TUBERKULINOVY ALLERGY — hypersensitivity of an organism to mycobacteria of tuberculosis or products of their life activity.
Development of T. and. it is accompanied by vegetation of causative agents of tuberculosis (see) in an organism or by introduction of vaccine BTsZh (see) for prevention of tuberculosis; in rare instances at transfusion to the recipient of significant amounts of leukocytes of blood of specifically sensibilized donor perhaps short-term adaptive targeting (passive transfer) of T. and.
For the first time T. and. R. Koch making subcutaneous injections of tuberculine (see) for diagnosis of tuberculosis observed. K. A tuberculine test found reactions to tuberculine in almost healthy children. They were designated by the term «allergy». T. and. carry to manifestations of hypersensitivity of the slowed-down type (see the Allergy). At statement of skin diagnostic Pirquet's tests or to Mant initial changes in an injection site of tuberculine can be found in 10 hours. However the expressed reaction develops in
24 hours, it reaches the maximum expressiveness in 48 — 72 hours, and fades within several days or weeks. On morfol. signs can allocate two phases of reaction. In the first phase in an injection site of tuberculine to the sensibilized person there is an acute nonspecific exudative inflammation, Krom is accompanied by intensive infiltration of a polinukleara-ma with impurity of lymphocytes. In 10 — 20 hours after statement of test the second develops — a specific phase; at the same time the number of mononuklear sharply increases in a zone of an inflammation, there is a picture of proliferative changes from cellular elements of connecting is woven also an endothelium of vessels.
By means of pilot studies it is partially opened immunol. mechanism of reaction to tuberculine. So, it is proved that the fundamental effector unit of reaction is caused by contact of sensibilized T lymphocytes with tuberculine, at the same time various mediators are allocated (see Mediators of cellular immunity), from to-rykh the subsequent development of reaction to tuberculine depends.
At hypodermic administration of tuberculine focal reaction in the bodies affected with tuberculosis develops especially intensively that speaks about their bigger sensitization. Use of provocative test of Koch is based on it (see the Tuberculinodiagnosis). Extremely seldom at very high sensitization tuberkulinovy tests can cause tuberkulinovy shock. As well as local reaction, it develops in a slowed-up way, in the second half of the first days after administration of tuberculine T. and. the phenomenon of «ignition» — development of inflammatory reaction on site of earlier put tuberkulinovy tests can accompany. Complex studying allows to consider that T. and. at moderate expressiveness has protective character, promoting an otgranicheniye of the center of defeat; at sharp expressiveness when intensive alteration of fabrics, T is observed. and. makes heavier a condition of the patient. Expressiveness of T. and. depends on specific and nonspecific factors. Refer localization, prevalence and a phase of tubercular process to the first, biol. properties of the causative agent of tuberculosis; to the second — a functional state nervous and other systems of an organism. Influence of nonspecific factors is noted at the scarifying graduated Grinchar's test — Kar-pplovsky or the accelerated definition of limit of sensibility to tuberculine by means of Mantoux reaction (see the Tuberculinodiagnosis). At extremely heavy course of tuberculosis the condition of a negative anergy is observed (see Reactivity of an organism). Use of a complex of antitubercular measures (vaccination of BTsZh, early identification of primary forms of tuberculosis, an intensive care) caused noticeable decrease in frequency of T in a crust, time. and. at TB patients. It reduced the importance of skin tests with tuberculine. At the same time interest to a lab increased. to diagnostic methods of an allergy (see. Leukocytic tests). In the conditions of mass antitubercular vaccination the problem of differentiation of a postvaccinal and infectious sensitization of an organism became complicated. Parenteral administration of live vaccine BTsZh causes development of an allergy to tuberculine at all vaccinated. The maximum intensity of skin tuberkulinovy tests is registered in a year after vaccination, and it remains for a number of years. Expressiveness of a postvaccinal allergy often does not differ from infectious.
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At assessment of slight reactions to tuberculine needs to take a possibility of infection of an organism with group of atypical mycobacteria into account. Nek-rye from them (e.g., Micobacterium kansa-sii) have a similar antigenic structure with the causative agent of tuberculosis. For the purpose of increase in informational content of diagnosis of allergic diseases in some cases use a combination of tests of in vitro and in vivo. Originally estimate initial expressiveness of one or several leukocytic tests with tuberculine, then enter tuberculine subcutaneously then again estimate reactions of leukocytes. Changes in expressiveness of in vitro tests indicate a tubercular etiology of process.
See also Tuberculosis, immunity.
Bibliography: Immunology and an immunopathology of tuberculosis, under the editorship of M. M. Averbakh, M., 1976; Medunitsyn N. V. Hypersensitivity of the slowed-down type, M., 1983; R and at x and A. E. N, the Chosen works, M., 1983.
V. A. Fradkin.