanical barriers to important viral transmissions including HIV, herpes simplex virus (HSV), hepatitis B virus (HBV), and cytomegalovirus (CMV), as well as bacteria such as Chlamydia trachomatis and Neisseria gonorrhea. Condoms are safe to use, particularly in view of the fact that AIDS is now 1 of the 5 leading causes of death for women ages 15-44. An important contraindication, however, is the presence of latex allergy, potentially leading to contact urticaria or manifestations of anaphylaxis. The female condom shows promise for placing personal protection increasingly under the control of women. Condom promotion in the US with education at both public and individual levels could emulate developed and developing countries that have promoted condom use with marketing and mass-media techniques, as well conspicuous and aggressive distribution methods. Nursing is involved in program efforts aimed at enhancing condom use and nurses can be effective in encouraging clients to use condoms to protect themselves.

Anaphylaxis

Anaphylactic reactions are acute medical emergencies characterized by the abrupt onset of hemodynamic instability, respiratory distress from bronchoconstriction or laryngeal edema, urticaria, and angioedema. These clinical manifestations may occur singly or in any combination. Inciting stimuli are diverse, ranging from penicillin, Hymenoptera venom, and radiographic contrast media to exercise. The pathogenesis usually involves interaction of an antigen with specific immunoglobulin E (IgE) antibodies on the surface of mast cells or basophils, which then results in the release of chemical mediators from intracytoplasmic granules and the generation of arachidonic acid metabolites, including prostaglandin D2, and leukotrienes B4, C4, D4, and E4, at the cell membrane. Mediator release from mast cells and basophils may also be stimulated by non-IgE mechanisms, such as complement activation or direct mast cell/basophil activation. Mast cell and basophil—derived mediators have a panoply of effects, including vasodilatation, increased vascular permeability, smooth muscle contraction, airway mucous gland hypersecretion, and chemotaxis of neutrophils and eosinophils. These cellular events result in the observed clinical features. Effective treatment depends on prompt recognition of the clinical syndrome of anaphylaxis, interruption of antigen exposure and absorption when feasible, and administration of appropriate medication. Epinephrine is the drug of first choice for all of the manifestations of anaphylaxis. Adjunctive therapy with oxygen, fluid, H1 and H2 antihistamines, bronchodilators, corticosteroids, and other vasopressors is frequently necessary. Prevention of recurrence is vital. The roles of patient education, skin testing, pretreatment, and desensitization are reviewed.

Characterization of Cardiovascular Events Mediated by Platelet Activating Factor During Systemic Anaphylaxis

Previous studies have shown that an anaphylactic reaction in the isolated perfused heart is characterized by drastic coronary constriction, arrhythmias, and severe impairment of contractility. In vivo anaphylaxis is associated with myocardial ischemia and rapid cardiovascular failure. Recently, not only histamine but also platelet activating factor (PAF) has been implicated in cardiac manifestation of anaphylaxis. The present study was designed to separate the effects of PAF from those of histamine on cardiovascular function during systemic anaphylaxis. In guinea pigs, sensitization was produced by subcutaneous (s.c.) application of ovalbumin. Fourteen days after sensitization, the effects of an intravenous (i.v.) infusion of ovalbumin were tested in anesthetized artificially ventilated guinea pigs. The renewed application of the antigen induced severe cardiac dysfunction. Within 3 min, cardiac output (CO) had already decreased by 90% and left ventricular end-diastolic pressure (LVEDP) increased significantly, indicating left ventricular pump failure. Concurrently, ECG recordings uniformly showed signs of acute myocardial ischemia. In addition, arrhythmias occurred in terms of atrioventricular block. After 4 min, blood pressure (BP) rapidly decreased. All animals died within 10 min. Pretreatment with the H1-receptor antagonist mepyramine (1 mg/kg i.v.) in combination with the H2-receptor antagonist cimetidine (10 mg/kg i.v.) delayed onset of myocardial ischemia, arrhythmias and cardiac pump failure. After 10 min, however, LV contractility and BP steadily decreased, leading to severe hypotension within 30 min. If the selective PAF antagonist WEB 2086 (1 mg/kg i.v.) was administered in addition to cimetidine and mepyramine, myocardial ischemia and LV contractile failure were markedly inhibited further. In contrast, pretreatment with WEB 2086 alone had no beneficial effects on the anaphylactic cardiovascular changes. Therefore, we conclude that histamine is the predominant mediator during the early phase of systemic anaphylaxis whereas PAF-mediated effects are involved in cardiac dysfunction during the protracted late phase of anaphylaxis.

The significance of complete decortication in the development of anaphylactic shock in dogs

Following unilateral decortication, the condition of sensitization and anaphylactic shock develops in dogs with the same doses of antigen (horse serum) as in intact animals. Fifteen days after removal of the second hemisphere the intensity of the shock reaction, appearing as a result of introduction of the same dose of the antigen was greatly decreased. One month after complete decortication the manifestations of anaphylaxis were even less pronounced. The intensity of anaphylactic shock was especially low six months after bilateral decortication. This demonstrates that bilateral decortication decreases the reactivity of the animal organism to the antigenic stimulus.

