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The case finding program of the Cuyahoga County Health Department for tuberculosis control includes the routine tuberculin testing of the children in the first, seventh and tenth grades of the schools under the jurisdiction of the department. The method of testing employed prior to the year 1939 was the Mantoux intradermal test of the first and second strength purified protein derivative. The Mantoux test, while very reliable, proved to have many disadvantages. This year the commissioner of health decided to substitute the tuberculin patch test as devised by Vollmer. We felt that an opportunity was presented to us to make a thorough comparison of the Mantoux and patch tests and to determine the reliability of the latter as compared to the Mantoux. So with the cooperation of the school boards and the Anti-Tuberculosis League of Cuyahoga County, who furnished the material, we prepared to do both the Mantoux and the

Iodopyracet injection, or "diodrast" N. N. R. (the diethanolamine salt of 3,5-diiodo-4-pyridone- N -acetic acid), is probably the drug most widely used as a contrast agent for intravenous urography. It is dispensed in 10, 20 and 30 cc. ampules of a 35 per cent concentration ("diodrast sterile solution"). The iodine content of "diodrast" is approximately 49 per cent. The other drugs used for visualization of the urinary tract, namely "iopax," "neo-iopax" N. N. R., "skiodan" N. N. R., "hippuran" N. N. R. and "diodrast compound solution" N. N. R., although they have different chemical construction, all contain iodine. 1 Sensitivity reactions are probably, although not necessarily, dependent on the iodine in the compound. It has been suggested that perhaps the person is sensitive not to the iodine but to a new substance produced by the body when the contrast medium is given. Reactions are not dependent on the amount of

Penicilloyl-polylysine was used in an intradermal skin test for the detection of penicillin hypersensitivity in 16,239 patients. In 1,003 patients with history of penicillin sensitivity, 396 had a positive skin test compared to a positive test in 775 of 12,559 patients with a negative history. Penicillin was administered to 13,530 patients with a negative skin test, of whom 63 had a reaction. Of 212 patients with a moderately positive and 206 with a strongly positive skin test who were given penicillin, 9 and 21 respectively experienced reactions. No anaphylaxis or life-threatening reactions occurred in patients with negative skin tests, although on the basis of previous experience this number of cases should have produced four reactions severe enough to require hospitalization.

TRICHINOSIS has been studied for more than 100 years and has caused many epidemics throughout this country. Despite this fact, there is a paucity of data regarding the incidence of this infection in American children. Strobel,1in 1911, introduced the first immunologic test for the diagnosis of trichinosis. This method was not widely used until 1928, when Bachmann * improved the antigen and described a precipitin test as well as an intradermal reaction in rabbits and guinea pigs infected with Trichinella. Between 1932 and 1941, other workers † studied the Bachman intradermal test and made various modifications. They concluded that patients with trichinosis gave an immediate positive skin reaction 11 to 43 days after infection in 74 to 98% of cases. Sawitz,8 in 1937, skin tested 200 patients using Trichinella antigen and found 5% had positive reactions. None of these persons gave a clinical history of trichinosis. Rose and Culbertson

In previous communications 1 evidence has been produced to show: (1) that in cases of idiopathic Meniere's syndrome one of two vascular mechanisms is at work, a primary vasodilator and a primary vasoconstrictor mechanism, either of which can produce the characteristic picture; (2) that these two groups can be differentiated by means of an intradermal test with histamine; (3) that the treatment appropriate to one group is inappropriate and in fact deleterious in the other; (4) that therefore accurate grouping is a prime requisite for effective therapy. Further experience has only served to confirm these conclusions. The satisfactory results obtained by desensitization to histamine in the primary vasodilator group have already been published. 1b It is gratifying to be able to report that similar results continue to be obtained and that the improvement in the original cases is maintained. This paper is concerned with the method and the results of treatment in

The serum level of immunoglobulin E (IgE) was found to be significantly greater than normal in a group of 23 out of 28 patients with atopic dermatitis. Each member of this group also showed several positive reactions to intradermal tests with 36 common antigens. The three atopic patients with the lowest IgE levels gave negative or, in one case, a single weak intradermal test. There was no correlation between the IgE level and the severity of clinical symptoms or a history of asthma or hay fever. IgE values were generally normal in a group of 34 patients with acute or chronic urticaria and in a larger group of patients with nonatopic dermatitis and various dermatological conditions.

