[Subsepsis allergica Wissler (author's transl)].
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Biomedical subjects
Publications and source records attributed to U F Haustein.
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Report on 3 patients with lupus-erythematosus-like syndromes, in which antinuclear antibodies in high titres and peripheral (or homogeneous) pattern--the characteristic leading immunologic phenomenon of SLE--could not be observed. The second patient suffered from the so-called pseudo-LE-syndrome described by Maas and Schubothe and characterized by antimitochondrial antibodies in high titres. The disease of the 3rd patient was explained as drug-induced LE-syndrome by Ovosiston. The variety of the antigens and antibodies directed against them, the improved diagnostics as well as the increased consumption of drugs were taken as reasons for the growing frequency of such LE-like syndromes. The coexistences, overlappings and transitional forms among the special autoimmune diseases render the diagnostics more difficult and explain the great variety of pictures of the SLE.
1. The patch test as an in vivo test has disadvantages. It is our impression that biologically false reactions occur in approximately 5%. 2. The MIT as an in vitro test is very time consuming, but safe for the patient. It is supposed to give up to 20% false reactions. 3. In 76 and 72% of 156 guinea pigs sensitized with potassium bichromate and sulfasol respectively, both the test methods gave results in agreement. 4. Sensitization by potassium bichromate estimated by patch test only was 30%, and by MIT only also 30%, but the two test methods disagreed in 24%. 5. Sensitization by sulfasol evaluated in the patch test only was 36%, and in the MIT only 48% but the two test methods disagreed in 28%. 6. The differences between the results of the two test methods are not satistically significant and their failure rate does not provide absolutely sure results, but we believe that the patch test is preferrable in recognition of contact allergy because it is in vivo and probably has a lower failure rate in comparison with the MIT in the human.
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Thin sections of pathologically changed skin lesions of patients suffering from purpura pigmentosa progressiva, a disorder which seems to be mediated by delayed type of allergy, were electron microscopically investigated. In 5 of the 7 cases we found cell infiltrates of the dermis consisting of many lymphocytes frequently in apposition to macrophages (histiocytes). The cell interactions observed occurred either by microvilli-like cytoplasmic protuberances or by local areas of the plasma membrane apposition. No submicroscopical alterations of the cytoplasm were found in the interacting cells although numerous macrophages show abundant microfilaments. The findings observed are interpreted as the ultrastructural substrate of cell cooperation for presenting and transfering antigens from macrophages to T lymphocytes. However, the question concerning the mechanism of the transfer remains open.
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Electron microscopic investigations were carried out on cutaneous lesions of different morphological appearances in 8 cases of vasculitis allergica Ruiter. The endothelial damages observed (defoliating, vacuolisation, forming of microvilli and bizarre membrane structures within the lumen, interruption of the endothelial continuity) put the question for participating of a Shwartzman phenomenon. The multilayered formation of the basement membrane or their homogeneous spreading may be a sequence of damage and a compensation phenomenon. It is quite possible that filamentous structures, being within the basal cytoplasm of the endothelial cells, represent immune-complexes. During the necrobiotic phase, the perivascular infiltrates partly consists of leucocytes, fibrin, and debris, and during the later phagocytotic phase, the infiltrates partly consists of lymphocytes and histiocytes (macrophages). The findings are explained as morphological substratum of the Arthus-reaction.
It is reported on 3 patients of medical profession who suffered from anaphylactic complications after the patch test with penicilline G, aminophenazone and promethazinhydrochloride. The triggering of the IgE mediated allergy is explained by the quick and complete epidermal penetration of the haptens because their low molecular weight and optimal solubility. It could be proved by the positive mast cell degranulation test, whereas the IgE level was elevated in serum only in one case, but in tissue in no case. Prophylactically, if the careful exploration is positive, the open patch test is indicated. It should carried out in the clinic or ambulance with consecutive observation of the patients for 60 min and with the possibility of the treatment of shock.
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