Max Grolnick

Studies in contact-dermatitis: VIII. The effect of feeding of antigen on the subsequent development of skin sensitization

Abstract Eleven adults ingested 24 ounces (710 ml.) of the tincture of krameria in teaspoonful doses (approximately 4 ml.) over a period of 8 weeks. Two weeks later patch-test applications were made with the fluidextract of krameria. In the absence of any reaction they were repeated at spaced intervals until evidence of sensitization was demonstrated. There were 10 control subjects in whom repeated patch-test applications were made according to the procedure followed in the prepared subjects. All test subjects and controls were sensitized. No difference existed in both groups, either in intensity of induced reactions or in the number of patch-test treatments required to provoke sensitization.

CONTACT ALLERGY OF THE SKIN

After definition and identification of the subject, this presentation will be primarily concerned with the mechanism or manner of the development of contact allergy. An attempt will be made to present such pertinent experimental data from the available medical literature as may aid in the formulation of a logical hypothesis for such a mechanism. The introduction of a vast literature on the clinical aspects of contact dermatitis will be avoided, except in particular instances where the experimental data suggest some clinical implication. Thus, many excellent clinical presentations by the later students of contact allergy, such as Schwartz, Sulzberger, Downing, Stokes, Shelmire, Epstein, and others will be omitted. Highly controversial aspects of the subject will not be entered into. Contact allergy is a manifestation in the skin of an inflammatory reaction, in response to an acquired hypersensitiveness to previous contact with an effective, specific, sensitizing substance. It can be reproduced at will by topical contact with the same or a related allergenic or sensitizing material. Clinically, it is represented by a superficial inflammation of the skin, generally with vesiculation, fairly sharply delineated, appearing in acute or chronic form and tending to recur. The specific diagnostic reaction, the patch test, is of the delayed and not the immediate whealing type, occurring in the already sensitized subject usually after twenty-four hours of suitable surface contact. It may appear after contact for a few hours or several days. There is no evidence of an inherited predisposition, a characteristic distinguishing it from the skin manifestations commonly referred to as atopic eczema or dermatitis of infancy or neurodermatitis of early childhood and early adult life. Contact dermatitis is commonly encountered in civilian medical practice and may be caused by a variety of substances such as poison ivy and other similar plants, by household materials, cosmetics, clothing dyes, adhesive plaster, and others. Injudicious and continued use of some local therapeutic agents may cause prolongation of the original lesion by inducing new sensitivities. Contact allergy is of special import among the various dermatoses encountered in industry, particularly since the advent of the newer synthetic products. Bonnevie,l in a discussion of the occupational dermatoses, stated that eczema (contact dermatitis) was a disease of civilization, having become more prevalent with industrial expansion. Contact allergy involving the skin is variously referred to as eczema (“Ekzem” of the European school), eczematous contact-type dermatitis (Sulzberger), dermatitis venenata, or epidermitis (S. Epstein). In this presentation, the general clinical entity just identiiied will be referred to for the most part as contact dermatitis, though the term eczema may be used a t times in referring to the older literature. Josef Jadassohn2 was the first to report on untoward (allergic) reactions

Immunologic studies in patients with subacute bacterial endocarditis treated by combined penicillin heparin method

A case of induced sensitivity to the drug heparin is reported. Reagins were demonstrated to heparin, beef serum, and to beef lung which is the source of heparin.Abstract A case of induced sensitivity to the drug heparin is reported. Reagins were demonstrated to heparin, beef serum, and to beef lung which is the source of heparin.

Studies in contact dermatitis: II. Adhesive plaster dermatitis: Clinical and immunologic observations on patients sensitive to adhesive plaster

Abstract Irritation from adhesive plaster (dermatitis) was unrelated to a family history of allergy, to the previous use of adhesive plaster, to dermographism, to the ability of the skin to tan, to the color of the eyes, or to the shade of the skin. Young adults reacted more readily than did older subjects, and females showed a greater tendency to react. Subjects did not react to the same extent at all times, and it did not seem possible to group them according to degrees of reactivity. About one in six normal subjects showed some phenomenon of irritation, by far the greater number showing only an erythema. Adhesive plaster dermatitis was of two types: (1) nonspecific and (2) specific. Both showed evidence of a dermatitis, though the former was less prone to show edema, vesicles, and desquamation. The nonspecific type was of shorter duration than the specific, and its effects were gone in a few days. There seemed to be an interplay of mechanical factors, such as tension, friction, maceration, skin infection, and capillary breakdown in the causation of nonspecific dermatitis. In the specific variety there was a more lasting dermatitis of the type venenata, and positive reactions by the surface or patch test to one or more ingredients in the adhesive plaster were obtained. Only two specifically sensitive subjects were found among 275 normals tested with adhesive plaster. Five known cases of adhesive dermatitis were also tested. The results showed all seven to be sensitive to rosin and three also to native rubber. There was a fluctuation in reactivity to these test substances. In addition four of the subjects showed positive reactions to cellophane of the moisture-proof variety. Specific adhesive plaster dermatitis seemed to occur in persons with a dermatitis due to other contact excitants. The person with a true sensitivity usually volunteered the information that he could not tolerate the application of adhesive plaster.

