Kanof, Naomi M.

Rostenberg, Adolph

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OBSERVATIONS ON THE PERSISTENCE OF SENSI-
TIVITY OF THE ECZEMATOUS TYPE AFTER PRO-
LONGED PERIODS OF REMOVAL FROM CONTACT
WITH THE ALLERGEN
NAOMI M. KANOF, M.D., AND ADOLPH ROSTENBERG, Ja., M.D.*
(Received for publication December 13, 1940)
This study was undertaken for the purpose of determining
whether an allergic sensitization of the eczematous type persists
after a period of non-exposure to the causative allergen. This
fact would seem to be of both theoretical and practical importance.
On the theoretical side it would be not only of interest in itself
but would also add to the mosaic which comprises our knowledge
of sensitization phenomena. From a practical point of view it
is desirable to know something about the prognosis for any
individual exhibiting an eczematous sensitization. The avail-
able evidence bearing on this point is (1) clinical impressions on
spontaneous sensitizations, (2) the retesting of individuals who
have previously been deliberately sensitized to substances with
which they ordinarily do not come into contact. Clinical ob-
servations on the whole would seem to indicate that sensitization
of the eczematous type, once established, persists for long periods
of time. The evidence for this view is well expressed by Sulz—
berger (1), who says, "But perhaps the best examples which
demonstrate that allergy often continues without continued ex-
posure or re-exposure to the allergen are to be found in the sensi-
tization to simple chemicals. Human beings sensitized (cc-
zematous, contact-type allergy) by exposure to formalin or to
specific dyes, etc., will often remain skin-sensitive for years or
for a lifetime without demonstrable continued exposure or re-
exposure. Individuals sensitized to such complex substances
* Drug Division of the Food and Drug Administration, Federal Security
Agency.
175
176 THE JOURNAL OF INVESTIGATIVE DERMATOLOGY
as, for example, arsphenamine will frequently remain perma-
nently sensitive when it is certain that they have had no inter-
vening opportunities for re-exposure to the particular complex
chemical." Such evidence, however, is not completely trust-
worthy because of the difficulty of being certain that the in-
dividuals studied had not come into contact with the allergen
between the time of first sensitization and the time of testing.
On the experimental side, i.e., the deliberate sensitization and
subsequent retesting of individuals with allergens with which
they ordinarily do not come into contact, the evidence is some-
what confficting (2, 3). However, such experimental studies
again are not satisfactory as an answer to our original question
for at least two reasons: 1) we do not know that the deliberately
induced eczematous sensitization parallels the spontaneously
acquired one in all respects; and 2) that the length of time for
which these patients were followed was rather short.
The last bit of evidence with which we are familiar is the work
done by Shelmire (4) in which he demonstrates that in individuaLs
of approximately 70 years of age, there was a marked reduction
in the incidence of eczematous sensitivity to poison ivy as com-
pared with a younger group in the same geographical milieu.
On the basis of this observation it is concluded "that the aged
seem to acquire a material loss of sensitivity to poison ivy if this
plant is avoided for long periods." However, to us, Shelmire's
observations are susceptible of another interpretation, namely,
that the lack of reactivity of the aged group was because of
changes in the skin incident to the aging process rather than to
the fact that these individuals did not come into contact with
the plant. Parenthetically we wish to say here that we have no
evidence to disprove the hypothesis offered by Shelmire, but
neither do we believe that there is any evidence which unequivo-
cally substantiates it.
The ideal group for the study of this problem would be a group
of individuals who had spontaneously become sensitized to some
allergen and had been proved to be so; and then could be re-
tested after a period of years in which time there had been abso-
lutely no contact with that allergen. Although such a group is
PERSISTENCE OF ECZEMATOIJS SENSITIVITY 177
obviously difficult to obtain, it occurred to us that we had the
unique opportunity of securing such a group as far as the allergen
poison ivy is concerned. This group was comprised of individuals
who had reached adulthood in an environment where it was to
be expected that they were exposed to poison ivy. These in-
dividuals had then been incarcerated for a period of five years
or more in an institution where there could be no opportunity
for contact with poison ivy since the individuals used were ones
who by reason of their mental condition have been confined to
a specific part of the hospital which has its own court and where
no poison ivy exists.l,2, 2a J can be assumed that prior to incar-
ceration this group had been sensitized to poison ivy in the same
percentage as the general population of the same age and the same
environment. Therefore, in order to see whether or not the group
had lost its eczematous sensitivity by virtue of lack of contact
with the allergen in question, all that remained to do was to
determine the percentage of sensitivity for the group at present
and to compare this with the original per cent. In order to get
this "original" per cent, we would then have to know the inci-
dence of sensitivity to poison ivy for the population of the age
range of this group; or we would have to get a proper control
group and determine its incidence of sensitivity. The latter
alternative, i.e., to determine the incidence of sensitivity for a
group of similar age and of similar environmental antecedents
was deemed preferable for several reasons. We do not think that
'We wish to thank Dr. Winfred Overholser, Superintendent of St. Elizabeth's
Hospital, Washington, D. C., for his cooperation.
'However, we cannot guarantee that there was absolutely no contact, as the
remote possibility exists that, in the burning of a brush pile, particles of resin
were air borne and came into contact with these nen or that some attendant after
touching poison ivy came on duty and touched these patients, transferring some
of the resin. Outside of these two rather remote opportunities for contact, we
can conceive of no others. (The first possibility would seem to be excluded
according to the recent work of Shelniire (Arch. Derm. and Syph. 43: 384, 1941))' Among persons connected with psychiatric institutions, there seems to be
