Declining cell-mediated immunity is associated with increased chronic disease burden

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Rationale We used delayed type hypersensitivity (DTH) skin testing to examine the hypothesis that declining cell-mediated immunity is more closely linked to chronic disease burden than to chronological age. Methods 58 elderly subjects were tested for delayed type hypersensitivity (DTH) response to Candida antigen. Each subjects' disease burden was quantified using the Cumulative Illness Ratings Scale (CIRS). Higher CIRS score reflects greater disease burden. Mean DTH response by age group (<71 yo, 71-78 yo, and >79 yo) was compared with mean DTH response by CIRS score (<11, 11-15, >15). Total serum IgE levels were measured and similarly stratified by age and CIRS score. Results Mean Candida DTH responsiveness declined progressively with increasing disease burden (increasing CIRS score). Mean DTH responses were 7.4 mm, 3.4 mm, and 0.0 mm for CIRS groups <11, 11-15, and >15 respectively. Interestingly, Candida DTH response showed no progressive decline with advancing age. Mean DTH responses were 5.2 mm, 3.5 mm, and 5.0 mm in subjects <71 yo, 71-78 yo, and >79 yo respectively. Total serum IgE levels increased with advancing age. Mean total IgE levels were 183, 249, and 342 in subjects >71 yo, 71-78 yo, and >79 yo respectively. No correlation was observed between mean total IgE levels and CIRS score. Conclusions We note an inverse relationship between Candida DTH response and CIRS score, suggesting that increased chronic disease burden is associated with diminished cell-mediated immune response. Surprisingly, advancing age did not predict a diminished DTH response in our subjects. No relationship was observed between disease burden and total serum IgE.