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The clinical picture of anaphylactic ophthalmia with observations on the pathogenesis of parenchymal keratitis
200
THE
JOURNAL
OF
ALLERGY
tory studies. In an allergic condition, any portion of the respiratory tract may present a mucous membrane lining in which the lymphoid tissue is hyperplastic, the mucous glands hypersecreting, and the tissue as a whole edematous. Proteins capable of producing such a conSpecific treatment is based upon dition are discussed at some length. the supposition that any particular protein that has given a positive skin reaction is etiologically important. In the case of pollen sensitivity, preseasonal treatment is advised, beginning about fourteen weeks prior to the expected period of onset. In the majorit,y of cases of food sensitization, satisfactory results can be obtained by the elimination of the offending food protein from the diet. Individuals sensitive to the epidermals; i.e., fine epithelial scales from horse, dog, cat, chicken, goose, etc., may often be treated by avoidance of contact. When this is not possible, treatment similar to that for pollen sensitization, is indicated. When other methods of determining the etiology have failed and the case appears to be one of the bacterial type, results may be obtained by the use of st,ock or aut,ogenous vaccines, Considerable discussion is given to the consideration of operative measures. The belief is expressed that, most sinus conditions in the allergic individual are merely coincidental or secondary to the existing allergic condition. Surgery, however, is advised whenever drainage or proper ventilation is interfered with. Polppi, if present, should be removed, and broadly speaking, all foci of infection should be eradicated for the general good of the patient. The otorhinolaryngolopist,, however, should realize that the removal of the sequelar will not affect the course of the allergic disease, and he should give symptomatic relief with the full realization that the underlying cause is not thus being influenced.
The Clinical Pioture of Anaphyiactic Ophthalmia with Observations on the Patbogenesis of Parenchymal Keratitis. Lijwenstein, A.: Klin.
Monatsbl.
f. Augenh.
83: 64, 1929.
In 1917, in a series of severe cases of trachoma, the author noticed acute inflammations of the cornea, which could not be brought into These observations led line with any of the known forms of keratitis. him to the definition of an anaphylactic keratitis in man. It was characterized by an acute dark red coloration of the eyeball and a smoky gray thickening of the parenchyma, hypotonia, severe pain, quick diminution of inflammation, and a residue of numerous speckled flakes in the clear portion of the cornea. This clinical picture he could not In support of a diagnosis of anaphylactrace to any known infection. tic keratitis, the following theory was offered : Subepithelial infiltration of the bulbus conjunctiva tunica and cieatrization in the pericorneal region lead to nutritional disturbances in The nutritional disturbance in the the parenchyma of the cornea.
SELECTED
201
ABSTRACTS
sphere of the marginal network leads on the one hand to the picture of compensation vessels in the superficial vessels of the conjunctiva, in the form of the pannus. On the other hand, there is an antigenie resorption of the tissue of the cornea, t.he basis of the anaphylactic reaction. Renewed resorption from the one or the other eye then gives rise to the anaphylactic inflammation. Three case reports are given in detail which deal with diagnosis, treatment, and prevention. Comment is made upon the anaphylactic stage of tuberculous iritis, as noted by Schieck and upon the reaction of the cornea which has been known to accompany an anaphylactic reaction to horse serum. It is suggested that anaphylactic symptoms occur in the eye more often than is commonly suspected.
Allergic Dermatoses and Their Treatment.
,Jessner, E.:
Therap. d.
Gegenw. 70: 163, 1929. The author lists those dermatoses which in his opinion may be considered as anaphylactic in nature: pruritus simplex, urticaria, prurigo, Quincke’s edema, Henoch’s purpura, eczema, and other atypical dermatoses. Of one of these, the eczema which Rost has described and brought into relationship with asthma, he writes in some detail. Before considering the questions of diagnosis and treatment, he enters into a lengthy discussion of the relationship between allergy and anaphylaxis. Diagnostic measures, such as skin tests, are dealt with in detail. Whenever it is possible to treat the allergic dermatoses by the elimination of the offending agent, such treatment is advised. In cases where this is not possible, desensitization must be attempted.
