Delayed Hypersensitivity Skin Test Research Articles

Effect of dietary supplement on nutritional status and clinical outcome in 501 geriatric patients—a randomised study

The present study was designed to evaluate to the effect of dietary supplements on clinical outcome and nutritional status in a large group of geriatric patients (n = 501). The patients were randomised into an experimental group which received nutritional supplementation (400 kcal) as well as a standard hospital diet, and a control group on hospital diet alone. The nutritional state was measured on admission and after 8 and 26 weeks by anthropometry, serum protein analysis and a delayed hypersensitivity skin test. Protein energy malnutrition was defined as the presence of three or more abnormal parameters. 28.5% of patients showed evidence of malnutrition on admission. Hospitalisation itself resulted in a gradual deterioration in nutritional status. Nutritional supplementation generally improved nutritional state. Among those patients who were well nourished on admission, and subsequently receiving dietary supplementation, 8.3% fulfilled malnutrition criteria after 26 weeks, while 21.1% were considered malnourished in the control group (p < 0.05). The improvement observed in transport proteins was probably related to nutritional support and not just to the reversal of inflammation. In the initially well nourished group of more than 300 patients, the mortality rate was 8.6% in those given nutritional support compared to 18.6% in the control group (p < 0.02).

The correlation between anergy, malnutrition and clinical outcome in an elderly hospital population

The nutritional state of 482 out of 501 newly admitted elderly patients was assessed by anthropometry, serum protein analyses and the delayed hypersensitivity skin test (DH) on admission and after 8 and 26 weeks. The mean age of the women was 81.3 ± 7.7 and of the men 77.9 ± 9.3. Protein-energy malnutrition (PEM) was initially defined as three or more subnormal criteria, one in each of the three categories of measurement. The data was then reanalysed excluding anergy and using the two other criteria only. The prevalence of PEM on the first assessment was 28.5% and was 10% higher when anergy was excluded as a criterion. PEM was more common in women and increased with age. The anergic patients had lower mean values in serum protein and anthropometry than those with normal reactivity. Anergic patients had a higher mortality rate and more pressure sores than the reactive group. Nutritional supplementation was associated with an increase in skin reactivity.

Cell-Mediated Immunity as a Predictor of Morbidity and Mortality in Subjects Over 60

Previous studies have suggested an association between depressed cell-mediated immunity and increased mortality in elderly persons. However, the effects of age and existing disease on this association have not been adequately addressed. We studied the association between cell-mediated immunity and subsequent morbidity and mortality in 273 initially healthy persons 60 years of age and older. In 1979, two tests of cell-mediated immunity were conducted--mitogen stimulation with phytohaemagglutinin, and delayed hypersensitivity skin testing. The study group was followed annually for development of pneumonia, cancer, and death. Anergy was associated with all-cause mortality (hazard ratio of 2.16; 95% confidence interval [1.10,4.28]). When the results were adjusted for age, the resulting hazard ratio was 1.89;[0.94,3.79]. A relationship was also suggested between anergy and cancer mortality although this association was not statistically significant. Response to phytohaemagglutinin was a poorer predictor of mortality than was response to delayed hypersensitivity skin testing. The results show that anergy may be a good indicator of subsequent all-cause mortality, and perhaps cancer mortality, in elderly who lack other indicators of poor health.

Impact of HIV infection on pharmaceutical services at Walter Reed Army Medical Center

Services developed by the pharmacy department at Walter Reed Army Medical Center (WRAMC) relating to the treatment and study of patients infected with the human immunodeficiency virus (HIV) are described. The WRAMC pharmacy department closely monitored use of azidothymidine (renamed zidovudine) before and after its approval by FDA. It has also done pharmaceutical cost studies for HIV-infected patients by disease stage according to the Walter Reed Classification System. An Army pharmacist at the U.S. Army Centralized Allergen Extract Laboratory is involved with the development and distribution of delayed hypersensitivity skin tests used to determine the progression of the disease; the current test battery correlates with the CD4 T-lymphocyte count, low numbers of which indicate disease progression. The Walter Reed Retrovirus Research Group includes an Army pharmacist who not only is involved with the traditional distributive and clinical aspects of the position but also is involved in clinical pharmacy, pharmacoepidemiology, and social and behavioral research. This pharmacist is the principal investigator on protocols studying the relationship of various factors to the frequency and distribution of both beneficial and adverse pharmaceutical outcomes in this patient population. The pharmacy department at WRAMC has taken an active role in both the treatment of HIV-infected patients and HIV-associated research, as part of an aggressive overall Army effort to develop effective treatment and chemoprophylaxis or immunoprophylaxis for this disease.