My purpose in this paper is to compare the results secured by intradermal tests with those secured by intramucosal tests. MATERIAL AND METHOD OF STUDY Sixty-five cases in which the condition was diagnosed as allergic rhinitis were studied. The patients were not selected. In half of the cases there were complications, such as asthma, headache, suppuration of the nasal sinuses or deflected septums. The cutaneous tests were made by Miss Zelma Alvis. Every effort was made to get accurate and reliable results. The technic for the intramucosal tests was the same as that previously reported, 1 except that the use of a 1 per cent solution of cocaine in the nose was discontinued; further, more than one set of tests per day were made provided the allergen used in the first test did not react within forty-five minutes. Approximately 95 per cent of the positive reactions to the intramucosal

In 1913 Ito, working with Carl Bruck at Neisser's clinic, devised a specific intradermal test for chancroid —Ducrey bacillus infection. The diagnostic value of this test was later confirmed by Reenstierna, working with a serum containing antibodies of the Ducrey bacillus. Today this test is spoken of as the Ito-Reenstierna reaction. Ito, for his cultures, used 24 hours old streptobacillus colonies from two Besancon blood agar tubes. The bacilli are suspended in physiologic solution of sodium chloride with the addition of 0.5 per cent phenol and heated at 60 C. for two hours. Reenstierna employed unheated material in the presence of phenol for fourteen days in the icebox. Frei1in his survey of the entire subject up to 1927 says that he employed the water of condensation. He also states that it makes little difference what method of preparation is employed. The antigen is employed as an intradermal test

Three years ago I published the results of the patch test in eight cases of postarsphenamine dermatitis. The conclusion of that study was that a positive patch test was an absolute contraindication to further arsphenamine therapy, but that a negative patch test permitted further administration of the arsphenamines. A resume of the literature accompanied the communication. 1 At that time it was thought that the patch test probably was the best method of determining cutaneous sensitization to the arsphenamines. The scratch test was thought to be unreliable, and the intradermal test was regarded as a procedure which might produce sensitivity to the drug. Moore, Woo, Robinson and Gay 2 studied the intradermal test in different types of patients. Their results showed positive reactions in 60 per cent of normal persons, in 70 per cent of patients who had had arsphenamine dermatitis and in 94 per cent of patients with hay

Sir .—We read with great interest the article by Ownby and Bailey. 1 While we agree with the authors that there is no reason for including in vitro tests for allergen-specific IgE in the current diagnosis of reaginic-mediated inhalant allergy in children, we disagree with the interpretation of the results concerning the skin tests that led them to conclude that the intradermal technique is more sensitive than prick tests and the in vitro radioallergosorbent (RAST) and multiple allergosorbent (MAST) tests. In our experience all patients with negative prick tests and negative RAST reactions and positive intradermal test reactions show a negative challenge (conjunctival and/or nasal and/or bronchial provocation challenge with the suspected inhalant allergens). We therefore believe that these positive intradermal skin tests are false-positive reactions (low specificity of the test) and that the negative reaction of the prick test and the positive RAST or MAST reaction in some patients

† Patients suffering from contact dermatitis caused by chromium sensitivity showed positive reactions to intradermal tests with chromium and cobalt chlorides. Patch tests to cobalt in unaffected and in healed eczematous skin areas gave negative results. A large number of chromiumsensitive patients also showed a positive intradermal test reaction to cobalt bound to human serum albumin and a negative reaction to cobalt bound to rabbit liver glycogen. It has been suggested that these positive reactions to cobalt are secondary sensitivities to cobalt, caused by cobalt-denaturated human serum albumin that is so similar to the denaturated product of chromium cations that the competent cells cannot distinguish between them. ( Arch Dermatol 112:37-39, 1976)

Nickel sulphate and formaldehyde in dilutions nonirritant to the adult person, give a high percentage of primary irritant reactions in children. The intradermal test is negative. The percentage of reactions declines with increasing age, disappearing in the seventh-eighth year. The reactions are follicular and/ or eczematous and are often accepted as positive allergic reactions. They may be repeated at brief intervals but not at longer intervals. Reactions to nickel sulphate and formaldehyde show several numerical differences, possibly due to the different chemical properties of the test substances. The findings indicate an epithelial barrier factor varying in the age group 0-8 years. A related phenomenon is known from the results of tuberculin testing. Patch tests on children require dilutions of allergens weaker than those used for adults, e.g., nickel sulphate 1%, formaldehyde less than 1%.

