Can You Be Allergic To The Tb Skin Test
Abstract
This report describes the frequency and characteristics of serious or life-threatening hypersensitivity reactions to the tuberculin pare test over an 11-yr period through Nov 2000. There were 24 reports and no deaths, indicating that such reactions are rare (0.08 reported reactions per million doses of tuberculin).
Tuberculin skin testing has for decades been an accepted help to diagnose latent infection with Mycobacterium tuberculosis [1]. One of the precautions listed in the product information sheet for tuberculin purified poly peptide derivative (Mantoux) (Tubersol; Aventis) is the "possibility of allergic reactions in individuals sensitive to the components of the product" [ii]. A review of the literature detected just 2 prior studies of allergic reactions to tuberculin (PPD) products [3, 4]. The purpose of the present report is to provide data on the frequency and characteristics of serious allergic reactions, presumably immediate hypersensitivity reactions, to the tuberculin skin examination.
Materials and methods . This review includes all adverse events for Tubersol that occurred in the Us and were reported to Aventis Pasteur. These events were reported on a Food and Drug Administration medical production program form (MEDWatch) [5]. Reports were received as spontaneous agin event reports made to the company and covered the xi-twelvemonth time period from 1 October 1989 to 30 November 2000. We excluded the following: reports with insufficient information, reports for which there was another explanation for the reaction, or reports where some other product such as a skin examination or vaccine was used simultaneously.
Results . There were 24 reports during this period that were classified as "serious," defined as resulting in decease, beingness life-threatening, requiring inpatient hospitalization or prolongation of existing hospitalization, or resulting in persistent or significant inability/incapacity. Fifteen reports were excluded: 11 were not considered to have been allergic events or to accept been triggered past a hypotensive type of hypersensitivity (paresthesia, cellulitis, seizure, breast hurting, viral infection, syncope, Guillain-Barré, and vaso-vagal reaction.), 2 had received another vaccine or skin test, and ii had bereft data. The remaining 9 patients had received only a tuberculin skin test. These were 8 women and 1 man, and the median age was 35.viii years (range, 24–53 years). Each had experienced an acute hypersensitivity reaction characterized past ⩾1 of the following findings within 48 h of skin testing: angioedema, urticaria, or dyspnea.
Table ane describes the characteristics of the astute hypersensitivity reactions in these 9 patients. None of these patients had cardiovascular shock, and there were no deaths. However, 8 of 9 patients were hospitalized, and several were reported to take received treatments commensurate with anaphylaxis. During this 11-year period there were ∼300 million doses of Tubersol distributed within the Us, although the actual number of doses used is unknown.
Table 1
Immediate hypersensitivity reactions reported as "serious" in patients who received simply Tubersol.
Table 1
Immediate hypersensitivity reactions reported as "serious" in patients who received only Tubersol.
Discussion . Even under the supposition of significant underreporting, the incidence of serious acute allergic reactions to tuberculin skin testing, specifically to Tubersol, is rare. We observed 24 serious reports in the United States over a time period in which ã300 million doses of tuberculin were distributed in the Usa, for an apparent incidence charge per unit of 0.08 per meg doses, well below 1 per meg doses.
In 1957, Cluff [3] reported a patient in whom immediate hypersensitivity to tuberculin adult later on 7–eight tuberculin tests over two years. In 1977, Tarlo et al. [4] reported that immediate hypersensitivity responses to 10 tuberculin units of PPD occurred in (2.iii%) of 3248 patients in an allergy clinic. The responses were all local reactions of the wheal and flare type, as observed with atopy. The mechanism for the immediate reactions was not elucidated by that study.
Immediate hypersensitivity reactions to tuberculin exercise occur, as shown by this review of our experience and past previous studies. Not–life-threatening reactions are non unusual; even so, serious reactions as reported in this review are quite rare. Nevertheless, this review reinforces a precaution and recommendation that epinephrine should ever be readily bachelor in the consequence that a serious acute hypersensitivity reaction does occur subsequently administration of a tuberculin skin test.
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© 2002 by the Infectious Diseases Gild of America
Source: https://academic.oup.com/cid/article/34/1/e12/312605
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