Sheppard Siegal

Diphenylhydantoin (Dilantin) hypersensitivity with infectious mononucleosis-like syndrome and jaundice

Abstract An instance of an allergic reaction to diphenylhydantoin (Dilantin) is described which was attended by a peripheral blood picture simulating infectious mononucleosis and by hepatic damage with clinical jaundice. After recovery, re-administration of a 100 mg. dose of the drug induced acute fever, lymph node swelling, and eosinophilia. Efforts to demonstrate sensitivity to Dilantin by means of passive transfer tests, precipitin reactions, and complement fixation tests were unrewarding.

Acute bacterial endocarditis in the aged

Abstract In an effort to clarify the disease pictures encountered in the aged, nine cases of acute bacterial endocarditis, with autopsy, have been reported among patients whose ages ranged from 60 to 80 years. In none of these cases was the diagnosis made clinically. The bacteriologic, pathologic, and clinical features are discussed, and it is pointed out that the diagnosis is obscured by the multiplicity of symptoms and signs, as well as by the prostration of the patient. It is believed that these cases will be detected more often if the possibilty of this complication is borne in mind, especially when positive blood cultures are found in old people, and even in cases in which the diagnosis seems to be obvious. Clarification of the clinical problems posed by the aged patient offers many fascinating opportunities to the discerning physician.

Fatal and near-fatal penicillin anaphylaxis: Three new cases with a note on prevention

Abstract 1.1. One death and two cases of nonfatal anaphylactic shock due to penicillin are described. 2.2. The fatality occurred in a patient with bronchial asthma. Three other known deaths attributable to penicillin anaphylaxis have also occurred in asthmatics. 3.3. Two of these patients, including the one with a fatal reaction, had received penicillin many times before without indication of allergy. The third patient responded previously with immediate reactions to penicillin which went unheeded as a warning of anaphylaxis. 4.4. A direct scratch test with aqueous crystalline penicillin was positive in one case, whereas similar tests were negative with aqueous procaine penicillin and 2 per cent procaine. Passive transfer tests were negative. 5.5. Detailed precautions are suggested toward the prevention of penicillin anaphylaxis, particularly for asthmatic and penicillin-allergic persons. The avoidance of the indiscriminate use of penicillin, particularly by injection, is emphasized. The value of a systematic inquiry as to previous penicillin treatment and reactions as well as of the general allergic status is stressed. Certain refinements in the method of penicillin injection are suggested. The technique and interpretation of preliminary penicillin skin tests are discussed.

Local allergic edema induced by injected procaine: Diagnostic value of the twenty-four-hour intracutaneous test

Abstract 1.1. Three cases of repeated edema at the site of procaine anesthesia for minor dental procedures are described. 2.2. Marked swelling of the cheek and face was noted several hours after injection and lasted for two to fourteen days. There was no evidence of general reaction or urticaria. 3.3. A positive twenty-four-hour skin test reaction of erythema and edema was induced by the intracutaneous injection of procaine and by injection of Monocaine as well. Immediate skin tests were negative. 4.4. Skin tests with Xylocaine were negative. This anesthetic proved a safe substitute for procaine. 5.5. A positive twenty-four-hour skin test reaction to crystalline penicillin G was also present in two cases. Two other patients with clinical allergy to penicillin also proved skin test-positive to procaine. A possible etiological relationship of procaine penicillin treatment to this form of procaine allergy is discussed.

Latent atopy and the incidence of the atopic state

Abstract 1.1. Two hundred twenty-seven persons admitted to the surgical wards of a general hospital for conditions not known to have any relation to atopy were tested intracutaneously with pollen and dander extracts, and interrogated as to the occurrence of clinical manifestations of atopy. 2.2. The latent, or subclinical, phase of atopy as indicated by reactions to intracutaneous testing in the absence of past or present allergic symptoms, was observed in 15 subjects, or 6.6 per cent. Atopy in its clinically manifest phase was found in 32 subjects, or 14.1 per cent, making a total incidence of 47 or 20.7 per cent. 3.3. Accordingly from this study it would appear that the total incidence of atopy in the general population is about 20 per cent, two-thirds being in the clinical phase and one-third in the latent phase. 4.4. Five subjects with latent atopy were tested by the passive transfer method. In only one case was this positive, in four others negative. It is suggested that in the latent phase of atopy circulating reagins may not usually be present in sufficient titer to permit a positive passive transfer reaction despite the presence of repeated strong reactions on direct skin testing.

Atopy and diabetes mellitus

Abstract Among 40 diabetic patients, whose insulin requirement was from 50 to 110 units a day, 8 individuals were found to have either clinically manifest or latent atopy, an incidence of 20 per cent. There were 6 patients with the clinical phase of atopy and 2 with the latent phase of atopy. An almost identical incidence of atopy, 20.7 per cent, was found in parallel observations in a nondiabetic control group of 227 patients, 47 of whom had clinical or latent atopy. These observations would indicate that there exists no special relationship between the two hereditary states of atopy and diabetes mellitus. Patients with severe diabetes have not been shown to have any unusual predisposition to atopy. It appears unlikely that diabetes of the severer type is based on any immunologic mechanism such as seems to occur in rare instances of insulin resistance and allergy.