Intradermal Spread of Vital Dye in Anaphylaxis and Bacterial Allergy

Abstract The ability of sensitized tissue to retain or fix a specific antigen locally, is a well known phenomenon. Thus Opie (1) has shown that rabbits sensitized with crystalline egg albumin or horse serum, localize these antigens at the point of injection in the skin, without the antigen entering the circulation. Kahn (2) has likewise shown that rabbits sensitized with diphtheria (horse) antitoxin, retain the antigen locally long before any manifestation of anaphylaxis can be demonstrated. Animals rendered allergic with bacteria possess the same ability to retain the antigen locally. The best example of this fact is offered in experimental tuberculosis. Thus Krause and Willis (3) have shown that if excised lymph-nodes draining the site of inoculation with tubercle bacilli in the normal animal are injected into other normal guinea pigs, it can be demonstrated that the tubercle bacilli reach these lymph-nodes within twenty-four hours.

NEURITIS AND MULTIPLE NEURITIS FOLLOWING SERUM THERAPY

With the increased use of therapeutic serums in the past twenty years, much has been written of the various manifestations of anaphylaxis. Urticaria, arthralgia, adenopathy and cardiac collapse are well known complications of serum therapy. Coma and occasionally death have been reported following serum injection. Many reports of multiple neuritis and myelitis following the use of Pasteur treatment have appeared, and encephalitis following vaccination is well known. Another unpleasant complication of prophylactic efforts, and fortunately one less frequently seen, is multiple neuritis. In 1912, Thaon1reported a case in which paralysis of the serratus magnus and other muscles developed following serum sickness due to the injection of 10 cc. of tetanus antitoxin. In 1915, Richardson2reported a case of severe tetanus with recovery, which was followed by a pronounced multiple neuritis that he attributed to the action of the tetanus toxin. Dyke3in 1918 wrote on neuritis

STUDIES IN ASTHMA

That vasomotor rhinitis and bronchospasm, as they occur in man, are in most instances manifestations of hypersensitiveness to some foreign substance has been recognized since 1906, when Wolff-Eisner 1 suggested the allergic nature of hay-fever, and 1910, when Meltzer 2 pointed out the possibility that bronchial asthma was a manifestation of anaphylaxis in man. Since then, different observers have reported instances of such varied symptoms as eczema, 3 migraine, 4 certain gastro-intestinal disturbances, 5 epilepsy, 6 and kidney and bladder pain 7 as being other manifestations of allergy. These contributions have opened new possibilities for the proper interpretation and better understanding of certain obscure symptom complexes in man. It is singular that cough, which often accompanies vasomotor rhinitis as well as bronchospasm, has always been considered secondary to these conditions and never as an independent symptom of allergy. In a recent communication one of us 8 described a case in

A modified anaphylactic reaction induced by X-rays

The following observations are of interest in connection with a theoretical consideration of the mechanism of classical serum anaphylaxis.We have found it possible, as has v. Heinrich also, to modify the manifestations of anaphylaxis in guinea pigs by exposing them to X-rays. Guinea pigs weighing about 250 grams were given an intraperitoneal inoculation of 0.1 c.c. of horse serum (1 c.c. of a 1 — 10 dilution) for sensitization. Half of the number of sensitized animals were radiated immediately and then each day thereafter for 10 days. The X-rays were delivered from a Coolidge tube governed by a spark gap of 3 inches with 10 milliamperes of current. The distance from the anode to the surface of the animal's body was 6 inches and the total time of exposure was 10 minutes.14 days after sensitization 0.1 C.C. or 0.01 C.C. of horse serum was inoculated into the jugular vein as an intoxicating dose. In the animals sensitized but not X-rayed, typical anaphylactic manifestations and usually acute death followed t...

Observations on the specific exhaustion of cutaneous reactions

Cutaneous reactions in hypersensitive individuals are of two quite distinct types. The reactions observed in patients with hay fever or asthma and after sensitization by foreign serum develop in a few minutes, consist essentially of a wheal and erythema, and fade out completely in one to two hours. The skin then appears normal. There is no visible evidence of cell destruction. Such reactions may be obtained with extracts of pollen, animal dandruff and feathers, with food proteins, with foreign serum, and occasionally with bacterial or other proteins. This type of cutaneous reaction has little in common with the local cutaneous reactions to tuberculin, typhoidin, luetin, and mallein. Here the reaction does not usually develop for 12 to 24 hours; it is characterized by induration and persistent signs of inflammation, requires many days to fade out entirely and clearly involves cell destruction. Zinsser has recently shown that the local tuberculin reaction in the guinea-pig is independent of the development of a state of anaphylaxis and it is highly probable that the same holds true for the reactions of this type produced by other substances of bacterial origin. Although it has commonly been assumed that the immediate skin reactions with urticaria-like lesions are manifestations of anaphylaxis, it has not been demonstrated that the mechanism consists of an antigen-antibody reaction. Similar reactions may sometimes be obtained with non-antigenic substances such as aspirin, salicylates and quinine, and there are a few substances, notably histamine, morphine and pituitrin, which produce this type of reaction in normal individuals. It appears to be essentially a vascular phenomenon with localized edema. In an effort to determine the nature of these urticaria-like skin reactions we have studied their exhaustibility by a simple procedure in five hypersensitive patients, the subjects of hay fever or bronchial asthma.

Studies in Anaphylaxis

Abstract It may now be regarded as a well established fact that cellular antibody alone is responsible for the reaction known as acute anaphylactic shock. There are, however, certain other manifestations of anaphylaxis which are with difficulty explained upon that basis, and on this account many conservative workers incline to the belief that under certain circumstances circulating antibody may also play an important part in the production of the symptoms. At first sight it might not appear to be a matter of great consequence whether the interaction between antigen and antibody takes place within the cells, or in the fluids of the body. Such, however, is far from the fact. The humoral theory requires the assumption of an intermediary toxic product, a hypothetical anaphylatoxin, which secondarily affects the cells. The cellular theory does not require such an hypothesis.