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PubMed1989

Your questions answered about tuberculin skin testing.

1. To understand TB skin testing, it is necessary to have a basic understanding of the disease process and the role of the immune system. 2. The Mantoux test is the tuberculin skin test of choice, the intermediate strength (5 TU) being the most commonly used. 3. Either the palpation method or the ball-point pen technique may be used to measure induration that results from TB skin testing. An induration of 10 mm or greater is considered significant. 4. TB skin testing should be administered regardless of patient history of BCG vaccination. To eliminate the confusion caused by the booster phenomenon, a two-step procedure is recommended for individuals who at initial screening have an induration of 5 to 9 mm.

BCG Vaccine↗
PubMed2003

Determination of the incidence of sensitization after penicillin skin testing.

BACKGROUND: Concerns for sensitization after penicillin skin testing are a factor in limiting the timing and population for whom this testing is offered. The sensitizing potential of the penicillin skin test has never been studied directly. METHODS: A total of 329 volunteers underwent prick and intradermal skin testing with penicillin G, benzylpenicilloyl-polylysine, and a minor determinant mixture. Those with negative skin testing had repeat testing 4 weeks later. Medical history and antibiotic use were determined by interview, questionnaire, and electronic pharmacy records. RESULTS: Seventy-two of the 329 subjects (22%) reported a history of previous beta-lactam reaction, of which 10 (14%) had a positive initial skin test. Overall, the initial skin test was positive in 23 of 329 (7%). Of the subjects with a negative initial skin test, 239 completed the second test 4 weeks later. Of these, 6 subjects (2.5%, 95% confidence interval 0.5% to 4.5%) converted to a positive skin test. None had taken a beta-lactam antibiotic between the two tests, and none had any previous history of beta-lactam reaction. One subject reported having never taken a beta-lactam antibiotic before. In comparison to the 233 subjects who did not convert their skin test, the statistically significant factors favoring sensitization were: female sex (odds ratio [OR] 6.53, P = 0.05), atopy (OR 5.31, P = 0.04), and history of food allergy (OR 6.35, P = 0.02). There was a trend toward more recent penicillin use in the newly sensitized subjects, but this was not statistically significant.. CONCLUSION: Penicillin skin testing may sensitize a small number of individuals to penicillin.

Adult↗
PubMed1997

Use of Leishmania major derived leishmanin for skin test surveys of visceral leishmaniasis in Ethiopia.

The potential use of Leishmania major derived leishmanin in surveys of visceral leishmaniasis (VL) was examined. The study was conducted in Konso sub-district, southwest Ethiopia involving 51 VL patients, 18 VL contacts, four localised cutaneous leishmaniasis (LCL) cases and 15 healthy controls. Sixty three percent of treated VL patients, 44.4% of VL contacts, all of LCL cases and none of untreated VL patients were positive to the test. Leishmanin skin test (LST) induration sizes of 41 treated VL patients were in the ranges of 0 to 10 mm, with a mean of 4.9 mm. The mean induration size and the positive LST rates in female patients were found to be significantly lower than in males. The major drawback of the antigen in the survey was the relatively smaller and flatter indurations. The relationship of LST to gender and leishmanial disease variant is discussed.

Adolescent↗
PubMed1990

Comparative assay of varicella skin test antigens by the ELISA and RPHA tests.

The antigenic potency of the varicella skin test antigens was assayed by reversed passive haemagglutination (RPHA) test using sheep red blood cells coated with zoster convalescent serum and by enzyme linked immunosorbent assay (ELISA) using anti-VZV sera or monoclonal antibody to gpI followed by an anti-IgG beta-galactosidase conjugate. Three kinds of varicella skin test antigens were compared: a soluble varicella skin test antigen, a modified soluble varicella skin test antigen, and a crude varicella skin test antigen. The RPHA test was suitable for the soluble and for modified soluble varicella skin test antigens but it was not suitable for the crude varicella skin test antigen. ELISA was applicable for all the three antigen types. It was possible to assess quantitatively the content of viral antigens in the same type of the skin test antigen, but not by comparing the different skin test antigen types. ELISA was more efficient in the quantitative assay of the amount of viral antigens than the RPHA test.