To the Editor:— InThe Journal(Oct. 29, 1960, p. 1200) the author writing concerning fatal anaphylactic shock following an intradermal skin test with horse serum tetanus antitoxin stated that a "skin test dose of 0.1 cc. horse serum tetanus antitoxin in 1:10 dilution with isotonic sodium chloride solution was given intradermally." Later he states that "the intradermal test should be given initially with a dilution no stronger than 1:100." It should be pointed out also that the proper skin test dose is approximately 0:01 cc. when testing for the immediate type of allergy, which is the purpose of the horse serum test. Larger doses are not necessary and increase the hazard of the skin test. The volume necessary for this type of skin test is distinctly smaller than that commonly used for a delayed type of antibody, such as the one involved in the commonly used tuberculin-type skin test.

The patch method of testing for specific hypersensitiveness to tuberculin has been in use since 1908. 1 With the introduction of the Vollmer patch test, in 1937, 2 there has been new interest in this technic. In the last few years many comparative studies of the patch test and intradermal (Mantoux) technics have been made. Reports vary considerably as to the relative efficiency of the two methods in detecting reactors. Some observers 3 have found almost complete correlation between the results obtained with the Vollmer patch test 4 and the Mantoux test with purified protein derivative 5 and with old tuberculin Koch. 6 Others have reported some disparities in the results obtained, having found the Vollmer patch test or patch tests with undiluted old tuberculin antigen either slightly more or slightly less sensitive than the intradermal test with various dilutions of purified protein derivative and

The importance of any facts bearing on meningococcus carriers makes advisable a brief report on our present limited series of observations with an intradermal test in meningococcus carriers, in order that they may be extended by others who are dealing with this problem. It would probably be impossible to make any conclusive statement at present as to the degree of systemic reaction of healthy individuals who harbor the meningococcus in their throats to this micro-organism. On the degree of this reaction would depend, of course, their resistance to further invasion of the coccus; and concerning this resistance we have conflicting testimony. Temporary carriers may, subsequent to the bacteriologic detection of the meningococcus in their throat, fall ill of meningitis; on the other hand, the majority of detected carriers certainly are themselves unaffected in any serious manner by the parasite they harbor. There is, indeed, certain evidence from the occurrence of

G. F. and G. H. Dick 1 recently reported the results obtained by them from the use of a specific streptococcus filtrate in an intradermal test for immunity against scarlet fever. Our purpose in this paper is to present the data accumulated in our series of cases using the same streptococcus filtrate. Through the courtesy of the Dicks, a small quantity of their original W filtrate, diluted 1:1,000, was obtained and used in our experiments. The filtrate, as we understand it, is from a hemolytic streptococcus isolated in pure culture from a case of scarlet fever. Our experiments, with those of the Dicks, give a series of only 301 cases; but the results are so strikingly similar, yet done under such varied circumstances, that one series checks the other very well. In making these tests and in reading them, we observed the technic and standards adopted by the Dicks. The

Our object in this study was to ascertain, if possible, the value of the intradermal test as an aid in the diagnosis of undulant fever as it occurs in this locality. Since the pioneer studies of Fleischner and Meyer 1 in 1918 and Burnet 2 in 1922, a number of workers have studied this reaction, some using bacterial extracts or filtrates similar to Burnet's "melitin," others using killed bacterial suspensions, the two groups agreeing as to a high percentage of positive results in definite infection but disagreeing somewhat concerning so-called false positives. Leavell and Amoss 3 give a very good analysis of this work and state that "the specificity of the tests has been the subject of the greatest contention. The consensus seems to be that the bacterial suspension gives fewer false positive reactions than the filtrate. In fact, only a few false positive reactions with the suspension have been

