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Pulay bases his explanation of the pathogenesis of eczema and urticaria on modern experimental pharmacologic investigations. He considers eczema a vascular inflammatory reaction of the skin resulting from both exogenous and endogenous factors, requiring an "eczematous" receptive condition and a hypersusceptibility of the epidermis and sensory nerve endings. A specific hypersusceptibility to a definite stimulus he terms an idiosyncrasy, and finds that it is characterized by an absence of eosinophilia and a negative reaction to epinephrine, atropine and calcium administration. On the other hand, an anaphylactic eczema is characterized by eosinophilia, vagotonic symptoms, low calcium content of the blood and increased potassium and magnesium content. This type is favorably influenced by calcium and atropine administration. Only a small percentage of eczema and urticaria cases he finds based on idiosyncrasy or specific sensitization. He is particularly impressed by the importance of changes in the blood chemistry in the eczema group. He
Ekzem und Urtikaria.. JAMA. 1926;86(3):222–223. doi:10.1001/jama.1926.02670290062039
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