Animals↗
PubMed1986

The value of skin testing for penicillin allergy diagnosis.

Skin testing is reliable and useful to rule out penicillin allergy in most patients who have a history of previous reactions. When we tested 291 inpatients in the University of Washington hospitals for the presence or absence of penicillin allergy, of 97 with a history of penicillin allergy, 12 (12.4%) had positive skin tests. Of 194 patients with no or an unknown history, only 4 (2%) had positive skin tests. Two of the 16 who had positive skin tests (12.5%) reacted only to minor determinant mixtures. Of the skin test-negative patients, 261 were treated with one of the penicillins and only two had any reactions.

Drug Hypersensitivity↗
PubMed1986

Comparison of the brucellin skin test with the lymphocyte transformation test in bovine brucellosis.

The brucellin skin test and the lymphocyte transformation test were compared in heifers infected with virulent Brucella abortus strain 544, heifers vaccinated against brucellosis and unexposed cattle. Results of the in vitro lymphocyte transformation test were consistently positive for all 9 Brucella-infected heifers while the skin test was consistently positive for 6 of the 9 heifers. In 7 heifers repeatedly vaccinated with B. abortus strain-19 vaccine the in vitro test classified 3 animals as positive whereas the skin test identified all the animals as infected during most of the experimental period. Four heifers injected with a single dose of B. abortus strain 19 were consistently negative to the lymphocyte transformation test while the skin test classified all the animals as infected during most of the experimental period. The skin test gave strong reactions indicative of Brucella infection in heifers vaccinated with 'Duphavac' and 'Abortox' vaccines whereas the lymphocyte transformation test was consistently negative with these vaccines. The two tests were negative in unexposed cattle. It was concluded that the in vitro test correlated better with Brucella isolation than the in vivo test did and that the lack of agreement between the results of the two tests is likely to be due to the different antigens used in the assays.

Animals↗
PubMed1982

In vitro changes in cell mediated immunity following tuberculin skin testing in humans.

Tuberculin skin testing with purified protein derivative (PPD) was found to induce alterations of in vitro measures of cell mediated immunity. T lymphopenia with proportionate decreases of TM and TG cell numbers were observed two days after skin testing. A relative augmentation of TM cells was demonstrated after one week. Peripheral blood mononuclear cells from negative skin responders had normal in vitro reactivity to PPD stimulation suggesting a cutaneous abberation in these individuals. Macrophage dependent depressed PHA reactivity of mononuclear cells was demonstrated two days after skin testing. No change in natural killer cell cytotoxicity was observed. Cytotoxicity was positively correlated to the number of TG cells in the assay.

Adult↗
PubMed1981

The "in vitro skin test": a reliable and repeatable assay of immune competence in the surgical patient.

In vitro blast transformation of human peripheral lymphocytes was tested using standard skin test antigens, the mitogens PHA and Con A, and the mixed lymphocytes reaction. The study group included 15 patients with multiple trauma, 40 with major burns, six following cholecystectomies, six following aortic reconstruction, and 30 normal volunteer controls. Repeated skin testing may sensitive patients to candida and streptokinase-streptodornase (SKSD), and desensitize them to mumps antigen. Blast transformation in response to PPD did not correlate with the clinical status of the patients; similarly, blast transformation in response to stimulation by the mitogens PHA and Con A could not reliably predict the occurrence of septic complications. Reactivity in response to stimulation by the soluble antigens SKSD and mumps and in the one-way mixed lymphocyte reaction accurately predicted the clinical course of patients. This method of "in vitro skin testing" is a reliable and repeatable method of monitoring the immunologic status of patients whose illness or injury requires longitudinal study.

Antigens↗
PubMed1983

Anergy and delayed hypersensitivity skin testing.

Delayed hypersensitivity skin tests, when properly planned and performed, are both practical and sensitive in determining the status of cell-mediated immunity. They can be diagnostic of specific exposure, such as tuberculosis, or they can rule out anergy. Pitfalls include poor selection of antigens, inappropriate application and poor timing of test interpretation. The transparent tape method is preferred for recording the results.

