Focal reactions

In most local reactions, antigen is eliminated after a few hours or a few days, in particular by activated macrophages. When antigen cannot be eliminated, a local chronic inflammation may occur in the form of a granuloma. In that case, any new massive parenteral administration of antigen may provoke a violent focal reaction following interaction of antigen with locally accumulated sensitized lymphocytes: this manifests as marked flare-up of the chronic inflammatory process. A historical example of focal reaction is the sudden aggravation of tuberculous lesions following intravenous injection of tuberculin, first attempted by Koch in the treatment of tuberculosis. Such reactions may still occasionally be observed after intradermal injection of too high a concentration of tuberculin. Similar focal reactions, for example in dental granulomas, sinusitis, etc., arc-frequently observed clinically. Flare-up reactions after new parenteral administration of antigen at the site of previous local DTH reactions may also be due to similar pathophysiology, but they are sometimes also due to local accumulation of plasma cells and specific antibodies.

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