596 ANAPHYLAXIS 



As antibodies are produced by the body cells, it is reasonable to 

 believe that they are present in the protoplasm of the cells, and, even 

 after thorough washing of the tissues, are capable of union with their 

 antigen. It is entirely likely that these attached or sessile antibodies 

 are chiefly concerned in the phenomena of anaphylaxis, but I cannot 

 subscribe entirely to the cellular theory, because of the mass of experi- 

 mental data bearing on the production of the protein poison, particu- 

 larly in vitro, by the free antibodies in an immune serum. The reactions 

 in vivo of hemolysis and bacteriolysis, which are lytic processes appar- 

 ently similar to those concerned in anaphylactic reactions, are probably 

 intravascular processes; it is also likely that in anaphylaxis to formed 

 antigens the first phase of the reaction, that is, the disruption of the 

 antigenic cell, is intravascular, showing that lytic reactions entirely 

 analogous to our conception of the mechanism of the production of the 

 protein poison in anaphylactic reactions may occur in the blood-stream. 

 For these reasons alone I cannot exclude the free antibodies in the blood 

 from playing some role in the phenomena of anaphylaxis. 



The extreme sensitiveness of the body cells in anaphylaxis to the 

 protein suggests to me that the cells acquire the property of union with 

 the protein poison to an extreme degree, as if they were furnished, as a 

 result of the initial dose of foreign protein, with an increased number 

 of specific and sessile receptors for the protein poison. In other words, 

 while the protein poison may be produced in the cells by sessile recep- 

 tors or in the blood-stream by free receptors, anaphylaxis itself, that is, 

 the hypersensitiveness of the cells, is due to the increased binding power 

 of the cells for the protein poison. In our opinion this in part explains 

 true allergy, that is, the effects of local or general sensitization (pro- 

 duction in the protoplasm of the cells or increased receptors for the 

 protein poison), and the immediate well-marked or even violent effects 

 following the production of what must be very minute amounts of protein 

 poison, as in the cutaneous tuberculin reaction or in the classical horse- 

 serum reaction in guinea-pigs, following the intravenous injection of 

 the intoxicating or second dose of protein in very minute or infini- 

 tesimal dosage. 



PASSIVE ANAPHYLAXIS 



Passive anaphylaxis is produced by the injection of normal animals 

 with the blood or serum of animals or persons already sensitized. It 

 is similar to passive immunization, and is specific for the anaphylactogen 

 with which the donor is sensitized. 