Studies in contact dermatitis VII. The response of healed specific dermatitis sites to stimulation with another contactant

Abstract 1.1. Healed areas of contact dermatitis were tested with a second contactant substance in forty-two subjects. Thirteen positive reactions were obtained, whereas the controls which had been done in most instances were negative. 2.2. The evidence suggests that a healed site of specific dermatitis is more reactive or responsive to a secondary chemical stimulus than is uninvolved skin, and that the effect of the latter may be nonspecific. 3.3. The subject of Meal skin sensitiveness is discussed. 4.4. An explanation is offered for the findings in this report.

Studies in contact dermatitis: I. Adhesive plaster dermatitis: Technics for surface testing on patients sensitive to adhesive plaster

Abstract The phenomenon of skin irritation from adhesive plaster has led to a formidable problem, in view of the extensive use of adhesive plaster clinically and as a constituent part of the patch test. I have undertaken a series of studies to determine the nature of these skin changes. In order to begin these investigations it was necessary to develop a technic for testing, by the patch or surface method, those subjects by whom adhesive plaster was not tolerated. In principle, this newly adopted procedure consists in stamping out, by means of a glass tube, a ring of some liquid adhesive or fixing agent around the test substance, and sealing this over by a disc membrane cut from some impermeable or nearly impermeable material. Several combinations are herein suggested, namely, plain cellophane and collodion (experimental), scrim cellophane and collodion (experimental), tracing paper and collodion (experimental), white single-faced rubberized cloth and duo liquid adhesive, rubber tissue and frisket type rubber cement. There exists a distinct need for a number of such substitute technics for patch testing, inasmuch as a combination suitable in one subject may be unsuitable in another. I prefer the technic employing rubberized cloth and duo adhesive for the reasons previously designated, and suggest this as a starting point when the problem of adhesive irritation arises. In fact, it has been found entirely satisfactory to use this procedure routinely in testing for contact dermatitis. I also desire to point out that cellophane, which is used extensively in the patch test as a constituent part of it, may be of the moistureproof kind, the surface coating of which contains a natural resin. This variety of cellophane may thus produce misleading positive reactions in selected instances.

Sensitization of the human skin: A study of location of sites and of exposure time of excitant

Abstract This is a further study into the problem of factors involved in the mechanisms of sensitization of the human skin. In devising techniques of sensitization, such variations in procedure were recognized as (a) short and prolonged patch test exposures, (b) their frequency of application, (c) their total number, and (d) their distribution on various areas of the body. A chemical substance, heretofore not used on the human skin, was employed, and was found in preliminary observations to be able to sensitize the skin by percutancous application. Four variations in procedure ( A , B , C , and D ) were cstablished, based on findings in previous experiments and studies in skin sensitization by myself and others. A fifth procedure ( E ), employed for purpose of comparison, was that suggested by the United States Food and Drug Administration for studying the sensitizing potentials of unknown chemicals. The number of subjects studied was 121, approximately equal numbers being treated by each of the five procedures. Seventeen subjects, or 14 per cent of the total, became sensitized, the percentages in each group being A , 19 per cent; B , 4 per cent; C , 32 per cent; D , 10 per cent; and E , 4 per cent. In comparing and evaluating the factors of location and distribution of patch test sites and of the exposure time or duration of application of the exeitant, I believe that the effectiveness of procedure C in yielding the highest incidence of sensitization can be attributed to the prolonged (seven-day) patch test and to the distribution of the patch test sites over a small area of skin.

Anaphylactogenic properties of heparin in the guinea pig

Abstract Schultz-Dale studies failed to reveal any evidence of anaphylactic sensitivity in the guinea pig following attempts at sensitization with heparin.

The response of contact dermatitis sites in atopic individuals to subsequent stimulation with specific wheal-inducing atopens

Abstract 1.1. When an area of skin in an atopic individual is stimulated by contact with a specific excitant and becomes the site of a contact dermatitis, its response to specific wheal-inducing atopens becomes altered. 2.2. When the dermatitis reaction has completely subsided, an intracutaneous test at this site with a specific wheal-inducing atopen, such as pollen or animal dander, tends to induce a wheal formation which is larger than that obtained at a normal site on the same subject. 3.3. The more intense the original dermatitis reaction is, the more pronounced is the tendency to increased wheal formation upon subsequent specific excitation. 4.4. Erythema formation on restimulated sites tends to be less intense than on normal sites.

Absorption pattern of ragweed antigen and active sensitization in man following repository pollen injection

Abstract 1.1. The reverse passive transfer technique was used to study the absorption pattern of ragweed antigen from the site of injection of the repository as well as the conventional aqueous solution. 2.2. It was found that the immunologic reaction following repository ragweed injection remained positive in the nonatopic subjects for a period of 29 to 35 days as compared to 15 days in an atopic subject. 3.3. It was demonstrated that the ragweed antigen persisted in the circulation following aqueous injection for a period of 8 to 15 days in nonatopic subjects and 3 days in the atopic individual. 4.4. The production of an induced immediate type wheal reaction following a ragweed skin test was demonstrated in the nonatopic subjects. This was not transferred by the serum passive transfer technique. However, skin test to ragweed in the atopic subject was intensified and transferred. 5.5. A delayed reaction in 1 nonatopic subject was followed by an immediate-type reaction. 6.6. The induction of hypersensitivity is discussed as to its significance in the evaluation of this mode of therapy. 7.7. Further investigation of the mechanism of adjuvant therapy is basic, over and above the simple clinical effectiveness of repository therapy.