Peculiar Reaction (Allergic?) to Scarlet Fever Streptococcus Toxin.

Abstract

During the winter of 1925-26 studies on scarlet fever toxin necessitated the frequent intracutaneous injection of various toxic filtrates. The author served as a subject for these tests and until December 9th, 1927, always gave a typical Dick reaction. On this date, however, and on every subsequent test he gave the peculiar, twophase reaction which is described below. On this occasion there appeared, within 15 minutes after injection, a raised, firm, whitish or cream colored spot about 2 cm. in diameter with a blotchy red or pink edge, the whole strongly suggesting a serum wheal in an anaphylactic person. This disappeared in about 2 hours. Four hours later the typical, red, Dick reaction began to appear. Five days later a toxin which had been prepared some months previously from a different lot of broth but with the same strain of streptococcus was diluted and injected as usual. This toxin had always previously given a typical Dick reaction, the first signs of which did not begin to appear for 6 to 8 hours after the injection. In this instance, within 2 hours, a diamond shaped wheal, 1.5x2 cm. in size, raised, sharply demarked, tender, itching and so yellow in color as to suggest suppuration appeared. There was little or no erythema. This gradually subsided. Several hours later this was completely overspread by an intensely red and somewhat swollen area which finally became an oval of 4x6 cm. at the end of 24 hours.

Some of the same material was injected into the shoulder, all previous injections having been made in the flexor surface of the forearm. The reactions obtained were like those previously obtained but were smaller. Their yellow color was no less marked, however. Neither of the 2 lots of sterile broth gave any reaction even when injected undiluted.

Filtrates from other strains of scarlet fever streptococci were tested. Some gave the early, yellow phase (A) and some did not. It was found that the intensity of the “A” phase, but not its time of appearance, seemed to parallel the intensity of the “B” phase. In other words it seemed to parallel the presence of toxin. In this connection the 24 hour growth on 4 agar plates was washed 3 times in saline solution, suspended in broth, heated for 1 hour at 60° C, 0.25% trikresol was added and some of the suspension injected as usual. No reaction occurred. It is recognized that the heating may have changed the bacterial protein immunologically.