In a previous communication, 1 it was pointed out that the percutaneous or patch test showed greater promise than either the intradermal or the scratch method in testing patients for hypersensitiveness to the arsphenamines. A review of the literature at that time showed that the intradermal test was not without danger. The skin of both man and animals has been sensitized to the arsphenamines by intradermal injection of the drug. Sensitization of normal skin does not occur with the patch test. This paper includes a report of eight cases of arsphenamine dermatitis in which the patch test was successfully used as a guide to further treatment with the arsphenamines. All eight patients gave evidence of cutaneous intolerance to the arsphenamines, manifested by arsphenamine dermatitis. Several papers have appeared in the American literature on this subject recently. Chargin, Sulzberger and Crowley 2 reported positive reactions with the patch test in patients

A recent report 1 on the use of antuitrin-S 2 intradermally as a test for pregnancy and certain gynecologic conditions aroused our curiosity, since the results reported were at variance with the observations of one of us (A. E. C.) in allergic individuals. The great number of names given to various glandular products, similar in many respects, has caused much confusion. Some authors have been careless in giving details regarding the product employed and have failed to give information on its source. We have attempted to clarify this situation as far as this intradermal test is concerned. Mazer and Goldstein 3 mention a skin test for pregnancy as follows: "Porges and Pollaczek, 4 working on the hypothesis that pregnant women whose blood is surcharged with the anterior pituitary sex hormone are desensitized to its effects, and that nonpregnant women are correspondingly sensitive to subcutaneous injections of the hormone, attempted to employ this difference in

The purposes of this paper are (a) to describe briefly the performance and interpretation of the laboratory methods which at present are believed to be most useful in the diagnosis of undulant fever (brucellosis) and (b) to report some of the results of a survey of the incidence of brucellosis in a large county hospital. LABORATORY METHODS The laboratory methods which are regarded as most useful are (1) the brucellergin intradermal test, (2) the opsonic (opsonocytophagic) test (3) the rapid agglutination test and (4) culture (isolation) of Brucella.1 The brucellergintest is performed by injecting 0.1 cc. of a suspensoid of nucleoprotein (1:2,000) isolated from Brucella cells intradermally on the forearm and is read after forty-eight hours (fig. 1). The brucella opsonic test is performed by incubating a mixture of a live forty-eight hour culture of Brucella abortus and the patient's citrated blood in a water bath at

Since diphtheria antitoxin came into general use in 1894, serum therapy and prophylaxis for this and many other bacterial diseases have been employed widely. Following this type of treatment, serum reactions of greater or less severity have been frequent. In many clinics today the intradermal test for sensitivity to horse serum is employed before serum is administered. The test, however, has never been completely satisfactory because of the inconstancy of the relationship of serum reaction to sensitivity, as determined by this method. There is a definite need for a simple test which will give a more reliable index of the degree of susceptibility of an individual to serum. In 1928, Spicer 1 reported a series of 353 patients in whom the intradermal and ophthalmic tests for sensitivity to horse serum were contrasted. The results obtained by her suggested that the ophthalmic test is of considerably more value than the intradermal.

About a year ago Sherrick 1 reported that "a positive pustular or nodular luetin reaction can be obtained in 99 per cent. of all persons irrespective of the presence of syphilis, by the administration of potassium iodid, either simultaneously, or shortly before or after the intradermal test. Other substances, such as agar and starch, when injected intradermally, will give a similar reaction when potassium iodid is administered," and other drugs containing iodin were found to have a similar effect. These observations were considered of such importance, not only in connection with the luetin test, but also in relation to anaphylactic phenomena in general and skin reactions in particular, that we have been studying the effect of iodids, bromids, chlorids, ether, chloroform and other drugs on the luetin, tuberculin and other skin reactions. The results with the iodids have proved definite and confirmed Sherrick's observation in practically every particular; since this

To the Editor: —The article "Diagnostic Criteria for Human Brucellosis" inThe Journal, June 28, 1952, page 805, a report of the Committee on Public Health Aspects of Brucellosis, National Research Council, includes various undocumented statements concerning diagnosis and one concerning treatment that require refutation. As a member of the Expert Panel on Brucellosis of the World Health Organization and Food and Agricultural Organization of the United Nations, I would like to point out that these statements are in conflict with the recommendations made by the panel (WHO Technical Report Series no. 37, Geneva, 1951). Among the statements in question are: (1) that the complement fixation reaction "is not recommended for routine use," (2) that the opsonocytophagic reaction "is not recommended for use," (3) that the intradermal test "should be abandoned," and (4) that the members of the committee "do not subscribe to the treatment of brucellosis with Brucella antigens."

