The lymphocyte transformation test and gold hypersensitivity.

The Empire Rheumatism Council's controlled trial (1960) showed that gold salts benefit patients with rheumatoid arthritis. However, side-effects still occur with this treatment despite regular blood counts and urine examinations and, although the incidence of severe reactions has probably been reduced by careful attention to the dose and number of injections given, serious haematological complications are still encountered (Saphir and Ney, 1966). It is widely believed that toxicity from gold therapy is immunologically determined, but so far there has been little convincing evidence to prove this assumption. Blast transformation of peripheral blood lymphocytes after their exposure in vitro to an antigen to which the donor has become sensitized has been used as a test for drug hypersensitivity (Vischer, 1966; Sarkany, 1967). We report here experiments in which the peripheral blood lymphocytes of patients with severe gold toxicity responded to in vitro challenge with Myocrisin. The results provide direct evidence that gold hypersensitivity is immunologically determined and suggest a possible method for predicting the likelihood of toxicity occurring in individual patients.