qSo anaphylaxis and anaphylactoid reactions 



blood-pressure fall and the increased tone of the bladder occur much sooner than in 

 serum anaphylaxis, and they interpret the result to indicate that the liver plays no 

 part. Much the same questions are raised by the- work of Zinsser and Parker/ and of 

 Sherwood and Stoland/ with bacterial bodies. Hyde^ finds that the phenomenon is 

 not due to the carriage of serum by blood cells, and his results favor the conception 

 that the reaction is anaphylactoid. 



SITE OF THE REACTION 



Acceptance of the statement that anaphylaxis is an antigen antibody reaction 

 raises the question as to whether the reaction takes place in the circulating fluids 

 (humoral theory) or in the tissue cells (cellular theory). 



If the reaction take place in the blood, it should be possible to inject antigen and 

 antibody simultaneously, or nearly so, with the production of shock. Zinsser^ quotes 

 experiments of Friedemann, Biedl and Kraus, Briot, Gurd, and himself to support 

 the conception that the meeting of antigen and antibody in the bloodstream, especial- 

 ly of rabbits and certain other animals, may lead to anaphylactic shock, but these 

 results had not the same searching analysis as is now demanded for the distinction 

 between anaphylactic and analphyactoid reactions. By perfusing the rabbit heart, 

 Manwaring, Meinhard, and Denhart^ claim to have shown that the reaction is en- 

 tirely humoral. Subsequent work (Manwaring and Kusama)^ with a more suitable 

 organ, the guinea pig lung, demonstrated cellular reaction. By perfusing with antigen 

 and antibody, a reaction occurred which is interpreted as typically anaphylactic and 

 humoral in origin. The work of Hanzlik^ and Karsner shows that such reactions may 

 occur under circumstances not to be regarded as truly anaphylactic. 



The conception widely held today is that anaphylaxis is a supra- or intracellular 

 phenomenon. Friedberger, in the development of his theory of anaphylatoxins, as- 

 sumed that the shock is due to the presence of intracellular precipitins ("sessile 

 receptors") which react with injected antigens to stimulate and damage the cells. 

 The work of Schultz and of Dale with isolated smooth muscle in vitro indicated the 

 capacity of cells to react, but was not conclusive because the possible influence of 

 blood in the specimens could not be excluded. At about the same time Pearce and 

 Eisenbrey^ transfused the blood of normal dogs into a sensitized dog and that of a 

 sensitized dog into a normal dog. The sensitized dog with normal blood reacted to 

 the shocking dose of serum, whereas the normal dog with "sensitized" blood did not 

 react, clearly indicating that the reaction is cellular. Coca' confirmed this with guinea 



' Zinsser, H., and Parker, J. T.: /. Exper. Med., 37, 275. 1923. 



2 Sherwood, N. P., and Stoland, O. O.: J. Immunol., 10, 643. 1925. 



3 Hyde, R. R.: J. Immunol., 12, 309. 1926. 



< Zinsser, H.: Injection and Resistance (2d ed.), p. 397. New York: Macmillan, 1918. 

 s Manwaring, W. H., Meinhard, A. R., and Denhart, H. L.: Prac. Soc. Exper. Biol, b' Med., 

 13, 173, 174- 1916. 



'Manwaring, W. H., and Kusama, Y.: /. Immunol., 2, 157. 1917. 



'Hanzlik, P. J.: J .A.M .A.,%2,2001. 1924. 



* Pearce, R. M., and Eisenbrey, A. B.: J . Infect. Dis., 7, 565. igio. 



' Coca, A. F.: Ztschr.f. Immunitalsjorsch. u. exper. Tlicrap., 20, 662. 1914. 



