HYPERSENSITIVITY AND RHEUMATIC FEVER

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Abstract
Recent immunologic studies, as they relate to the problem of rheumatic fever, are reviewed and correlated with clinical observations on this disease. Radioactive isotopic and fluorescent antibody studies have demonstrated the rapid passage of antigenic substances into living cells. It is suggested that antibody is produced by an intracytoplasmic process akin to anabolism of proteins in general. The prominent role of plasma cells in production of antibody is indicated. It is suggested that one of the fundamental physiologic defects induced by an in vivo antigen-antibody reaction is the alteration in permeability of cell membranes, which may be mediated by the adrenal cortex. Evidences from epide-miologic, immunologic and prophylactic studies show that a beta hemolytic streptococcal infection precedes the development of rheumatic fever in a constant but small proportion of the exposed population. Results of studies of the immune response in subjects with rheumatic fever are compatible with the hypothesis that these individuals react in an exaggerated fashion to the infection. The specific antigenic substance or substances in the streptococcus responsible for the development of rheumatic fever are not known. Limited studies to date suggest the development of alterations in the distribution of body fluids and electrolytes and changes in the permeability of cell and capillary membranes during the acute phase. The probable mechanisms of action of ACTH and cortisone on the rheumatic process are discussed.