24 An Introduction to Medical Mycology 



W. Jadassohn, Schaaf and.Wohler and their collaborators found the 

 uterine horn of a guinea-pig ( Schultz-Dale technic) to be capable of 

 sensitization to products of fungi. Anaphylactoid shock followed the intra- 

 cardial injection of desiccated trichophytin in a sensitized animal one month 

 after the sensitizing injection. Utilizing the Schultz-Dale phenomenon, 

 these workers found that the extracts prepared from various species of 

 dermatophytes all showed a common antigenic factor and that, in addition, 

 each species contained several other antigenic factors not found in other 

 species. Antigens characteristic of each species were present, and there 

 may have been another antigen common to two or more species. 



A number of cases of immediate wheal reaction to trichophytin have 

 been reported. These were mentioned by Marcussen, who summarized 

 the evidence that the reaction to trichophytin is specific. He reported eight 

 cases in which there was an immediate wheal reaction at the site of the 

 intracutaneous test with trichophytin. In six cases there was either a family 

 history of allergic disease or the presence of such a disease in the subject. 

 Both this factor and the presence of prolonged deep mycosis, often with 

 hematogenous spreading, were considered by Marcussen to be important 

 factors in the production of the immediate wheal reaction. He stated that 

 a mycotic infection was capable of giving rise to the formation of two dif- 

 ferent antibodies. One of these circulated in a patient with allergic mani- 

 festations or history, while the other was a sessile antibody which might 

 be present in any person but was often absent in patients with allergic 

 diseases. Both antibodies were directed against the same antigen com- 

 ponent. Thus, in the case of patients showing an immediate wheal reaction, 

 there was diminution or complete absence of a delayed reaction, since 

 the antigen was consumed in whole or in part by the other antibodies. No 

 local desensitization followed the wheal reaction, since the injection of 

 trichophytin in sites previously used for Prausnitz-Kiistner experiments 

 resulted in the same strength of delayed reaction normally present. Marcus- 

 sen stated that a patient is seldom inspected immediately after an injection 

 of trichophytin. For this reason the immediate reaction is apt to be over- 

 looked. Marcussen mentioned that Bernton and Thorn found 12 cases of 

 immediate wheal reaction among 400 patients. Marcussen was able at 

 times to transmit the susceptibility by means of passive transfer, which 

 usually was not possible with serum from patients who exhibited the more 

 usual delayed reaction. 



In a series of over 400 patients Lewis, Sulzberger and Wise observed six 

 instances of a flare-up reaction seven days after a test dose of trichophytin, 

 in a site where no reaction was present at the end of 48 hours. When these 

 patients were retested with trichophytin, reactions appeared within 48 hours. 



