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The relation of various pathological states in man to sensitization to foreign proteins, with special reference to diseases of the skin

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CoullieAG_1921redux.pdf (18.96Mb)
Date
1921
Author
Coullie, Alexander Glover
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Abstract
 
 
Throughout the ages it has been recognised that certain individuals have an idiosyncrasy for particular articles of food such as eggs, shell-fish, or strawberries, and that the ingestion of them would unfailingly be followed by various toxic manifestations, such as gastro-intestinal disturbance or urticaria. This observation has been crystallised in the well - known Scots proverb that "Ae man's meat is anither mans s poison".
 
In more recent times John Hunter described "the flushing and erysipelatous inflammation of the skin" that occurred in some individuals after eating strawberries. In 1539 Magendie observed that eggs were toxic to certain- people. Jenner also noticed an individual idiosyncrasy to certain common articles of food. Modern text -books on Medicine and Dermatology give long lists of articles of food which have at various times been found to be responsible for toxic manifestations in certain individuals, and the success achieved in particular cases by the elimination of certain articles from the dietary has no doubt been responsible for the vogue that certain systems of diet have enjoyed from time to time. The phenomenon has usually been ascribed to an idiosyncrasy or idiopathy, and it is only since the beginning of the present century that any attempt has been made to explain the underlying mechanism or to find a cure for the condition.
 
A parallel is found in the case of Hay Fever which had long been a puzzle to physicians. It's seasonal recurrence was first recognised by Bostock in 1819, but it was not till 1873 that Blackley of Manchester wrote the first good account of the affection, and submitted evidence that it was caused by the pollen of certain grasses, and especially the Rye grass. Following on this, Marsh of New York proved the "Fall Fever" of America to be due to the pollen of Ragweed and in 1885 Morell Mackenzie asserted that Hay Fever was not associated with any morbid condition of the nose and was entirely due to an idiosyncrasy to pollens.
 
After the birth of Serology in the last decade of the 19th Century, Dunbar of Hamburg, using a watery extract of various grass pollens, was able in 1903 to prove that they contained a toxin, against which a specific antitoxin was developed in the blood of the injected animal. He also demonstrated the presence of 'a specific precipitin and the deviation of complement in the serum of sufferers during the Hay Fever season.
 
In 1911 Noon's and Freeman published papers on the immunization of Hay Fever patients with injections of grass pollen extracts.
 
In 1894 Behring and Kitasato introduced as a therapeutic measure the passive immunisation of Diphtheria sufferers with the antitoxic serum of the immunised horse and the medical profession became familiar with the phenomena of Serum Sickness. When in 1902 Chas. Richet observed the phenomenon of Anaphylaxis, there was a tremendous development of interest in the effects of introducing foreign protei into the living organism, and Von Pirquet and Schick recognized in Serum Sickness the occurrence of Anaphylaxis in the human subject. In 1906 Langlois suggested an anaphylactic origin for Hay Fever, and in 1907 Wolff Eisner pointed to the analogy between Urticaria, Hay Fever, and Serum Disease, and was the first to suggest that Urticaria could be explained on the ground of hypersensitiveness to foreign protein.
 
In 1909 Auer and Lewis of the Rockefeller Institute, and in 1910 Theobald Smith, showed that the lung of an anaphylactic guinea-pig has all the characteristic appearances of a case of Bronchial Asthma, and Meltzer wrote on Asthma as a phenomenon of anaphylaxis. In 1910 Fordyce at the Annual Meeting of the American Dermatological Association suggested that Eczema might be anaphylactic in origin and at the next annual meeting of the same association he extended the suggestion to the case of the Erythemata remarking that though there was "probably a plurality of causative agents underlying the toxic dermatoses, there was no more plausible explanation of their modus operandi than that advanced by the theory of Anaphylaxis ". The same theory of anaphylaxis has been brought in to explain the incubation period, eruptions, and other clinical phenomena of the exanthemata, and year by year, diseases such as Epilepsy and Migraine have been taken out of the class of idiopathies or Functional Neuroses and ascribed to the same mechanism that underlies anaphylaxis. The whole subject is still obscure and involved in the dust of controversy, but a large body of responsible opinion finds expression in the words of Dr John Thomson who writes that "There can be no doubt whatever that anaphylaxis is destined in the near future to play an essential part in the explanation of several morbid phenomena, which we have not hitherto been able to understand ".
 
URI
http://hdl.handle.net/1842/30971
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