Delayed-Type Hypersensitivity Skin Testing: Variance Among Candida albicans Extracts

<h3>To the Editor. —</h3> Accurate assessment of cellular immune response by delayed hypersensitivity skin testing requires skin-test materials of defined quality. This type of skin testing provides important information about cellular aspects of the immune system and the ability to process and present antigen to cellular effector cells. Certain delayedtype skin-testing materials are regulated by the Center for Biologics Evaluation and Research of the Food and Drug Administration to ensure consistent potency.<i>Candida albicans</i>is an important antigen, but only one product with guaranteed potency exists, the Merieux "Multi-Test CMI." This product delivers<i>Candida</i>and other extracts by multiple percutaneous puncture. Many physicians have preferred standard intradermal techniques because more predictable amounts of antigen are delivered intradermally. Extracts of fungal species contain diverse antigens and may differ substantially in content. Thus, equivalence is difficult to ensure. With antigens not licensed for delayed-type hypersensitivity skin testing, practitioners generally select materials licensed

The Relationship between the Percentage of Circulating B Cells, Corticosteroid Levels, and Other Immunologic Parameters in Thermally Injured Patients

Thermal injury is known to induce alterations in the immune system, but the precise mechanisms have yet to be elucidated. We investigated the temporal relationship between serum and urine corticosteroid levels, the number of circulating B cells, serum immunoglobulin levels, and delayed hypersensitivity reactions in the postburn period. Fifteen adult patients (mean age, 44 years) admitted with thermal burns greater than 20% body surface area (BSA) (mean, 50%) were evaluated during four postburn periods. Using a bacterial adherence assay in blood smears, we observed an increased percentage of B lymphocytes (20.3%) in the early postburn period compared to normal controls obtained during the same time period (13.1%). The percentage of B cells gradually decreased during the subsequent 4 weeks and was not influenced by the eventual clinical outcome. The changes in B-cell percentage were paralleled by changes in the level of urine 17-hydroxysteroids. Serum IgG concentrations were low during the initial postburn period in survivors and nonsurvivors and returned to normal and above-normal levels in the late postburn period in both groups. The delayed hypersensitivity skin test reactions were also depressed in the immediate postburn period and returned to normal only in the surviving group at the end of the second postburn week. We speculate that the increased endogenous secretion of stress hormones results in an increase in circulating B cells secondary to their release from lymphoid organs and that the normalization of hormone levels as wound healing ensued was associated with the return of B cells to the lymphoid organs. This lymphocyte redistribution may result in polyclonal cellular interactions, with subsequent B-cell activation, and increased IgG production.

Immunological assessment and its predictive role in malnourished infants with diarrhoea and/or systemic infections.

The Immune capacity of 47 marasmic 1–12 months old ill infants with weights below 75 per cent of Brazilian standards and of 12 well-nourished healthy controls was studied, by measuring: the absolute and relative T and B lymphocyte subpopulatioits, the blastogenic response to phytohaemagglutinin (PHA), expressed as stimulation index (SI), and the delayed hypersensitivity skin test with PHA. Eight (17 per cent) of the malnourished infants died and results were evaluated with respect to ultimate outcome. In addition a discriminant analysis was retrospectively applied to the immunological data of the two groups of malnourished infants.Both groups of malnourished infants presented significantly lower values than the control group for all measurements, although not very evident for B lymphocytes. The immunodepression was more intense for the infants who died than for those who survived, as shown by significantly lower values for the SI, the skin test, and by the discriminant analysis. The discriminant analysis led to a linear predictive model which accurately classified 85 per cent of the survivors and 100 per cent of those who died. It was con cluded that immunological parameters may be useful to select prospectively those infants who need a different therapeutic approach because of their high risk of mortality.

Future options for brucellosis surveillance in New Zealand beef herds

It is probable that bovine brucellosis will be eradicated from New Zealand by 1990. However, continued surveillance for the disease will have to be maintained for a number of years. This paper examines alternative methods of surveillance in beef herds with a view to ensuring that the most cost effective method is used. The three surveillance methods examined are the present automated complement fixation test, abattoir surveillance, and a system based on a delayed hypersensitivity skin test using a purified Brucella protein antigen. It is concluded that despite the relatively low sensitivity of the skin test the probability of its identifying herds as infected is likely to be greater in practice than abattoir surveillance. The skin test is cheaper than the present complement fixation test.

