Delayed hypersensitivity in mycoplasma pneumoniae infections.
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Thirty-eight patients were examined because of ocular redness, irritation, and corneal changes apparently related to soft contact lens wear. The corneal changes were transient and ranged from faint epithelial opacities to a coarse, punctate epithelial keratopathy. Solutions containing thimerosal had been used by all of the patients for lens care, and 31 responded to an ocular challenge with a thimerosal-preserved lens lubricant. Twenty-seven of these 31 also reacted to thimerosal patch testing. The 31 resumed lens wear with relief of symptoms by using unit-dose, preservative-free saline for lens storage and thermal disinfection. A hypersensitivity to thimerosal was assumed responsible for the clinical findings.
Topical hypersensitivity to corticosteroids was studied by epicutaneous testing using the Finn Chamber technic. The steroids were tested in both ethanol and white petrolatum and, in certain cases, in dimethyl sulfoxide. Additionally, commercial preparations were tested. Three groups of patients were studied: (1) patients with a history of hypersensitivity to at least two topical preparations (five of ten patients studied showed a positive patch test reaction for corticosteroids), (2) patients in whom topical corticosteroid hypersensitivity was suspected because of treatment-resistant eczema (seven of twenty-five patients showed a positive patch test reaction), and (3) dermatologic inpatients and outpatients undergoing epicutaneous testing for suspected topical hypersensitivity. Hydrocortisone-17-butyrate (H-17-B) was included in the standard patch test series; of 450 patients tested, two showed a positive patch test reaction. All the patients with corticosteroid hypersensitivity had a positive reaction to H-17-B. In six patients, additional hypersensitivities to one or several other steroid preparations were seen. Use testing was performed as an open test, with 0.1% or 1% H-17-B in ethanol on normal skin of the flexor side of the upper extremities. A positive test reaction was seen in only one of nine patients. Results of use testing with the commercial 0.1% H-17-B (Locoid) ointment were always negative. Our study suggests that the sensitivity of patch tests for corticosteroid hypersensitivity can be increased by using ethanol as vehicle.
During trials of aluminium adsorbed diphtheria-tetanus/acellular pertussis vaccines from a single producer, persistent itching nodules at the vaccination site were observed in an unexpectedly high frequency. The afflicted children were followed in a longitudinal observational study, and the presence of aluminium sensitization was investigated in the children with itching nodules and their symptomless siblings by patch tests. Itching nodules were found in 645 children out of about 76,000 vaccinees (0.8%) after both subcutaneous (s.c.) and intramuscular (i.m.) injection. The itching was intense and long-lasting. So far, 75% still have symptoms after a median duration of 4 years. Contact hypersensitivity to aluminium was demonstrated in 77% of the children with itching nodules and in 8% of the symptomless siblings who had received the same vaccines (P<0.001). Children with persistent itching nodules and/or aluminium sensitization should be warned about aluminium containing products (e.g. vaccines and antiperspirants). The reason for the high incidence of itching nodules after SSI vaccines is unknown and should be further investigated.
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A brief introduction is given stressing the importance of host reactions against tumour specific antigens. Two groups of patients are presented. Positive tests are associated with a better prognosis in both groups. Energy is commonly associated with widespread disease, but other factors appear to be concerned as well. Immune competence is impaired soon after surgery, but as time progresses this appears to recover. Tumour bulk appears to be the biggest barrier to the immune mechanism and it would appear that the role of immunotherapy in the future will be to supplement more conventional methods of treatment, especially surgery.
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