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To the Editor.—
The paper by Maibach and Johnson on contact urticaria to diethyltoluamide (the Archives 111:726, 1975) presented a well "worked-up" case of a phenomenon that, although not common, may occur more frequently than is diagnosed. In their case study, the patient's sensitivity was to an organic chemical, which possibly acted as a hapten that, on linkage with a protein, provoked an antibody response by the host.The authors' finding that specificity of the chemical with respect to positional isomerism is necessary for immunologic activity has been demonstrated previously. Gordon has stated that simple chemical haptens (such as aminobenzene sulfonate) linked covalently to carrier proteins elicit antibodies highly specific for the steric structure of the hapten employed (Gordon BL: Essentials of Immunology, ed 2. Philadelphia, F.A. Davis Co, 1974, p 26). For example, antibodies directed against meta-aminobenzene sulfonate cross-react poorly with different hapten isomers such as the orthoor
Falk MS. Contact Urticaria Syndrome. Arch Dermatol. 1976;112(4):559. doi:10.1001/archderm.1976.01630280077036