THE USE OF ANERGY PANELS IN CONJUNCTION WITH PPDS

Definition: When the immune system, specifically lymphocytes, fail to produce an immune response to a
specific antigen.

Indications: Immunosuppressed persons may have compromised ability to react to PPD-tuberculin skin
testing. Anergy testing is a diagnostic procedure used to obtain information regarding the competence of the
cellular immune system.

CDC recommendation (1997): the use of anergy testing in conjunction with PPD testing is no longer
recommended routinely for screening programs for M. tuberculosis infection conducted among HIV-infected
persons in the United States.

Drawbacks:
-Some individuals with TB exhibit specific anergy to TB antigen but respond to other antigens. Associated with
miliary TB
-HIV (+) individuals, who have not advanced to AIDS, and have (+) PPD results are just as likely to have no
response to the anergy panel as they are to have a (+) response.
-Geographic differences in reactivity. For ex. reactions to trichophyton are common in some areas but not in
others.
-Factors limiting the usefulness of anergy skin testing include problems with standardization and
reproducibility and the lack of apparent benefit of preventive therapy for groups of anergic HIV-infected
persons.

Causes of Immune Suppression:

-Sarcoidosis
-Corticosteroid use
-HIV
-Immunosuppressive drugs such as cyclosporine
-Severe malnutrition

Mechanism: Delayed type hypersensitivity reaction. Small amount of soluble antigen is introduced into the
dermis. Previously sensitized circulating T cells react with the antigen and release cytokines which generates
inflammatory reaction (vasculitis and edema).

Reaction appears 24-76 hrs.

Antigens:
Multitest Tetanus toxoid
Diphtheria toxoid
Candida albicans
Streptococcus antigen
Trichophyton antigen
Proteus antigen
Old Tuberculin
Mumps antigen

WCMC Trichophyton
Candida albicans
*pediatric dosing is the same.

Contraindications:
-Do not apply to acneiform, inflamed, infected skin sites.
-Known severe allergic reactions to antigens. Ex. reactions to the MMR vaccine. Epinephrine should be readily
available in case.

Adverse Reactions:
-Pain or pruritus over site.
-Systemic allergic reactions.
Positive result:
Multitest Induration ≥2 mm
If induration also occurs at glycerin (negative)
control, any positive induration is defined as being ≥2
mm larger than the control.
WMC >5 mm induration