CLINICAL SIGNIFICANCE OF ANAPHYLAXIS 435 



time, an abnormal "Durchlassigkeit" or penetrability of the cutis 

 and mucosa for the pollen substances. He claims to have shown that 

 a solution of pollen protein instilled into the eye or even dropped 

 upon the skin of a hay-fever patient gives rise to a prompt and 

 severe reaction, while it produces no effect upon normal persons. 

 Unlike experimental serum anaphylaxis, the repeated instillation of 

 the pollen substances rather increases than diminishes the suscepti- 

 bility even when these are carried out daily. Furthermore, unlike 

 serum anaphylaxis, against the manifestations of which no direct 

 passive immunization has so far been possible, Dunbar claims to 

 have produced a curative immune serum by the treatment of horses 

 with the pollen extracts ("Pollantin"). Dunbar, therefore, while 

 admitting an anaphylaxis-like hypersusceptibility of the patients, 

 still believes that the antigen in this case is a true "toxin" against 

 which an antitoxin can be produced the condition being more 

 directly comparable to the sensitization against diphtheria and 

 tetanus toxins observed during the earlier phases of these investiga- 

 tions by v. Behring and his associates rather than to the phenomena 

 of serum anaphylaxis themselves. 



Schittenhelm and Weichhardt, 25 on the other hand, regard hay 

 fever as truly anaphylactic in every sense. They speak of it as 

 epithelial anaphylaxis (hay fever being specifically designated as 

 "conjunctivitis and rhinitis anaphylactica," in distinction from 

 other forms of cellular anaphylaxis, i. e., enteritis anaphylactica). 

 They believe that the manifestations of the disease result from a 

 local hypersusceptibility in which a toxic substance (Abbau Produkt 

 similar to anaphylatoxin) is produced. The so-called "antitoxin" 

 of Dunbar acts favorably only when locally applied, and not on sub- 

 cutaneous administration. For this reason they do not regard it as 

 a true antitoxin, but think it acts as a local antiferment which pre- 

 vents or delays the cleavage of the pollen-substance into its toxic 

 split-product thereby preventing or ameliorating the attacks. 



Similar to hay fever are the sudden attacks of catarrhal naso- 

 pharyngitis and conjunctivitis often of asthma-like respiratory dif- 

 ficulty, with itching of the nose and eyes and sneezing which many 

 individuals experience when coming close to horses, cats, or other 

 animals. In the Stanford University laboratory the writer had an 

 assistant who invariably had such attacks, sudden, violent, and of 

 several hours' duration, when handling guinea pigs for experiment. 

 The character of such attacks has long aroused the suspicion that 

 the reaction was anaphylactic in nature, especially since it was known 

 that extremely slight amounts of antigen could give rise to symptoms 

 in susceptible subjects. The difficulty in these cases was the ques- 

 tion of the nature of the antigen which emanated from the animal 

 to excite an attack. Recently, however, observations having impor- 

 25 Schittenhelm and Weichhardt. Deutsche med. Woch., 37, No. 19, 1911. 