Antigens↗
PubMed1997

Bevel-down superior to bevel-up in intradermal skin testing.

BACKGROUND: Intradermal skin testing is one of the most widely used procedures in the diagnosis of hypersensitivity diseases in vivo. It is critical to perform the test accurately and expediently. Yet, there are few articles describing its detailed technique or proficiency available. OBJECTIVES: To identify the better method for intradermal testing between the bevel-up and bevel-down techniques. METHODS: Three inexperienced testers performed intradermal injections using both methods. Four sets of paired trails each consisting of ten injections were applied randomly, alternating between the same volunteer subject's contralateral arms. Duration to complete ten injections was measured. Numbers of injection sites that bled, that squirted into the air, and failed to form a bleb were counted. The overall comfort level was determined. RESULTS: The time to complete the injections by bevel-up and by bevel-down methods were 165.5 +/- 31.3 and 152.5 +/- 27.4 seconds, respectively (P < .015). The number of injection sites that bled was higher in the bevel-up method, particularily on trial one (P < .001). Completion rate of successful bleb formation in bevel-down was 27.3 as compared with 23.3 in bevel-up method (P = .013). The comfort level was higher with the bevel-down than the bevel-up method (P = .0001). CONCLUSION: The bevel-down method of intradermal testing is superior to the bevel-up method.

Equipment and Supplies↗
PubMed1979

Kala-azar in Ethiopia: survey of south-west Ethiopia. The Leishmanin skin test and epidemiological studies.

The Leishmanin skin test was performed on 1353 people in a kala-azar endemic region of south-west Ethiopia. Physical examinations were also carried out on 2723. Two of these individuals, both males, had active visceral leishmaniasis with Leishmania organisms demonstrated by spleen puncture. Two other males, including one member of the research team, had parasitologically proven cutaneous leishmaniasis. Because there was negligible migration and little movement of individuals outside of their tribal territories, the geographical distribution of skin test positivity and clinical findings could be determined and correlated with environmental parameters. The level of positive skin tests for the groups tested ranged from over 64% for the three tribes collectively inhabiting the lower regions of the Omo Valley (altitude approx. 500 m) to 6.4% for the Suri tribe, which lives at 1400 m. Skin test positivity was highest in areas of deeply fissuring montmorillonite soils and where Phlebotomus langeroni orientalis have been collected. Termite mounds of the pipe-organ type seemed to occur independently of the proportion of positive skin tests, possibly because alternative resting and breeding sites for sandflies were available in the cotton clay soil or because of the cultural patterns of the people. Almost always, males had a markedly higher prevalence of positive skin tests than did females. The degree of positivity was strongly correlated with increasing age, most positive conversions occurring in the ten to 20 year olds, the age at which males join cattle camps as part of their herding activities. Splenomegaly reached a prevalence of nearly 50% among the Hamar speaking people to the east of the Omo River, where the pattern of disease suggests malaria as the principal cause. Hepatomegaly, however, was highest in the lower Omo Basin among the Nyangatom, Dassanetch and Kerre, where hydatid disease was a major cause of liver enlargement, but seemed unrelated to the proportion of positive Leishmanin skin tests.

Adolescent↗
PubMed1975

Screening of cellular immunity in patients with rheumatoid arthritis by phytohaemagglutinin skin test.

Phytohaemagglutinin (PHA) skin test was used for screening of non-specific cell-mediated immunity in 30 patients with rheumatoid arthritis (RA) and its results compared with those obtained in age- and sex-matched controls with non-inflammatory rheumatic diseases. Purified protein derivative (PPD) of M. tuberculosis was used for testing of specific cell-mediated immunity in the same two groups. The reactivity to both PHA and PPD was found to be significantly lower in patients with RA, indicating the decreased cell-mediated immunity in this disease, as compared to controls.

Adult↗
PubMed1985

Skin test reactivity in infancy.

