Positive Cutaneous Reactions Research Articles

INFLAMMATORY STRICTURES OF THE RECTUM ASSOCIATED WITH VENEREAL LYMPHOGRANULOMA

Although the clinical picture associated with that form of venereal lymphogranuloma occurring mainly in males and resulting in inguinal adenitis has been known since 1913,1it was not until 1927 that Frei2suggested that certain types of benign rectal stricture of unknown cause, together with many strictures thought to be due to tuberculosis, gonorrhea and syphilis, might be manifestations of this same disease. Frei and Koppel3then substantiated this assumption by demonstrating a positive cutaneous reaction to intradermal injections of diluted pus known to contain the virus of venereal lymphogranuloma in a number of their cases of inflammatory stricture of the rectum. Since that time a number of other reports have appeared in the literature confirming their results. ETIOLOGY Certainly all benign strictures of the rectum cannot be attributed to venereal lymphogranuloma; however, many of the etiologic theories suggested in the past are entirely unconvincing. A comprehensive

ALLERGIC ABDOMINAL PAIN IN CHILDREN

Pain in the abdomen is a common complaint in children. Frequently the cause of the pain cannot be determined, as investigation is usually uninformative. Lust 1 described abdominal pain, particularly the type localizing about the umbilicus (navel colic), as common among children. Moro 2 also depicted recurrent navel colic. Both writers mentioned the difficulty of ascertaining the cause of the condition and the paucity of objective findings. Food allergy as a cause of abdominal pain has been emphasized by several investigators (Bray, 3 Rowe, 4 Laroche and his co-workers, 5 Duke, 6 Andresen, 7 Rackemann, 8 Hollander, 9 Alexander 10 and Lintz 11 ). Occasionally, in these studies it has been shown that abdominal pain of obscure origin followed the eating of certain foods, that the pain disappeared on withdrawal of these foods and that positive cutaneous reactions to extracts of these ingestants could be demonstrated. Such a triad fulfils in

Sensitivity to taka-diastase (aspergillus oryzae)

The case of a druggist is presented, who on two occasions developed violent attacks of asthma while compounding a prescription containing taka-diastase. His clinical observation was substantiated by a strongly positive cutaneous reaction to this mold and by smaller positive reactions to other members of the Aspergilli and Penicillia species. This case is presented merely as a matter of record in order to add taka-diastase to the long list of substances to which man may be allergic.

PUSTULAR BACTERIDS OF THE HANDS AND FEET

In a previous article¹one of us (G. C. A.) reported a group of cases of recalcitrant pustular eruptions occurring on the palms and soles in which the causative rôle of focal infections was stressed. The disorder as studied in fifteen patients showed four main characteristics: 1. There are chronic recalcitrant pustular eruptions symmetrically located on the palms and soles. 2. The histologic picture shows pustules deep in the epidermis, without much acanthosis and parakeratosis, and the microscopic changes resemble those seen in cases of trichophytids. 3. The condition in our patients had a direct relationship to focal infection and was often accompanied by leukocytosis and by positive cutaneous reactions to staphylococcus and streptococcus toxins. Cultures of material from the lesions were consistently sterile. 4. Cures resulted when the focal infection was identified and removed. CLINICAL FEATURES The pustular eruptions of the hands and feet in these

Unusual Allergic Manifestations in B. Dysenteriae Infections

SummaryWe believe we have demonstrated atopic (anaphylac-tic type) sensitivity for B. dysenteriae, occurring during course of infestation or infection of the bowel with these organisms. We know of no previous report. Cook's postulates have been fulfilled by: 1. Positive cutaneous reactions with the vaccines. 2. Reproduction of symptoms by subcutaneous injections of the vaccines. 3. The organism was isolated from the individual (in 3 cases; in the 4th serological evidence indicated the patient's contact with the organism).

A Non-Specific Cutaneous Sensitivity Which is Passively Transferable with the Serum to the Normal Human Skin

Abstract Prausnitz and Küstner (1) demonstrated that the serum of a fish-sensitive individual with positive cutaneous reactions possessed the power of specifically and locally sensitizing normal skin. This finding has been shown to be generally applicable to atopic sensitivity to antigens and has served as a basis for the indirect method of testing for hypersensitiveness (2). In this technic, it has generally been accepted that when the reaction on the sensitized site is greater than that of the control test on normal skin, a specific sensitivity has been transferred with the injected serum. In the course of studying more than 200 cases of atopic hypersensitiveness by the indirect method of testing, the writer has found 3 sera which, when injected into normal skins, induce a non-specific hypersensitiveness; that is, the resulting reaction in the sensitized site is greater than that obtained on a normal site with the same intracutaneous test, regardless of the substance with which the injected site is subsequently tested intracutaneously.