To the Editor :—The following inquiries have been received pertaining to my paper, entitled, "Specific Treatment of Ophthalmic Tuberculosis with a New Tuberculosis Antigen `A O,' " in the August issue of theArchives, page 161. As ophthalmologists in general may be interested in them, I am sending the answers for publication: Where is A O to be obtained? It can be obtained at Arimakenkiujo Ebie Nishinariku, Osaka, Japan. When you are using a single optimal dose, do you always give it at four day intervals, and for how long a period? For fifteen years I have been using only the optimal dose, but during the past year I have used A O, no. 1, 1 cc. for the optimal dose, for adults, every eight days. What method have you found the best for diagnosis, the subcutaneous reaction to tuberculin or the Mantoux intradermal test? Patients are

The history of lymphogranuloma inguinale, for which name Durand, Nicolas and Favre1are responsible, dates back at least to 1859, when the French surgeon Chassaignac2described this disease entity. According to Hellerstrom,3the description of some buboes given by Greek, Roman and Arabian physicians coincides with the clinical picture of lymphogranuloma inguinale. There is an interesting and extensive literature on this subject, particularly since the introduction of the intradermal test by Frei4in 1925, known since then as the Frei test. Of the many papers written on this subject I wish to mention the thesis by Phylactos5in 1922, the monographs by Fischl6in 1927 and that by Hellerstrom3in 1929; of papers written in this country, one by Pardo-Castello7and a comparatively recent one by DeWolf and Van Cleve.8 Lymphogranuloma inguinale is a venereal disease. The primary lesion is in

In 13 out of 50 patients with eczematous dermatitis with recurrence or aggravation every summer, eczematous reaction was elicited to crude extract ofAlternaria, Aspergillus, orPenicilliumon intradermal tests. Eczematous reaction was also elicited on patch tests in five of them. Subcutaneous injection or inhalation of crude extract provoked skin lesions. Such eczematous reaction to intradermal test was reproduced with acid-soluble, undialyzable fraction of crude extract, but not with acid-insoluble fraction or ether-soluble fraction. The skin lesions consisted of scattered or grouped, minute papulovesicles in various areas, most frequently in the forearms, dorsa of hands, and neck. Clinical findings differed from those of atopic dermatitis, and the incidence of atopic disease in the past and in family history was low.

Introduction Method and Technic Time and Number of Tests Observation after Tests Types of Reactions Immediate, Early and Delayed Reactions "Positive" Reactions Reactions to First and Later Tests Compared Tests in Patients With and Without Arsphenamine Therapy Intradermal Tests in Tolerant as Compared with Intolerant Patients Tests in Patients without Arsphenamine Therapy Intradermal Test as an Aid in Diagnosis and Prognosis of Complications from Arsphenamine Therapy The Test in Diagnosis: Specificity Reactions to Different Arsphenamines Differences in Reaction to Arsphenamines and to Other Arsenical Preparations Epidermal Reactions as Compared with Other Types The Test in Prognosis Syphilitic Patients not yet Treated with the Arsphenamines Syphilitic Patients Previously Tolerant of the Arsphenamines Sensitization and Desensitization The Test as a Sensitizer Reaction of Patients to Subsequent Intravenous Injections Reaction of Patients to Repeated Intradermal Tests Arsphenamine Dermatitis as a Phenomenon of Sensitization Dermatitis after Few Injections and Small Doses Polyvalent Sensitization Role

About ten years have passed since Mantoux and Moussu 1 in France, and Mendel 2 in Germany, first called attention to the value of the intradermal method of eliciting cutaneous hypersensitiveness, although in 1903 Mendel established the fact that, if in giving tuberculin intravenously a portion went into the tissues around the vein, a severe reaction took place in infected individuals. Antedating these observations by several years, however, Escherich described a local reaction following the subcutaneous injection of tuberculin, which he called "stich reaktion," and in 1905, von Pirquet 3 published his epoch making observations on cutaneous hypersensitiveness, to which he applied the term "allergy." Since these publications, it is, indeed, striking to note the paucity of investigators that have interested themselves in this fascinating problem. A fairly large number of men has drawn clinical deductions on the relative value of the intradermal test, as compared with the von Pirquet