Skin tests represent a major tool in the diagnosis of reaginic allergy; however, their interpretation does not appear to be without difficulty in children under the age of 3 yr. Seventy-eight infants from birth to 24 mo were prick tested and compared with 30 nonallergic adult subjects. Skin tests were performed without bleeding by use of two strengths of histamine hydrochloride (1 and 10 mg/ml), a mast cell degranulating agent (codeine phosphate, 50 mg/ml), and allergenic extracts. Negative control solution elicited a small wheal (less than 1.5 mm) in two infants who were excluded from further results. A clear and significant (p less than 0.001) hyporeactivity to both histamine and codeine phosphate was observed in infancy, especially before the age of 6 mo. Six infants were allergic and presented positive prick tests to either food or inhalant allergens. These tests were confirmed by serum specific IgE and a suggestive clinical history. The size of the allergen-induced prick test wheal ranged from 2 to 5 mm in diameter, suggesting that prick test wheals may be smaller in infants. This study confirms that prick tests can be performed and interpreted without difficulty in infants, keeping in mind the small wheal size induced by both positive control solutions and allergen-induced prick tests.

Allergens↗
PubMed1990

Screening for delayed-hypersensitivity in Italian children: multicentric study by multitest skin testing.

The Multitest skin test allows the simultaneous intradermal application of seven standardized recall antigens in a reproducible manner. Response reading is based on a scoring system that distinguishes between normal and diminished delayed hypersensitivity (DH). To determine incidence and size of DH responses for each antigen in relation to age and sex in healthy Italian children, a multicentric study was performed on a representative paediatric population of 491 subjects (285 males and 296 females) aged from 4 months to 16 years. In both sexes DH reactivity as measured by score and number of positive responses increased significantly with age. The incidence of anergy was 8.8% for the whole population and decreased significantly with age in both sexes. Incidence of positive responses was highest for tetanus and diphteria toxoids, intermediate for Candida, Proteus and Streptococcus, and lowest for tuberculin and Trichophyton antigens. There was no significant difference between sexes in the incidence of positive response to each antigen.

Adolescent↗
PubMed1997

The cost-effectiveness of preventing tuberculosis in physicians using tuberculin skin testing or a hypothetical vaccine.

BACKGROUND: Tuberculin skin testing using the purified protein derivative is recommended as part of a tuberculosis control program for health care workers. However, compliance with skin testing programs has been poor and their cost-effectiveness is unknown. METHODS: A Markov-based decision analysis was performed to determine the cost-effectiveness of tuberculin skin testing over the entire lifetimes of physicians who are now in medical school. Assumptions were deliberately chosen to present a conservative estimate of cost-effectiveness. Indirect costs were not included. RESULTS: Annual testing cost $29,000 per life-year saved and $39,000 per case of pulmonary tuberculosis prevented. In contrast, particulate respirators have been shown to cost millions of dollars per case prevented. Skin testing every 6 months was cost-effective in a subpopulation at high risk of infection (> or = 1.8-fold). During their entire lifetimes, physicians now in medical school can expect to avert 137 cases of pulmonary tuberculosis, prevent 7 tuberculosis deaths, and save 182 life-years because of skin testing programs. Improved compliance with annual skin testing and prophylactic isoniazid could more than triple this benefit. If available, a moderately effective vaccine would be even more cost-effective than tuberculin skin testing programs. CONCLUSIONS: Tuberculin skin testing is cost-effective and should be an integral part of any tuberculosis control program. Vaccination may one day be a feasible and cost-effective alternative to skin testing programs.

Adult↗
PubMedDate not supplied

[Allergy skin testing after topical anesthesia].

Immediate skin test reactions are the hallmark of atopic diseases. EMLA (eutectic mixture of local anesthetics) is a local anesthetic that reduces the pain and apprehension for skin testing. We studied EMLA effects on the skin prick test with allergen and histamine. Reactions were evaluated by means of wheal and flare crossed diameters, speed of reaction and local temperature changes. One hour occlusion dressing with EMLA significantly delayed the beginning of reaction with antigen (129%) and histamine (101%). It decreased wheal diameter (33% and 15%) as well as local temperature variation (55% and 80%) respectively with antigen and histamine. Local anesthesia with EMLA probably interferes with histamine action and reduces the immediate skin test reaction. Therefore, it should not be used to reduce the pain of allergy skin testing.

English Abstract↗