Prognostic significance of nutritional status in cancer surgery.

Malnutrition is a common accompaniment of malignant disease [5, 9]. The presence of nutritional deficiencies in patients for whom surgical therapy is indicated is of clinical importance because a relationship between the existence of such deficiencies and the occurrence of postoperative morbidity and mortality is assumed. Based on this premise the need for perioperative intensive nutritional repletion in malnourished cancer patients was established [1, 2, 10]. Only a few studies demonstrated that preoperative total parenteral nutrition reduced postoperative complication rates in cancer surgery. The available data are inconclusive and might be influenced by patient selection [8, 11, 12]. Further, the retrospective approach in most of the reported studies is questionable [4, 6, 7]. The problems related to these trials mainly concern the identification of the surgical cancer patient in need of supportive nutrition. Various parameters like secretory proteins, delayed hypersensitivity skin test, and skinfold thickness are taken to be of relevance to the nutritional status of the patient [7]. Buzby et al. described a computer-generated regression equation designed to predict the risk of postoperative complications [3]. This parameter is called the Prognostic Nutritional Index (PNI). The PNI includes serum albumin and transferrin concentration, triceps skinfold thickness, and delayed hypersensitivity skin test reactivity. Our objective was to test in a prospective trial the validity of the single nutrition-related factors as well as the whole model in predicting the operative risk in GI tract cancer patients.

184 Correlation of delayed hypersensitivity skin testing (DTH) with CD4 number and clinical progression in HIV disease

184 Correlation of delayed hypersensitivity skin testing (DTH) with CD4 number and clinical progression in HIV disease

A theoretical basis for use of a skin test for brucellosis surveillance in extensively-managed cattle herds.

Summary: The theoretical basis for a system based on a delayed hypersensitivity skin test for screening extensively managed cattle herds for the presence of brucellosis is discussed. Calculations based on the hypergeometric distribution and test sensitivity are used to calculate the probabilities with which the skin test may identify herds in which infection is present at different prevalence. It is concluded that despite the relatively low sensitivity of the skin test the probability of its identifying a herd as infected is sufficiently high for it to be used as a low-cost screening test.

Delayed hypersensitivity skin testing and anergy in a population of gay men

Anergy is almost universal among patients with the acquired immunodeficiency syndrome (AIDS). To determine the prevalence and correlates of anergy in a population at risk for AIDS, we performed skin tests in 1120 gay men who were enrolled in a prospective study of the natural history of human immunodeficiency virus (HIV) infection. Anergy, defined as no induration to any of four intradermal antigens, was present in 12%. Individually, no induration was detected in response to tetanus toxoid (41%), mumps (28%), candida (47%), and trichophyton (72%). Anergy was strongly associated with the presence of antibody to HIV and with a reduced number of T helper lymphocytes, but not independently with generalized lymphadenopathy, the number of reported male sexual partners in the previous 2 years, the number of T suppressor lymphocytes, or with high titers of antibodies to cytomegalovirus. Nine percent of HIV antibody-negative subjects and 20% of antibody-positive subjects were anergic; anergy is not specific for serologically documented HIV infection in this population. Skin testing with only tetanus toxoid, candida, and mumps antigens may be sufficient to detect anergy. In the presence of HIV antibody, the ability of anergy to predict progressive immunodeficiency remains to be determined.

Nifedipine-induced hyporeactivity in delayed hypersensitivity skin tests

Four patients and three healthy volunteers were submitted to delayed hypersensitivity skin tests to candidin, tuberculin, streptokinase/streptodornase (SK/SD) and mumps antigen before and after a 1 week treatment with nifedipine 10 mg q. 8h. A decrease in the scores of induration and erythema was observed, especially in response to SK/SD antigen challenge. We conclude that nifedipine may induce an anergy status in delayed hypersensitivity skin tests.

Effect of Misoprostol on immune function in elderly subjects

The immunologic effects of misoprostol, an oral prostaglandin E 1 (PGE 1) analog, were tested in 25 individuals over age 65, compared to 25 individuals given placedo. Elderly subjects were chosen because previous in vitro studies had found an increased sensitivity to PGE of lymphocytes in older subjects. After two weeks of ingestion of misoprostol or placedo, there was a small but statistically significant decrease in IgM-rheumatois factor in the misoprostol group when compared to control and a significant decrease in the vitro sensitivity of lymphocytes from the misoprostol group to inhibition by PGE. There were no differences in total lymphocyte count, T cell or T cell subset count, delayed hypersensitivity skin test reactivity, serum immunoglobulins, or response to mitogens between the two groups. Therefore, the short term administration of an oral PGE analogue to normal elderly individuals is not associated with any detrimental effects on immunologic function after two weeks.

