Critical Evaluation of Allergic Phenomena in Rheumatic Diseases

The allergic theory of rheumatism may be summarized as follows: Clinical aspects: There are (a) manifestations provoked by pharmaceutical substances or foodstuffs; (b) occurrences or reoccurrences following surgical operations, exposure to cold, or contact with bacterial or physical allergens, particularly in the autumn and spring; and (c) periodic sinovial fluxion, resembling that of typical allergic serum sickness. Histopathological aspects: There is a nucleus rheumatoid necrotic exudate, a peripheral proliferation of mesenchymal cells with characteristic nodules, and íibroblastic granuloma. Bio-humoral aspects: There appears to be a rise in circulating antibodies, resulting in positive agglutination reactions for ß-haemo-lytic streptococci. An increase in anti-fibrinolysin, antistreptolysin 0, anti-hyaluronidase, precipitins and haemolysin have also been reported, also an increase in the specific agglutinins against sensitized red blood cells of sheep. The rise in yglobulin increases the sedimentation rate of red blood cells and the colloid lability of serum. Serum albumin is generally diminished. Therapeutic aspects: Cortisone-like substances possess marked anti-phlogistic and anti-allergic activity and must be ranked higher than the common anti-rheumatic preparations such as salicylates and pyrazoles.