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The Relationship of Immediate Wheal Reactions to the Repeated Administration of Diphtheria and Tetanus Toxoid¹

From the Department of Pathology, New York University School of Medicine, New York, N. Y.

Abstract

Immunization with single vs. repeated doses of diphtheria toxoid was carried out in human subjects to determine the effects of the mode and schedule of administering this antigen upon antitoxin titers and upon immediate wheal responses. A similar study was carried out using repeated doses of tetanus toxoid. Schick positive persons who remained Schick positive did not develop wheal reactions to toxoid. Schick negative persons who were immunized orally did not show appreciable increases in antitoxin titer or in immediate wheal reactions. All Schick negative persons who received repeated parenteral doses of toxoid showed considerable increases in antitoxin titer and immediate wheal reactions until after the time that toxoid was discontinued. The same amount of toxoid given in one dose usually caused a marked increase in antitoxin titer up to about 3 weeks, and this was followed by a rapid decrease in titer. Wheal reactions were not present as frequently or in as marked degree in persons who received one dose of toxoid as in persons who were repeatedly immunized. Delayed reactions occurred many times in most Schick negative persons who received repeated doses of parenteral toxoid, but did not occur in persons who received only one dose of toxoid. Delayed reactions following a dose of toxoid generally occurred prior to the onset of immediate wheal reactions. Evidence is presented for the concept that immediate wheal reactions, as inflammatory responses, are coincidentally within the framework of the immune response. The degree of coincidence may be influenced by modes and schedules of immunization. These factors may be important in complex formation, and complexes may in turn provide the potential for wheal reactions.

Footnotes

¹ This work was supported in part by U. S. Public Health Service Grants E3724 and E3766 and the American Heart Association Grant 60 G 174.

² The author is a recipient of Investigatorship of the Health Research Council of the City of New York under Contract No. 1-121.