ANAPHYLACTIC OR ALLERGIC SKIN REACTIONS 621 



certain drugs, particularly the iodids and bromids, may so favor the 

 non-specific reaction as to present evidences of a violent reaction in 

 normal persons which may be interpreted as anaphylactic (Sherrick, 1 

 Kolmer, Matsunami and Broadwell, 2 Kolmer, Matsunami, Immerman 

 and Montgomery 3 ). 



Anaphylactic Skin Reactions as Indices of Infection and Hyper- 

 susceptibility. As is well known, anaphylactic skin reactions may be 

 elicited in various bacterial and protozoan diseases with anaphylactogens 

 prepared from the protein of the respective microparasites, particularly 

 in tuberculosis, glanders, typhoid fever, and syphilis. Well-marked and 

 specific reactions have also been found by Amberg 4 and Kolmer and 

 Strickler in ringworm and favus, and isolated reports show that they 

 may be elicited in various other diseases with the proper preparations. 



In these conditions, however, the skin reactions are not always 

 elicited, and especially during the early and acute stages. An interval 

 of time is required for the purpose of sensitization, and during the acute 

 stages antigen and antibody may both be present in the cells and body 

 fluids, as shown by Weil 5 and Denzer, 6 with continual interaction ex- 

 pressed in the symptom-complex of the infection, and thereby giving no 

 response when the protein is applied or injected into the skin. Further- 

 more, the chemical nature of the protein of our anaphylactogen may have 

 been altered in the course of preparation to a sufficient extent to fail 

 to elicit an anaphylactic reaction. These and other factors not under- 

 stood diminish the practical value of a skin test. At present, however, it 

 may be stated that they possess a diagnostic value which is particularly 

 high in chronic infections, and that no other satisfactory clinical or 

 laboratory test for the state of anaphylaxis to a perticular protein 

 and for the anaphylactic antibody has been discovered except that by 

 which the protein is actually brought into relation with the body cells, 

 as in the parenteral introduction of the protein. Of great interest in 

 this connection is the relation of the intensity of the anaphylactic skin 

 reaction to the extent of the infection. Krause 7 has recently studied 

 in a thorough and excellent manner the tuberculin skin reaction in 

 relation to experimental tuberculosis, finding that cutaneous hyper- 

 sensitiveness to tubercle protein is inaugurated by the establishment 

 of infection and the development of the initial focus; that the skin 



1 Jour. Amer. Med. Assoc., 1915, July 31, 404. 



2 Jour. Amer. Med. Assoc., 1916, Ixvii, 718. 



3 Jour. Lab. and Clin. Med., 1917, ii, 401. 4 Jour. Exper. Med., 1910, xii, 435. 



5 Proc. Soc. Exper. Med. and Biol., 1914, xii, 37. 



6 Jour. Infect. Dis., 1916, xviii, 631. 



7 Jour. Med. Research, 1911, xxiv, 361; ibid., 1916, 35, 1; 25. 



