CLINICAL SIGNIFICANCE OF ANAPHYLAXIS 443 



the ophthalmoreaction. The principle involved in these reactions 

 was then further emphasized by the introduction of the Moro tuber- 

 culin-ointment method and the intracutaneous test of Romec. The 

 mere observation that the infection with tuberculosis results in a 

 general tissue hypersusceptibility immediately suggests the interpre- 

 tation of the tuberculin reaction as a manifestation of anaphylaxis. 

 Von Pirquet, accordingly, on the basis of his previous studies upon 

 serum sickness includes the reaction in the category of what he calls, 

 "allergic." 



He assumes that the reaction depends upon the presence in the 

 system of antibodies, which form a union with the applied tubercu- 

 lin, the result being the formation of poisons and a reaction. This 

 assumption, according to the anaphylatoxin theory of Friedberger, 

 would imply the participation of alexin in the reaction acting upon 

 the united tuberculin-antituberculin complex, though v. Pirquet 

 does not express himself positive as to this. 



This, moreover, is the clearly expressed opinion of Friedberger 41 

 himself. Consistently with his general theory of anaphylaxis he 

 assumes that the injected tuberculin comes into relation with specific 

 antibodies with which it unites, the alexin then splitting off anaphy- 

 latoxin from the complex. He bases this view upon his experimental 

 demonstration, mentioned above, of the production of anaphylatoxin 

 from tubercle bacilli by in vitro digestion with guinea pig comple- 

 ment. 



In principle the view of v. Pirquet is similar to that previously 

 expressed by Wolff-Eisner 42 that the union of tuberculin with its 

 lytic antibody, present in the tuberculous animal, gave rise to pois- 

 ons as the result of lysis. Both of these theories simply apply to the 

 special case of the tuberculin reaction theories of mechanism applied 

 to anaphylactic reactions in general. 



We must admit that the facts of the "allergic" reactions as a 

 class seem to force upon us the acceptation of von Pirquet's views. 

 Apart from the purely clinical observations made in carrying out the 

 routine tests we have the additional evidence that the instillation of 

 tuberculin into the eye of normal individuals gives rise to no reac- 

 tion, but a repetition of the instillation into the same eye after ten 

 or more days results in a marked and typically positive test. Further- 

 more, von Pirquet 43 states that individuals showing no clinical tu- 

 berculosis and negative to a first test will often react ("sekundare 

 Reaktion") to a second test carried out a few days after the first. 



These facts all seem to indicate acquired hypersusceptibility more 

 analogous to true serum-anaphylaxis than to the toxin hyper suscepti- 



41 Friedberger. Munch, med. Woch., Nos. 50 and 51, 1910. 



42 Wolff-Eisner. Berl. klin. Woch., Nos. 42 and 44, 1904. 



43 Cited from Lowenstein in "Kraus u. Levaditi Handbuch," Vol. 1, p. 

 1039. 