the impression that the incidence of certain allergic diseases (asthma, hay fever)
is less than that in the normal population. While we know of no study of the
incidence of the eczematous form of allergy in the insane, some as yet un-
published work of our own would indicate that the insane can become experi-
mentally eezematously sensitized as readily as the non-insane.
178 THE JOURNAL OF INVESTIGATIVE DERMATOLOGY
in the present state of knowledge surveys made on the incidence
of poison ivy sensitivity by different workers, at different times, at
different places, with different extracts and on different subjects,
can or should be compared when quantitative questions are under
consideration.
The control group8 was made up of patients obtained from the
observation ward of a general hospital. The individuals had been
admitted for drunkenness, disorderly conduct, etc. As far as
we were concerned they were entirely unselected inasmuch as we
TABLE 1
E
th0 .
p. . 4
,
.
'
.
,
O50s
.4
s
Z0OZ05o
.4
Incarcerated
White
Colored
Control unincar-
cerated
White
Colored
Total
Incarcerated. ..
Control
32
34
23
25
66
48
6
4
7
5
10
12
18.75
11.76
30.4
20
15.15
25.0
47.8
44.5
43.5
41
45.2
42.1
53
43
41.0
38.8
47.8
39.8
46.6
44.7
44.1
42.0
45.7
43.0
11.25
11.05
11.15
12.50
10.70
11.60
10.9
11.1
11.0
All figures for time periods are in years.
took all that were available without inquiry into their previous
history. Nor did the patients know to what they were being
tested, so that there could be no unconscious selection on the
basis of individuals knowing that they were sensitive and ac-
cordingly refusing to have the test applied. All these individuals
bad been in the hospital for only a few days and prior to that were
residents of areas where it is to be expected that in the course
We wish to thank Dr. Lillian Malone of Gallinger Municipal Hospital, Wash-
ington, D. C., for her cooperation.
PERSISTENCE OF ECZEMATOUS SENSITIVITY 179
of a normal existence they would come in contact with the poison
ivy plant.
The extract4 used contained 13 per cent solids in acetone. This
extract was then diluted 100 times with acetone (0.13 per cent
solids), and it was this diluted extract timt was used for the
actual testing. The patients were tested on the volar surface
of the right arm by means of a patch test of 3 measured drops of
the extract. All tests were read at 48 hours. The tests were
applied to both groups at the same time, i.e., the experiment was
started and completed in one week in August, 1940.
In view of the difficulty of obtaining sufficient material, both
white and Negro males were tested. No females were used.
We have tabulated our results separately for the white and for
the Negro and also for the two combined. Statistically there
does not appear to be any significant difference between the white
and the Negro. In both groups the direction of change is the
same and is of practically the same magnitude. Therefore, from
a statistical point of view it would be a legitimate procedure to
combine the two; however, on the chance that there may be a
difference in biological reactivity in the two races we have given
our figures separately as well.6
Our results apparently show a lower incidence of sensitivity in
the incarcerated group. However, this difference is not signif-
icant from a statistical point of view considering the number of
people involved. It is, however, suggestive that the disparity
The extract was furnished to us by Dr. A. F. Coca, Fearl River, N. Y., to
whom we are greatly indebted.
The word significant is used here in the statistical sense meaning that the
distribution obtained could have happened by pure chance less than 5 times
in 100. In our study, the probability of the distribution obtained being from
chance was 6.5 (in 100). We wish to thank Dr. B. J. Vos of the Food and Drug
Administration, Federal Security Agency for his help with the statistical
evaluations.
° There does seem to be some evidence that the negro sensitizes less readily
than does the white and some as yet unfinished work of ourown would so far seem
to corroborate this. Actually, however, this does not have a direct bearing on
the problem in question inasmuch as the question here is the ability to maintain
a sensitivity without further contact once it has been initiated. We know of no
evidence which shows a difference between the two races in this respect.
180 THE JOURNAL OF INVESTIGATIVE DERMATOLOGY
is in the direction of what might be expected if any disparity at
all was to be expected.
SUMMARY AND CONCLUSIONS
1. Patch tests with the poison ivy extract were applied to 66
individuals who were of an average age of 47.8 years and who had
been incarcerated for an average period of 11 years (minimum
5 years) without any opportunity to come into contact with
poison ivy during that time and 15.5 per cent of these were
positive.
2. A control group of 48 adults of an average age of 44.5 years
was simultaneously tested with the same extract and 25.0 per cent
of these were found to be positive.
3. These findings indicate that acquired specific sensitivity of
the contact type can persist for many years without exposure to
the causative allergen.
4. The results also suggest that there is a tendency for some
loss of sensitivity to occur when the sensitized individual is
absolutely removed from contact with the allergen to which
he has become sensitized. Unequivocal evidence on this last
point is, as yet, not available. These remarks apply only to
the eczematous type of sensitivity.
REFERENCES
(1) SIJLZBERGER, M. B. 1940 Dermatologic Allergy, page 23. Charles C.
Thomas.
(2) WEmt0FF, N. S., AND DOLGOFF, A. P. 1934—35 tYber die spezifische Sensi-
bilität der Haut einfachen chemisehen Stoffen gegenuber. Archiv
für Dermatologie und Syphilis, 17i-172: 647.
(3) SULZBEEGEE, M. B., AND ROSTENBERG, A. Ja. 1939 Method of experimental
sensitization; and demonstration of sensitivity in individuals with
eczematous dermatitis of contact type. Journal of Immunology
(Jan.) 86: 17.
(4) SRELMIRE, BEDFORD. 1940 Contact dermatitis from vegetation. Southern
Medical Journal (Apr.) 83: 337.


Observations on the Persistence of Sensitivity of the Eczematous Type After Prolonged Periods of Removal from Contact with the Allergen 

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Observations on the Persistence of Sensitivity of the Eczematous Type After Prolonged Periods of Removal from Contact with the Allergen

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