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Related post: sensitization on the recipient (Otto); immediately, with proper dosage (Doerr and Russ).
There is the Differin Adapalene same, specificity as with other antigens. Specific sensitization may thus be
secured simultaneously to several proteins. Wells and Osborne, 1911 and 1913, have
studied particularly the specificity for pure proteins. They believe that the specificity
is due to certain constituent groups within the protein molecule; but that the whole
molecule is involved in the Purchase Adapalene reaction.
The provocative injection must be considerably larger than the sensitizing in-
jection. It is much more effective by vein. The response is immediate. If an
animal recovers from the toxic effects, it becomes immediately refractory or immune
to further injection, because the anaphylactic antibodies are saturated or exhausted
(Weil and Coca, 1913). This antianaphylaxis (anergy) persists for a time, but is
General Phenomena. However induced, anaphylaxis presents fun-
damentally the same phenomena, differing merely in intensity, according
to conditions. The relative predominance of the individual effects in
different species may complicate the picture. The actions are essen-
tially peripheral. They consist in: fall of blood pressure (shock); tonic
contractions of smooth muscle, especially the bronchioles, resulting in
severe respiratory disturbance; and local urticarial reactions.
370 MANUAL OF PHARMACOLOGY
Symptoms of Anaphylactic Reaction. These are mainly as follows: Great
restlessness; severe fall of blood pressure, generally attributed to paralysis of the
splanchnic vessels and Adapalene Clindamycin consequent shock; fall of temperature (Pfeiffer and Mita, 1910),
etc.; rigidity of the lungs by violent contraction of the bronchial muscles, resulting in
respiratory distress and asphyxial convulsions; stimulation of other smooth muscle
(uterus, stomach and intestines); diminished coagulability Purchase Adapalene Online of the blood; leucopenia;
eosinophilia; loss of complement; increased lymph flow (Calvary, 1911); local inflamma-
Repeated anaphylactic shock results in cell destruction in several organs,
with subsequent chronic inflammatory changes. In the liver, the results resemble
portal cirrhosis (Longcope, 1913).
Analogous but less severe parenchymatous degenerations of the myocardium, liver
and kidneys may occur Adapalene Differin in rabbits after a single injection of a large dose of horse-serum
or egg-albumen. They develop Adapalene Cream in ten to twenty-one days, about the time when the
antidodies are produced (Longcope, 1915).
Susceptibility. Guinea pigs are especially susceptible, and in them the
lung rigidity is most prominent, arresting respiration and producing
asphyxial death in a few minutes (Auer and Lewis, 1909). In dogs
and rabbits this phenomena is much less marked, the severe and prolonged
fall of blood Adapalene 0.1 Gel pressure being the most prominent feature. Cats are inter-
mediate (Edmunds, 1914). Man seems to be relatively insusceptible.
The rare acute accidents in the injection of antitoxic sera, serum-disease,
and some varieties of Adapalene Gel 0.1 asthma and hay fever (Meltzer, 1910) are probably
Lung Rigidity. Auer and Lewis, 1909, showed that in guinea pigs dying acutely
of anaphylaxis the lungs are rigidly distended and incollapsible even after death, by
tetanic contraction of the bronchial muscles. The effect occurs after destruction of the
central nervous system and even after degeneration of the vagi, so that it must be
exerted directly on the muscle fiber or myoneural junction (Auer, 1910). It is abolished
by atropin (Auer). Chloral is uncertain (Rosenau and Anderson, 1909). Schultz
and Jordan, 1911, showed that the severity of the bronchial phenomena in guinea pigs
is explained by their Order Adapalene Online relatively thick mucosa; so that the contraction occludes absolutely
even the larger bronchi.
Blood Pressure. In guinea pigs, the circulatory changes^are mainly asphyxial
(Auer and Lewis, 1910). In other animals, there is a characteristic fall of blood pres-
sure, often to 20 to 30 mm. Hg. The mechanism of this "anaphylactic shock" appears
to be complex. It was commonly attributed to vasodilation (Biedl and Kraus, 1909);
but the later evidence Buy Adapalene indicates that it is caused by contraction of the smaller hepatic
vessels, preventing the adequate return of blood to the right heart (Mautner and Pick,
1915). The blood accumulates mainly in the large veins, especially of the liver and
portal system; so that the smaller vessels of the kidneys, intestines, and other parts cf
the body are mechanically drained (Pearce and Eisenbray, 1910 and 1912; Edmunds,
1913); indeed, the fall does not occur if the liver has been excluded from the circula-
tion. The liver therefore has a predominant share, directly or indirectly, in the fall,
the blood pressure being lowered because a greater part of the blood stagnates in the
Zucker and R. G. Pearce found evidence that the essential process of the anaphy-
laxis, peptone or histamin "shock" does not consist in vasodilation, but in constriction
of the liver vessels, resulting in deficient blood supply of the right heart, and therefore
in venous stasis and fall of arterial pressure. This has been confirmed by Mautner and
Pick, 1915. In carnivorous animals, in which the circulatory changes are prominent,
they find swelling of the liver volume, from spasm of the smaller hepatic vessels. Adapalene Online
Immunity to repeated injection is explained by paralysis of these vessels. These effects
do not occur in herbivorae, frogs and turtles, whose liver vessels also fail to respond to
epinephrin and barium, and which therefore probably lack constrictor inneryation. Adapalene Benzoyl Peroxide
The intestinal arteries are actively constricted, during life, Adapalene Gel in all animals; the veins be-
come congested later. The arteries of the lung are also constricted, constituting a
further factor in the venous congestion.
The vasomotor center is not directly involved in the fall; nor is there any good
evidence of a peripheral action on the blood vessels. These continue Order Adapalene to contract to
epinephrin or barium; they do not contract to splanchnic stimulation, but this could
be explained simply by the altered distribution of the blood. It is conceivable that the
anaphylaxis directly lowers the tone of the hepatic vessels; but this has not been proven.
Airila, 1914, attributes the fall in rabbits to increased resistance of the pulmonary
vessels; but Edmunds, 1914, found no evidence of deficient blood supply of the left
heart in cats; to the contrary, the pressure in the pulmonary veins often rose. v.
Behring, 1914, attributes the shock to clumping of the platelets and thrombosis of the
The heart suffers by the low blood pressure, and is also affected directly, although
this usually plays a minor part in the "shock." The changes are peripheral. As shown
by electrocardiograms, on rabbits and dogs, they consist in disturbances of conduction
and abnormalities of ventricular contraction, affecting especially the right heart.
These may progress to final rigor (Robinson and Auer, 1913; Auer and Robinson,
1913). The heart-muscle and diaphragm show histologic changes; Generic Adapalene also with other
anaphylactoid agents (Kundratitz, 1913). The isolated heart of sensitized animals is
directly poisoned by the antigen (Cesaris-Demel, 1910-1912), Acute heart failure Buy Adapalene Online is
also sometimes seen in intact cats (Edmunds, 1914).
Treatment of Anaphylactic Shock. The continued low blood pressure furnishes
nn opportunity for investigating ^ the treatment; this is of practical importance
because the phenomena are very similar to those of surgical shock. The indications
are evidently to relieve the splanchnic congestion and to increase the volume of blood
to the heart and medulla. Pearce and Eisenbrey, 1910, found that venous transfusion
with blood or saline only increases the splanchnic congestion without aiding the heart
or medulla. Arterial transfusion is more successful; but the best results are obtained
by combining transfusion into an artery with bleeding from a vein. Cardiac or
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