Delayed-type Hypersensitivity Medication

  • Author: Harumi Jyonouchi, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Aug 1, 2011
 

Medication Summary

Purified protein derivative (PPD), used to evaluate exposure to M tuberculosis, and Candida antigen (Ag) are the only currently available US Food and Drug Administration (FDA)-approved Ags for delayed-type hypersensitivity (DTH) skin testing. The most clinically informative Ags used for delayed-type hypersensitivity reactivity are Candida and tetanus Ags because most individuals are exposed to these Ags as infants. By age 9-12 months, more than 80% of immunocompetent children mount positive responses to these Ags.

Previously available delayed-type hypersensitivity Ags that were withdrawn from clinical use include the Cell-mediated immunity (CMI) multitest, coccidioidin, mumps, and histoplasmin. Mumps Ag is a relatively poor Ag in eliciting a positive delayed-type hypersensitivity reactivity. Studies have shown only 60% of previously mumps infected adults to have a positive delayed-type hypersensitivity reactivity. An even lower response is predicted when the only exposure to mumps is by measles, mumps, and rubella (MMR) immunization.

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Tuberculin tests

Class Summary

These agents are used to detect infection with M tuberculosis.

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Tuberculin, purified protein derivative (PPD Mantoux test, Aplisol, Tubersol)

 

The standard skin test uses 5 U of PPD in a volume of 0.1 mL. A lower concentration of 1 U/0.1 mL is used when a high exposure to antigen, as in caseating tuberculosis, is suspected; 250 U can be used if standard test result is negative and person is known to be immunocompromised. A negative DTH reaction does not rule out infection but may indicate disseminated infection as in miliary tuberculosis.

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Tetanus antigens

Class Summary

These are used to assess cellular immune responses following the primary series of diphtheria-tetanus-pertussis vaccine (3 doses). Conventionally used as a control for tuberculin testing in patients who are immunocompromised or suspected to have disseminated tuberculosis.

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Tetanus toxoid adsorbed or fluid

 

The standard TD vaccine is diluted to 1:100 or 1:10. A positive DTH reaction indicates recognition by cell-mediated immunity; protection correlates with antibody responses.

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Candida antigens

Class Summary

Most infants have been exposed to Candida antigen (Ag) even without clinical thrush or Candida diaper dermatitis. Japanese studies showed that 80% of children had positive DTH responses by age 1 year; therefore, Candida is a conventional Ag used as a positive control for tuberculin skin testing in individuals who are immunocompromised or when disseminated tuberculosis is suspected.

Candida skin test antigen (Candin, NDC#38697-200-1; Allermed)

 

Also known as Dermatophytin. It is diluted 1:10 or 1:100 with sterile water.

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Contributor Information and Disclosures
Author

Harumi Jyonouchi, MD  Associate Professor, Division of Pulmonary, Allergy/Immunology, and Infectious Diseases, Department of Pediatrics, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Harumi Jyonouchi, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American Association of Immunologists, American Medical Association, Clinical Immunology Society, New York Academy of Sciences, Society for Experimental Biology and Medicine, Society for Mucosal Immunology, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Terry W Chin, MD, PhD  Associate Director, Pediatric Allergy/Immunology/Pulmonology, Miller Children's Hospital, Long Beach Memorial Medical Center; Associate Professor, Department of Pediatrics, University of California, Irvine, School of Medicine

Terry W Chin, MD, PhD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Allergy, Asthma and Immunology, American College of Chest Physicians, American Thoracic Society, California Thoracic Society, Clinical Immunology Society, and Western Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

John Wilson Georgitis, MD  Consulting Staff, Lafayette Allergy Services

John Wilson Georgitis, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American Association for the Advancement of Science, American College of Chest Physicians, American Lung Association, American Medical Writers Association, and American Thoracic Society

Disclosure: Nothing to disclose.

David Pallares, MD  Clinical Assistant Professor, Department of Pediatrics, Division of Allergy and Immunology, University of Louisville School of Medicine

David Pallares, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Ann O'Neill Shigeoka, MD, to the original writing and development of this article.

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