ioo8 ATOPY 



theless, it is strange that the anti-worm reagins (Rackemann, Brunner) can be pro- 

 duced by all persons, presumably at any period of life, under the sole influence of the 

 worm antigen, whereas only the atopic individual can produce reagins to typical 

 atopens, and he only after he has reached a certain age, and then, in some instances, 

 only to a particular substance or group of substances, 



ATOPIC SHOCK TISSUES 



The term "shock organ," suggested by Doerr to designate the tissue in which the 

 physiological reaction of anaphylactic shock takes place in the different animals (the 

 bronchial muscle in the guinea pig, the arteriole media in the rabbit, and the hepatic 

 vein in the dog), can be applied also in human hypersensitiveness. In the lower an- 

 imals, as has just been indicated, the shock organ is different in the different species, 

 but it is the same in all individuals of the same species. In the human being, there are 

 several shock tissues (in the conjunctiva, the nasal mucous membrane, the bronchial 

 mucous membrane, the skin, the subcutaneous and submucous tissue);^ and these are 

 seldom all affected in the same individual; often only one is affected in a single in- 

 dividual. In fact, the same excitant may in one individual excite asthmatic symptoms 

 only, and in another person only those of hay fever. 



Thus, in contrast with anaphylactic sensitiveness, which has been demonstrated 

 only in the lower animals, and in which the sensitizing antibodies are physiologically 

 effective always in the same organ, the reagins of atopy may be effective in one person 

 through the bronchial shock tissue (asthma), in another through the nasal shock 

 tissue (hay fever). 



The facts just recited clearly indicate that the mere presence of atopic reagins in 

 the blood does not determine the clinical form of the hypersensitiveness (asthma or 

 hay fever) which the individual will exhibit. An atopic state of the shock tissue must 

 be assumed to be necessary for its involvement in the hypersensitive person. This 

 assumption is supported by other evidence. 



Baldwin^ has shown that specific reagins can be demonstrated in the blood of the 

 offspring of an atopic parent before the child itself has begun to suffer atopic symp- 

 toms. 



Brunner and Walzer,^ in confirming Rackemann's finding of sensitizing reagins in 

 worm-infested persons, observed constitutional reactions (asthma) in three of the 

 individuals whose blood carried the anti-worm reagins, when a certain quantity of 

 worm extract was injected into the skin. These three persons suffered from asthma, 

 but were free of worms. The same quantity of the worm extract was injected into 

 other individuals whose blood contained the anti-worm reagins, but none of these 

 persons exhibited any constitutional reaction. The bronchial shock tissue in these 

 non-atopic persons was not susceptible to the "reaction" between the worm excitant 

 and the reagins; it was not in the atopic state. 



In this connection, an explanation may be offered for the success in one case and 

 the failure in the other of passive sensitization in the well-known observations of 



' Coca, A. F.: /. Lab. 6° Clin. Med., 12, 1135. Sept., 1927. 

 * Baldwin, L. B.: /. Immunol., 13, 345. 1927. 

 J Brunner, M., and VValzer, M.: to be published. 



