The Value of Cutaneous Sensitization Tests Employed in Eczema and Papular Urticaria of Childhood

Abstract

In this discussion, we are not concerned with the controversy as to whether the cutaneous sensitization observed clinically in eczema, urticaria papulosa and angioneurotic edema in infants and children is a phenomenon of anaphylaxis or a state of allergy. We believe that the question will be settled when the mechanism of protein sensitization is more definitely known. However, the fact remains that local cutaneous reactions are brought to light when various proteins are applied by cutaneous or intracutaneous tests to the skin of patients who are subjects of the diseases mentioned. The results indicate that these cutaneous reactions depend on a protein substance which is the essential cause of the efflorescence in a comparatively large number of cases.Moreover, the cause of the disease having been determined, with intelligent cooperation on the part of the parents of the patient in regard to diet, the clinical cure far surpasses the results of any other mode of treatment.The application of cutaneous sensitization tests in cases of derma¬ titis in adults in which a protein may be suspected as a possible cause has been a routine practice of late in the Dermatological Dispensary of the Jefferson Medical College Hospital. The favorable results derived from the practice prompted us to apply protein sensitization tests to children having eczema and urticaria.Pirquet1 was the first to suggest a method for determining cuta¬ neous sensitization to proteins, but it remained for Schloss to make clinical application of the procedure in children. Schloss'2 patient was a boy, 8 years of age, who was subject to marked urticarial lesions caused by the ingestion of eggs, oatmeal and almonds. The patient's history suggested that the urticaria subsequent to the ingestion of these foods was not a congenital condition but was acquired during early life. It was found that the cutaneous reaction was produced -only by the protein constituent of egg, almonds and oats. During the time the