Common Bile Duct Obstruction and Anaphylaxis

Abstract

We have elsewhere reported that blockade of the reticulo-endothelial system with India ink or saccharated iron oxide does not materially modify anaphylactic shock in the dog. In the preceding paper we have shown that the hyperbilirubinemia resulting from injections of bilirubin leads to a retention of bromsulphalein. Klein and Levinson 1 and more recently Mills and Dragstedt 2 have reported studies indicating that reticulo-endothelial blockade causes a retention of bromsulphalein. Interpreting the dye retention from a hyperbilirubinemia as a form of physiological blockade of the reticulo-endothelial system it seemed worth while to repeat our anaphylactic studies on jaundiced animals. Theoretically at least, the blockade occurring in dogs with obstructive jaundice should be more complete than that produced with foreign materials as it is constant and progressive.

Anaphylactic shock was induced in 8 horse serum sensitized dogs in which the common bile duct had been obstructed. In one animal the obstruction preceded the sensitization, in the remainder the operation was done after the sensitization and at varying intervals before the test or assaulting injection of serum. Dye retention tests and determinations of the plasma levels of bilirubin were made just prior to the assaulting dose. For this the animals were anesthetized with ether and sodium barbital and the degree of shock evaluated by the blood pressure records as previously described. 3 The essential data are shown in the accompanying table.

Severe to fatal reactions occurred in all but one animal. This animal was in poor condition and the blood pressure was extremely low before the horse serum was injected. No additional effect was produced. In 2 animals the shock was somewhat slower in developing than is usually the case. There is therefore no evidence of any mitigating effect on anaphylactic shock. Actually the percentage of fatal reactions obtained is higher than that occurring in a large series of normal animals.