Delayed-type Hypersensitivity Treatment & Management

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

Medical Care

Delayed-type hypersensitivity (DTH) skin testing requires the use of Ag doses as defined under Lab Studies. See Lab Studies for a more complete discussion of the interpretation of delayed-type hypersensitivity reactions.

Delayed-type hypersensitivity responses represent cellular immune responses to recall antigens (Ags) to which the subject has been exposed at least 4-6 weeks previously. The reaction occurs 48-72 hours after exposure and induces induration of 5 mm or more.

The inflammatory reaction may be sufficient to induce pain at the local site. Topical steroids and diphenhydramine have been used to decrease an unusually severe reaction. If an excessive reaction is anticipated, such as in caseating tuberculosis, decrease the amount of Ag; for M tuberculosis, for example, decrease the strength of the purified protein derivative (PPD) from the customary 5 units to 1 unit.

Negative reactions to a recall Ag to which the patient is known to have adequate exposure require investigation for an underlying illness or a T-cell deficiency.

Positive delayed-type hypersensitivity reactions do not indicate protection against the recall Ag that is tested. Antibody responses to the specific antigen usually reveal better correlation with immune protection.

In patients with mutations in the interferon (IFN)-γ/interleukin (IL)-12/IL-23 signaling pathways, medical care includes consideration of hematopoietic stem cell transplantation (HSCT) in patients with severe deficiencies and consideration of exogenous IFN-γ therapy in patients with partial deficiencies with milder clinical features. In the presence of nontuberculosis mycobacteria (NTM) infection, patients require treatment with an aggressive regimen of antimycobacterial drugs. In these patients, HSCT may not be successful in the presence of systemic, progressive NTM infection.

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Consultations

In a context in which a T-cell disorder is likely, a clinical immunologist should manage the diagnostic workup in order to obtain informative cell-mediated immunologic testing and appropriate mutational analysis.

Both types of evaluations for rare T-cell disorders are commonly available only in laboratories of specific investigators. However, intracellular cytokine staining of IL-17 and mutational analysis of genes associated with deficiencies of IFN-γ and IL-12 pathways can be attainable in the commercial laboratories.

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  • Resolution of protein-energy malnutrition in immunocompetent hosts induces an intact delayed-type hypersensitivity response.
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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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