The histology of a case of anaphylactic shock occurring in a man

Abstract

THE patient, a soldier aged 22, was wounded in the back and right shoulder by shrapnel on 30th March 1917. The only serious damage was a laceration of the right kidney. This was successfully treated. He received prophylactic injections on 30th Narch, 4th April and 20th April. No symptoms were produced by the second and third injections. On 2nd May, about eleven o'clock, he was given his fourth dose of serum, 500 units. Almost immediately he called out that he felt very ill. He became cyanosed, and began to vomit. The cyanosis increased, breathing became difficult, there was a thick secretion of tenacious niucus in the upper respiratory passages, the pulse could not be felt. Hot cloths and massage were applied to the precordial area. Artificial respiration was performed for about twenty minutes. The lips and eyelids were edematous. After twenty minutes respiration commenced, and continued for about an hour. During this period no heart action could be detected. The body was that of a well-nourished and well-developed young man. There was no cyanosis or cedema at the time of the post-mortem examination. Over the back of the right loin was an incision which had almost completely healed, but had broken down at one point where a few drops of blood had exuded. Over the right hypochondrium was a small superficial scar, about 1 in. by 1 in., brownish in appearance, and probably the result of a superficial burn. The superficial veins were engorged, but no other change was noted in the brain and membranes. There was no excess of fluid in the ventricles or subarachnoid space. ik'outh and Neck.-The tonsils were enlarged. The cesophagus was normal. The larynx and trachea were congested, and contained a large quantity of tenacious mucus. The lymphatic glands of the neck were enldrged, pale and soft. The heart weighed 12+ oz. The heart muscle, valves, and the great vessels were normal. There was no trace of thymus tissue. Except for some slight congestion of the posterior part of the lower lobes, the l u g s were normal in appearance. There were numerous enlarged glands in the mecliastinum ; these were soft and pale. Ether was injected. He died at ten minutes past twelve. The post-mortem was made during the afternoon of the same day. The Brain weighed 49 oz. Thorax.-The pericardium contained about an ounce of clear fluid. The right lung weighed 13 oz., the left lung lo$ 02.

Anaphylaxis in the Baboon <i>(Papio cynocephalus)</i>

“…In this respect it resembles human cases of anaphylaxis as that reported by Parish and Oakley (1940) where the skin and gut was affected, that of Dean (1922) where there was liver damage, and one case of J ones and Austen (1964) where the liver was congested. Sudden death in infancy is, however, more likely to be accompanied by anaphy lactic changes in the lungs so that, in this respect, the baboon is not a good model for a study of anaphylaxis as a possible cause of cot death.…”

Anaphylactic Pneumonia

“…Tbere is no doubt tbat we are dealing with a clinical entity distinct from other types of pneumonitis and certainly distinct from pneumonitis which follows asthmatic attacks'. It has heen produced experimentally in animals; it has been observed following antigenic injections in men (Dean and Webb,8) and it was noted by Rich and Gregory (6} in death from sensiti/ation to sulfapyridin. Furthermore, it is distinct from an allergic or so-called constitutional reaction which occurs in patients witb an existing allergic disease following injection.…”

A Comparison of the Immunologic Responses of Normal and Atopic Individuals to Parenterally Injected, Alum Precipitated Protein Antigen

“…) It is known that upon anaphylactic challenge, different species have particular 'shock organs' and patterns of pharmacologic mediation, which likely reflect differences in smooth muscle con centration and distribution, nature of the pharmacologic inter mediates and type of antibody formed (12,13). However the pattern of systemic anaphylaxis in man can resemble that of several species (e. g. guinea pig or rabbit among others [14,15]). It would seem that the initial 'shock organ or area' in our cases was simply the site previously exposed to antigen, suggesting that greater amounts of skin sensitizing antibody are 'fixed' at such sites.…”