122 ANAPHYLAXIS AND ANTl-ANAPHYLAXIS 



under what conditions it acts when present, are 

 questions yet to be solved. 



The relation of insect stings to anaphylaxis has 

 not so far been investigated to any great extent, but 

 occasionally cases are recorded^ which suggest that 

 there is some close connexion. The condition of 

 hypersensitiveness to drugs, on the other hand, has 

 received a fair share of attention. For many years 

 it was regarded as a personal idiosyncrasy incapable 

 of explanation, but recently the explanation has 

 been sought for in anaphylaxis. The drugs most 

 commonly associated with the condition are quinine, 

 copaiba, iodoform, iodides, bromides, antipyrin, 

 atropine, and various alkaloids. Quinine especially 

 has been the subject of recent investigation (Boerner) * 

 If the original view of anaphylaxis be true, that it is 

 invariably due to the injection or ingestion of a 

 foreign protein, one is faced with the difficulty of 

 reconciling this so-called drug anaphylaxis with the 

 true condition of protein sensitisation. Hence the 

 introduction of the terms " indirect " or " secondary " 

 anaphylaxis, which assumes that the drug acts upon 

 the protein molecules and liberates a toxic product. 

 There is some diversity of opinion regarding the 

 source of the protein. It has been suggested (Jobhng 

 and Petersen,^ and Doerr^) — (i) that absorption of 

 complement from the blood-serum may render the 

 latter poisonous; (2) that the poison, whatever it is, 

 is already pre-formed in the serum, but that its 

 action is neutralised by some constituent of the 

 serum which becomes absorbed at the time of the 

 administration of the drug; (3) that the absorption 



1 Atkinson, T. R., Brit. Med. Journ., London, ii., p. 1148, 1907; 

 and Goodall, loc. cit. 



2 Journal of American Med. Assoc, Ixviii., p. 907, 1917- 



3 Journ. Exper. Med., xix., pp. 459, 480, 1914. 



* " Handb. d. path. Mikroorgan.," KoUe and Wassermann, 

 2nd edition, ii., p. 947, 1913. 



