In my opinion those hypothetic concepts of upgrading and downgrading reaction only confuse

Leprosy Mailing List – April 30^th, 2012

Ref.:   In my opinion those hypothetic concepts of upgrading and downgrading reaction only confuse

From: P AM Schreuder, Maastricht, The Netherlands

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Dear Salvatore,

I have problems with the explanation of Prof. Bryceson [LML April 26^th, 2012]:

<< "Add more lymphocytes (as in upgrading) and the reaction, as measured by titrated thymidine incorporation, increases.  Add more antigen (as in downgrading) and the reaction increases." >>

What we, however, see is that most reactions happens the first six months after starting with MDT.  You would expect an enormous increase in antigen, while at the same time the patient has a so-called "upgrading" reaction.  In my opinion those hypothetic concepts of upgrading and downgrading reaction only confuse.

  

Kind regards,

Pieter AM Schreuder