The relationship of nutritional parameters to mortality and septic complications.

The relationship of a number of nutritional parameters to mortality and sepsis was assessed in a group of 82 patients requiring total parenteral nutrition (TPN). Duration of TPN ranged from 9 to 105 days with a mean of 32.3 days. Parameters assessed were serum albumin, transferrin, absolute lymphocyte count (ALC), delayed hypersensitivity skin test reaction, mid-arm muscle circumference, triceps skin-fold thickness and weight. Combinations of parameters were found to be more useful than single parameters. The only single parameter of significance was ALC. The best overall predictor of death and/or sepsis was a combination of reduced serum albumin, transferrin, ALC and anergy, which was found to be related to a significantly higher mortality (P = 0.002) and incidence of septic complications (P = 0.003). This combination of parameters also had the best specificity (90%), accuracy (79%) and positive predictive value (65%) for prediction of death and/or sepsis. Increasing age was also found to be associated with a higher mortality (P less than 0.001) and increased incidence of septic complications (P = 0.01).

Booster effect in delayed hypersensitivity skin testing.

After a pilot study had suggested that a drug augmented delayed hypersensitivity, we conducted a control study in which 19 normal volunteers had the same skin test battery applied as in the pilot study, on two occasions one month apart with no intervening treatment. No change was observed in delayed hypersensitivity response to PPD, Candida, or tetanus antigens. However, a significant decrease in response to mumps antigen was observed, and there was a marked "booster" or augmented response to SKSD antigen. These observations have implications for studies of immunomodulation and the mechanism of action of delayed hypersensitivity response.

Vitamin E supplementation suppresses prostaglandin E 21 synthesis and enhances the immune response of aged mice

The potential for vitamin E to modulate prostaglandin metabolism and alter immune response in aged mice was studied. Semi-purified diets containing 30 ppm or 500 ppm dl-α-tocopheryl acetate (VitE) were fed for 6 weeks to young (3 months) and old (24 months) C57BL/6J mice. Delayed hypersensitivity skin test to DNFB and the proliferative response of splenocytes to T- and B-cell mitogens were assessed. Ex-vivo synthesis of Prostaglandin E 2 (PGE 2) was measured in spleen homogenates and serum vitamin E was measured by HPLC. Vitamin E supplementation of aged mice enhanced percent ear swelling to DNFB as well as the mitogenic response of splenocytes to Con A and LPS ( P < 0.05). Furthermore, spleen homogenates from old mice fed 30 ppm VitE had a significantly higher PGE 2 level than young mice fed 30 ppm VitE and old mice fed 500 ppm VitE (3.20 ± 0.07 μg/g vs. 2.60 ± 0.08 and 2.3 ± 0.10, respectively). Thus, the vitamin E enhanced immune response of aged mice appears to be mediated by decreased prostaglandin synthesis.

Effect of operation on certain parameters of humoral and cell-mediated immunity of the organism. 11. Delayed hypersensitivity skin test and blastic transformation. (Polish)

Effect of operation on certain parameters of humoral and cell-mediated immunity of the organism. 11. Delayed hypersensitivity skin test and blastic transformation. (Polish)

The Delayed Hypersensitivity Skin Test Response, Granulocyte Function and Sepsis in Surgical Patients

The Delayed Hypersensitivity Skin Test Response, Granulocyte Function and Sepsis in Surgical Patients

Anergy and the severely ill surgical patient.

Delayed hypersensitivity skin test reaction was evaluated using Multitest CMI, an implement which provides seven standardized antigens in a single application. Eighty-two patients requiring Total Parenteral Nutrition for a variety of conditions were studied. The incidence of anergy was 65%. Seven anergic patients died, but there were no deaths in the reactive group, this difference being significant (P = 0.04). There was a significant association of anergy with carcinoma (P = 0.007) and anergic patients with carcinoma had a significantly greater risk of dying than reactive patients without carcinoma (P = 0.038). Anergic patients also had significantly lower nutritional parameters of serum albumin (P = 0.04), transferrin (P less than 0.001), absolute lymphocyte count (P = 0.009) and mid-arm muscle circumference (P = 0.02) compared to the reactive group.