• An allergic contact dermatitis from fluorouracil developed in two patients 8 and 18 days respectively after institution of topical fluorouracil therapy. The character of the usual irritant dermatitis changed to that of an allergic dermatitis. Epicutaneous patch tests and intradermal tests with fluorouracil were reactive. Histologic specimens of positive test sites revealed the changes expected in allergic contact dermatitis. Twelve control subjects failed to react to intradermal fluorouracil tests. ( Arch Dermatol 113:196-198, 1977)

A patient had a chronic hand eczema, presumably as a manifestation of atopy. Treatment resistance appeared due to handling certain foods that produced burning and stinging in the chronically eczematous skin and not in otherwise normal skin. Selected tests for delayed hypersensitivity and for immediate hyper sensitivity on intact skin of the back produced negative results, but on chronically inflamed skin of the arm and back, application of the pertinent foods produced a wheal and flare response. On intact skin, scratch tests with the foods produced positive results. Intradermal tests with commercial antigens were negative. Avoidance of these foods, as contactants, led to resolution of the dermatitis. Reappraisal of the role of immediate-type hypersensitivity in chronic hand eczema is important.

Atopic dermatitis is a genetically determined skin disease that is strongly influenced by environmental factors. The skin of affected patients is usually colonized by large numbers of Staphylococcus aureus bacteria. These bacteria may aggravate atopic dermatitis or prevent resolution of the disease. The deleterious effects of S aureus on atopic dermatitis may be due to direct biologic action or may be due to indirect damage mediated by the immune and inflammatory systems.

In Reply.—Drs Longo, Strinati, and Tedesco are concerned with the relative diagnostic sensitivity and specificity of prick vs intradermal skin tests. We would agree with them that the quality of the allergenic extract is critical to this question. This is the reason that we chose to use extracts from the same manufacturer in both in vitro tests and for skin testing since we felt that this would provide a more valid comparison of the methods without the compounding variable of different extracts. We also agree that with high-quality extracts prick testing is the preferred method in children, and we have published improvements to the technique for young children.1Drs Longo, Strinati, and Tedesco have, however, misinterpreted the data concerning the number of positive and negative prick and intradermal tests. When we stated that there were four patients with negative prick tests and positive intradermal and in vitro tests

The purpose of this study was to determine whether rabbit serum can produce reactions of the skin and the eye that are significant. The advantages of rabbit antipneumococcus serum have been well summarized by Horsfall and his co-workers. 1 In the first paper on the clinical use of rabbit serum, these authors 2 reported its administration in twenty-two cases of pneumonia and stressed the fact that the intradermal reactions to rabbit serum were not significant as an indication of sensitivity. Neither conjunctival nor intravenous tests were postive in this series of cases. In the second paper, they 3 reported on the use of rabbit serum in sixty-seven cases of pneumonia. They reiterated that no reliance had been placed on the results of intradermal tests because of the commonness of false positive reactions. A marked positive intradermal reaction occasionally occurs in persons subsequently shown not to be sensitive to rabbit serum

Our interest in arsenic as a possible cause of vitiligo was aroused in October, 1930, when we first noticed the development of multiple snow-white spots on the skin of a Negro man, following the disappearance of a generalized arsphenamine dermatitis. Since that time we have seen two similar cases of vitiligo, both in Negroes, after arsphenamine dermatitis. In each case there was an increase of pigmentation in some areas, as well as apparent total absence in others, giving a very striking clinical picture. Because of this unusual finding, we undertook a study of the retention and elimination of arsenic, together with intradermal tests, to determine, if possible, the role played by arsenic in the development of these clinical symptoms. On analyzing our clinic reports of the cases, we found certain factors common to all three: The three patients were full-blooded Negroes. 2. Each had areas of total absence of

To the Editor:— It has occurred to me that the great prevalence of allergy to inhalants (other than pollens) could be markedly reduced if manufacturers of pillows, mattresses, cushions, upholstered furniture, automobile upholstery, stuffed toys, and so forth could be persuaded to make such articles only with nonallergic stuffing such as foam rubber or other suitable nonallergenic synthetic material. In fact, if such a program were effective, the entire allergy situation in this country would be dramatically ameliorated; it would serve as a nationwide prophylactic measure. For example, when exposure to certain inhalants is materially reduced, there is a change in incidence of sensitization to those materials in our population. This is illustrated by the change in the incidence of sensitivity to silk and to rabbit hair. When I first became interested in children's allergy and began doing intradermal tests in 1933, positive skin tests and serious clinical sensitivity were

