HYPERSENSITIVENESS, PROTEIN INTOXICATION 227 



syncrasies, spontaneous hypersensitiveness does occur and symptoms may 

 appear after the first use of the drug. 



Though multiple sensitizations are common in the idiosyncrasies 

 and occur in approximately 50 per cent, the groups of substances to which 

 the patients are sensitive are not always of one type, and though certain 

 individuals may react to several varieties of plant pollen and others to the 

 proteins of eggs or to the extract of vegetables only, this is by no means 

 uniform, and frequently individuals are encountered who may react not 

 only to pollens but to the extract of animal dust and to egg albumen. Also 

 in spite of these multiple reactions, there seems often to be a specific selec- 

 tion amongst the different proteins which go to make up a complex sub- 

 stance such as egg white, cereal seeds or animal hairs. The patient may 

 show a typical reaction with ovomucin, but none to ovalbumin ; a typical 

 reaction to wheat proteose, but none to wheat gliadin or leucosin ; to horse 

 dander, but not to horse serum or to the alkali metoprotein of dog hair, but 

 none to the peptone or vice versa. 



It is difficult, therefore, to understand this multiple sensitization on 

 the basis of a group reaction or upon the basis of non-specific sensitiza- 

 tion. 



It is interesting too to note that the presence of circulating antibodies 

 in these naturally hypersensitive individuals is extremely rare and though 

 isolated reports of specific precipitins, of complement fixing antibodies and 

 of passive transfer of sensitiveness to guinea-pigs with the serum of in- 

 dividuals who showed idiosyncrasy to such varied proteins, as pollen, egg 

 white and the extract of horse dander have been recorded, most observers 

 have failed consistently to obtain such results. 



One instance has been reported by Ramirez of possible transfer of 

 hypersensitiveness to horse dander by transfusion of blood from one human 

 being to another and if this, by accident, should be repeated, it would have 

 important bearing on this entire subject. 



To summarize this part of the subject, one may say that the natural 

 idiosyncrasies or allergies which occur towards various proteins and even 

 non-protein substances, such as drugs, differ in such essential respects from 

 the true experimental anaphylaxis in the animal and indeed from the 

 artificial sensitization in man, the prototype of which is serum disease, 

 that one cannot at the present time consider this group of individuals who 

 are so frequently sufferers from hay fever, asthma, eczema, urticaria, etc., 

 in the same category as the animal who has been sensitized to a foreign 

 protein. Some investigators and notably Coca take rather the extreme 

 view and consider that all these manifestations in the human being are 

 to be considered as instances of allergy and as different fundamentally 

 from anaphylaxis. Coca would include in this category not only the 

 spontaneous sensitization, both to protein substances and to such chemicals 

 as drugs, but artificial sensitization in the human being as well as serum 