A Practical Application of the Method of Desensitization by Repeated Skin Reactions, Urticarial Reaction to Insulin. Jeannert, R. : Rev. med. de la Suisse Rom. 49: 99, 1929. The author reports a case of severe urticaria following insulin treatment. Skin tests gave positive reactions to insulin. Control patients gave negative reactions. The possibility was considered that the pa; tient might be sensitive to the particular animal component of that particular insulin product (Sandoz). Samples of insulin prepared from different kinds of animals-cow, horse, hog, sheep, etc.-were obtained and a skin test with Walker’s technic was done with each type, The statement is made that all the reactions were positive and of about an equal intensity. The accompanying table, however, shows a range from a wheal 17 mm. in diameter (Roussep’s insulin made from the pancreas of horse) to one of less than 4 mm. (Allen and Handbury’s made from beef pancreas). As insulin treatment was necessary to the health of the patient, desensitization was undertaken by means of repeated sl$n tests. These were performed at two or three day intervals. The first fifteen reactions were clearly positive,
THE
JOURNAL
OF
ALLERGY
tory studies. In an allergic condition, any portion of the respiratory tract may present a mucous membrane lining in which the lymphoid tissue is hyperplastic, the mucous glands hypersecreting, and the tissue as a whole edematous. Proteins capable of producing such a conSpecific treatment is based upon dition are discussed at some length. the supposition that any particular protein that has given a positive skin reaction is etiologically important. In the case of pollen sensitivity, preseasonal treatment is advised, beginning about fourteen weeks prior to the expected period of onset. In the majorit,y of cases of food sensitization, satisfactory results can be obtained by the elimination of the offending food protein from the diet. Individuals sensitive to the epidermals; i.e., fine epithelial scales from horse, dog, cat, chicken, goose, etc., may often be treated by avoidance of contact. When this is not possible, treatment similar to that for pollen sensitization, is indicated. When other methods of determining the etiology have failed and the case appears to be one of the bacterial type, results may be obtained by the use of st,ock or aut,ogenous vaccines, Considerable discussion is given to the consideration of operative measures. The belief is expressed that, most sinus conditions in the allergic individual are merely coincidental or secondary to the existing allergic condition. Surgery, however, is advised whenever drainage or proper ventilation is interfered with. Polppi, if present, should be removed, and broadly speaking, all foci of infection should be eradicated for the general good of the patient. The otorhinolaryngolopist,, however, should realize that the removal of the sequelar will not affect the course of the allergic disease, and he should give symptomatic relief with the full realization that the underlying cause is not thus being influenced.
The Clinical Pioture of Anaphyiactic Ophthalmia with Observations on the Patbogenesis of Parenchymal Keratitis. Lijwenstein, A.: Klin.
Monatsbl.
f. Augenh.
83: 64, 1929.
In 1917, in a series of severe cases of trachoma, the author noticed acute inflammations of the cornea, which could not be brought into These observations led line with any of the known forms of keratitis. him to the definition of an anaphylactic keratitis in man. It was characterized by an acute dark red coloration of the eyeball and a smoky gray thickening of the parenchyma, hypotonia, severe pain, quick diminution of inflammation, and a residue of numerous speckled flakes in the clear portion of the cornea. This clinical picture he could not In support of a diagnosis of anaphylactrace to any known infection. tic keratitis, the following theory was offered : Subepithelial infiltration of the bulbus conjunctiva tunica and cieatrization in the pericorneal region lead to nutritional disturbances in The nutritional disturbance in the the parenchyma of the cornea.
SELECTED
201
ABSTRACTS
sphere of the marginal network leads on the one hand to the picture of compensation vessels in the superficial vessels of the conjunctiva, in the form of the pannus. On the other hand, there is an antigenie resorption of the tissue of the cornea, t.he basis of the anaphylactic reaction. Renewed resorption from the one or the other eye then gives rise to the anaphylactic inflammation. Three case reports are given in detail which deal with diagnosis, treatment, and prevention. Comment is made upon the anaphylactic stage of tuberculous iritis, as noted by Schieck and upon the reaction of the cornea which has been known to accompany an anaphylactic reaction to horse serum. It is suggested that anaphylactic symptoms occur in the eye more often than is commonly suspected.
Allergic Dermatoses and Their Treatment.
,Jessner, E.:
Therap. d.
Gegenw. 70: 163, 1929. The author lists those dermatoses which in his opinion may be considered as anaphylactic in nature: pruritus simplex, urticaria, prurigo, Quincke’s edema, Henoch’s purpura, eczema, and other atypical dermatoses. Of one of these, the eczema which Rost has described and brought into relationship with asthma, he writes in some detail. Before considering the questions of diagnosis and treatment, he enters into a lengthy discussion of the relationship between allergy and anaphylaxis. Diagnostic measures, such as skin tests, are dealt with in detail. Whenever it is possible to treat the allergic dermatoses by the elimination of the offending agent, such treatment is advised. In cases where this is not possible, desensitization must be attempted.
A Practical Application of the Method of Desensitization by Repeated Skin Reactions, Urticarial Reaction to Insulin. Jeannert, R. : Rev. med. de la Suisse Rom. 49: 99, 1929. The author reports a case of severe urticaria following insulin treatment. Skin tests gave positive reactions to insulin. Control patients gave negative reactions. The possibility was considered that the pa; tient might be sensitive to the particular animal component of that particular insulin product (Sandoz). Samples of insulin prepared from different kinds of animals-cow, horse, hog, sheep, etc.-were obtained and a skin test with Walker’s technic was done with each type, The statement is made that all the reactions were positive and of about an equal intensity. The accompanying table, however, shows a range from a wheal 17 mm. in diameter (Roussep’s insulin made from the pancreas of horse) to one of less than 4 mm. (Allen and Handbury’s made from beef pancreas). As insulin treatment was necessary to the health of the patient, desensitization was undertaken by means of repeated sl$n tests. These were performed at two or three day intervals. The first fifteen reactions were clearly positive,