THE ENDERMIC REACTION IN BRUCELLA INFECTIONS

The endermic reaction forBrucellainfection has been used for the most part as a confirmatory test. But Burnet1and others have reported positive cutaneous reactions in cases in which the blood serum showed no agglutination withBrucellaand in which the blood cultures were negative. Various antigens have been used in testing for cutaneous hypersensitiveness toBrucellaand its products. These antigens may be classified roughly into two groups: (1) bacterial suspensions and (2) filtrates of broth cultures. The use of the filtrate of a broth culture from twenty to thirty days old was described in 1922 by Burnet,2who called the substance melitin. It has since been widely used, particularly in countries bordering on the Mediterranean, and the results have varied. Trenti3in 1923 reported specific reactions in nine cases of undulant fever, with negative results in forty controls. Olmer and Massot,4Debre, Marie

SPECIFIC CUTANEOUS REACTIONS AND CIRCULATING ANTIBODIES IN THE COURSE OF LOBAR PNEUMONIA

1. A group of 41 non-serum treated patients with Type I, II or III pneumococcus pneumonia were studied during their disease and convalescence with respect to their skin reactions to specific pneumococcus polysaccharides and, in most instances, for the presence of circulating agglutinins and protective antibodies for all these 3 types. 2. One-half of the Type I and two-thirds of the Type II and Type III recovered cases gave the typical immediate "wheal and erythema" response to the homologous polysaccharide at or about the time of recovery. All cases tested showed protective antibodies and almost all showed agglutinins for the homologous pneumococcus. In the fatal cases, in general, positive cutaneous reactions and circulating antibodies were not obtained. 3. In cases of pneumonia receiving repeated cutaneous inoculations with various types of specific polysaccharide, antibodies for pneumococci differing from the infecting type but corresponding to the types of carbohydrate injected were present 1 week or later after such injections. These heterologous antibodies were most frequently demonstrated for Type II and were probably the result of immunization by means of the cutaneous injections. 4. Positive skin responses to homologous polysaccharides and corresponding circulating antibodies were demonstrated with similar frequency in the first 3 weeks after crisis in patients who had not previously received intracutaneous injections. In such patients heterologous antibodies were rarely found. 5. Typical skin reactions with the specific pneumococcus polysaccharides and mouse protective antibodies were demonstrated independently in a number of hospital patients who had had no recent history of pneumonia. 6. Some patients with demonstrable foci of persistent infection or with latent infections which later proved fatal showed positive cutaneous responses to the homologous type polysaccharide and circulating specific antibodies for the corresponding type. 7. The agglutination test, though less sensitive than the mouse protection test for determining the presence of antibody, has many advantages over the latter and is simplest to use in following the course of the untreated pneumonia.

SPECIFIC CUTANEOUS REACTIONS AND CIRCULATING ANTIBODIES IN THE COURSE OF LOBAR PNEUMONIA

1. Characteristic cutaneous responses to the type-specific protein-free carbohydrates of both Type I and Type II pneumococci have been "produced" in cases of lobar pneumonia due to either of these types by the intravenous injection of concentrated bivalent (Types I and II) antipneumococcic sera (Felton). 2. A positive cutaneous response to the specific polysaccharide of Type II pneumococci has been passively transferred from human cases convalescing from this infection to a patient suffering from pneumonia due to this organism. 3. The cutaneous responses to the type-specific polysaccharides and circulating antibodies were studied in 51 cases of lobar pneumonia. Positive cutaneous reactions were, in most instances, associated with recovery, even when purulent complications were present. Failure to elicit a positive reaction was usually followed by a fatal outcome. 4. The positive reactions in patients who were treated with concentrated sera and recovered were most often elicited within 24 hours after the first dose and after a total of 40 cc. had been given. 5. The positive skin reactions obtained after the administration of specific antisera were associated with the presence of mouse protective antibodies and agglutinins in the sera of the patients. 6. The immune reactions in serum treated cases receiving repeated inoculations with the specific carbohydrates disappeared more rapidly than in similar cases receiving no antiserum. It is suggested that the administration of antisera in someway interferes with the production of antibodies by the intracutaneously injected carbohydrates.

RÉSUMÉ OF THE LITERATURE ON SKIN DISEASES OF INFANTS AND CHILDREN (1920-1923)

The contributions to medical literature on the skin diseases of infants and children have been numerous the past three years. Those of real value or marking advance in our knowledge, however, have been few. It has been my purpose to include only these in this review. In some instances, it has seemed profitable to review articles published before the year 1920. ECZEMA The most interesting advancement in the skin diseases of infants and children has been the demonstration of the relationship of protein sensitization to eczema, one of the most common skin diseases of children. Using the scratch method of applying the proteins, O'Keefe 1 found that 41 per cent, of the cases of eczema in bottle-fed infants and older children whom he tested gave a positive reaction to proteins. In forty-one cases of breast-fed infants with eczema, 61 per cent. gave positive cutaneous reactions. In Schloss' 2 series of

ASTHMA COMPLICATING THE SERUM TREATMENT OF PNEUMONIA

As the use of antipneumococcus horse serum becomes more extensive, cases are met with wherein sensitiveness to serum complicates its administration, as happens with the therapeutic use of other serums. The reaction induced by giving horse serum to such patients may vary, depending on several factors, among which is liability to "horse asthma." Patients with this condition complain that proximity to horses, whether currying them, driving them, or even going into stables, may bring on symptoms which are typical of bronchial asthma, due doubtless to suspended particles of horse dandruff or horsehair. Walker¹has found that most patients suffering from this condition give positive cutaneous reactions to horsehair proteins, whereas in addition a much smaller number (22 per cent.) react to horse serum proteins. Woodehouse²has established the fact that the fractional portions of the protein mixture hair, may sensitize, or rather, that its administration results in multisensitization to its