It is not the purpose of this paper to enter into an exhaustive resume of the literature pertaining to cutaneous hypersensitiveness, nor to discuss the various theories that have been offered as an explanation of its occurrence. With the exception of a very few observers who explain the phenomenon as an indication of immunity or a phase of anaphylaxis, cutaneous hypersensitiveness is now generally considered to be an evidence of infection, although it is by no means certain that the future will not modify some of the generally accepted views referable to the methods of its production. In an effort to determine the frequency with which certified milk was infected with tubercle bacilli, in 1916 and 1917, a large number of guinea-pigs was injected with the sediment of this product and the animals studied in the following manner. Several weeks after the milk was injected intradermal tests were made. At

The occurrence of a fixed eruption due to tryparsamide is a rare complication of antisyphilitic treatment, the case reported by Robinson 1 being the only one on record. For some time I have had under observation a patient in whom sensitivity to tryparsamide developed at the sites of pigmentation which remained after arsphenamine dermatitis sustained four years previously. It was found that the patient was sensitive to all trivalent arsenicals over the entire cutaneous surface, as evidenced by patch and intradermal tests, and to tryparsamide only in the pigmented areas. REPORT OF CASE W. Y., a white man aged 40 years, was first seen in June 1933, when he requested continuation of antisyphilitic treatment. He stated that he had a penile lesion in 1919, which healed in five or six weeks. No secondary lesions were noted and no treatment was given. In 1925 he became depressed and nervous.

ALLERGIC reactions to insulin may be local or generalized. Local reactions are said to occur in 5%-30% of insulin-treated patients 1 and are characterized by redness, heat, pain, pruritus, and swelling at injection sites. Generalized reactions are uncommon and may appear as generalized rashes, 2 gastrointestinal disorders, 3 serum sickness, and even anaphylaxis. 4 It is the present purpose to report five cases of insulin allergy and to describe certain observations on the use of insulins from various species, including human, and on the use of dealaninated pork insulin. Methods Intradermal tests were performed by injecting 0.1 ml of each test substance intradermally into the upper back. The injected sites were examined at 15, 30, and 60 minutes for the development of erythema, induration, and pseudopods, and the results were graded as follows: 0—erythema or induration, or erythema and/or induration at 15 min disappearing by 30 min. 1+—Induration of less

The title of this paper is somewhat presumptuous in that it implies that the intradermal chancroidal test is diagnostic. We wish to modify this premise, for if the evidence we are to present is to carry any weight, we must not attempt to prove all that the title infers. 1. This paper deals with two different intradermal tests so far as in one a pus antigen is used and in the second a bacillary antigen is employed. 2. This paper, in reality, is merely an evaluation of these two tests in the diagnosis of infection by the bacillus of Ducrey. 3. This paper attempts to prove the superiority of the test with bacillary antigen as advocated by us 1 over the test with pus antigen described by Cole and Levin. 2 In the routine work of a special clinic organized at the University Hospital for the study of the so-called

This is the second edition of a small book first published in 1949. Since then newer knowledge, especially that concerning the use of corticosteroids in asthma, has prompted rewriting. The work contains a good deal of valuable information. Concerning the use of corticosteroids in asthma, the author correctly urges thorough physical examinations and fluoroscopic observations. He devotes a large section of the book to a discussion of the injection of gold-containing products, with excellent results in 54% of 203 asthmatic patients, and good results in another 9%. Gold therapy is rarely used in this country. Strictly from the standpoint of allergy, there are serious omissions and controversial statements. The skin tests are done intradermally only, and only in groups. This technique is dangerous because of possible extreme sensitivity of a patient (scratch tests should be done before intradermal tests are attempted). Group testing is also wrong because positive reactions may

A relation between brucellosis and multiple sclerosis has recently been postulated by Kyger and Haden. 1 They reported a high incidence of cutaneous sensitivity to Brucella antigens in patients with the diagnosis of multiple sclerosis. In 118 patients, results of intradermal tests with killed Brucella organisms were reported as positive in 115. The possibility of multiple sclerosis being etiologically related to brucellosis was proposed largely on the basis of these findings. Widespread interest has been stimulated by this implied relation. In several instances which have come to our attention, patients with multiple sclerosis have been treated by methods believed to be useful in brucellosis. A further investigation of a possible relation between these two diseases seemed desirable. MATERIAL AND METHODS Subjects.— Fifty-two patients with the diagnosis of multiple sclerosis were studied for evidence of brucellosis or of previous exposure to Brucella. The diagnosis of multiple sclerosis had been established by

I have not been able to find in the literature any other case of asthma with this particular botanic causation. Mrs. B., aged 45, seen, March 9, 1925, for many years had had severe bronchial asthma lasting daily and almost continuously for several weeks from the middle of March to the end of April, with complete freedom from allergic symptoms at all other seasons of the year. She had lived in the same neighborhood in San Antonio for many years and had always been at home at this season. The sharply defined seasonal incidence and cessation of the asthma suggested a tree as the only known air-borne pollination possibility coinciding with the history. Intradermal tests were positive to the pollens of the grasses and ragweeds, obviously impossible factors in her case. Of the trees pollinating at this season in the locality, tests were negative to the various oak pollens, pecan

In general, allergic cutaneous sensitivity reactions, after the topical application of neomycin, are considered to be rare. Baer and Ludwig 1 reported the first case of contact sensitivity to neomycin. Sulzberger and Baer 2 stated that they occasionally saw contact sensitivity to this antibiotic. Epstein 3,4 was the first to report a series of patients with neomycin sensitivity. However, his patients did not present the typical and easily recognizable picture of contact dermatitis. In the majority of cases which he reported, for the most part, the diagnosis depended upon a heightened index of suspicion, rather than on the easy recognition of the classical clinical features of an acute contact dermatitis. In this series, Epstein was of the opinion that he proved the etiological role of neomycin by the demonstration of positive intradermal tests to the antibiotic. Patch tests with neomycincontaining ointments and/or 10% solution of

The behavior of dextrose and electrolytes in the tissues of persons with diabetes is of considerable interest. Seelig 1 has recently reported on the response of diabetic patients to intradermal tests with a solution of sodium chloride and 0.1 per cent dextrose. He found an increased "avidity" of the skin for dextrose in the diabetic as compared with the nondiabetic patient. McClure and Aldrich, 2 Petersen and Levinson 3 and others have reported on the intracutaneous wheal as a measure of permeability in persons with nephritis as well as in normal subjects. There has been a lack of controlled studies on cellular permeability as measured by the absorption time of various solutions in the diabetic as compared with the nondiabetic, so-called normal subject. The results of a preliminary study, based on the method of Seelig, 1 suggested that the test may be of value, first, in studying differences in absorption

To the Editor:— We have read with great interest the article by Dr. Howard Hailey, "Pruritus Ani et Vulvae,"The Journal, March 26, page 837. Dr. Hailey is to be commended for stressing the importance of an allergic etiology in some of these patients. However, one must disagree strenuously with his statement, "Cutaneous tests for allergy have no legitimate place in the diagnosis and treatment of eczema, and the practice will probably be discontinued in the near future." Simple scratch tests as ordinarily carried out are valueless in most chronic allergic states. When the simple cutaneous tests are followed by intradermal tests using potent material, in sufficient concentration, positive skin reactions of great clinical importance are obtained. Reliance on elimination procedures alone to solve such cases results frequently in a protracted period of investigation which in many cases can be shortened by carrying out proper intradermal tests. Our results with

Intradermal tests with purified nuclear antigens from calf thymus nucleoprotein, histone, and deoxyribonucleic acid were carried out on 258 patients with various rheumatic and nonrheumatic diseases and on 46 healthy controls. A wide spectrum of variation in the degree of reactivity of the different patient populations studied was noted. At 24 hours postinjection, most of the patients with systemic lupus erythematosus (SLE) showed strong reactions (induration, 10 mm or more) to histone and nucleoprotein, and 40% of them to DNA. On the other hand, most of the patients with other diseases exhibited weak (induration, 0 to 4 mm) or intermediate (induration, 5 to 9 mm) reactions to the nuclear antigens. The study suggests that, when proper interpretive criteria are applied, the greater skin reactivity to purified nuclear antigens from calf thymus observed in patients with SLE may serve as another useful criterion to aid in distinguishing SLE from other diseases.