IMMUNOLOG
Prepared by: FRITZ VON T. GELLA, RMT, MD
College of Medicine
Davao Medical School Foundation, Inc.
SKIN TESTING
(PRELAB DISCUSSION)
Prepared by: FRITZ VON T. GELLA, RMT, MD
College of Medicine
Davao Medical School Foundation, Inc.
Learning Objectives
At the end of this video lecture, the students are
able to:
Apply the principle learned in different types of
hypersensitivity.
Understand the procedure in skin testing (penicillin
and tuberculin skin test).
Learn the correct interpretation of the tests.
Know the clinical importance of the tests.
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Materials Needed
• Penicillin vials
• PPD Mantoux kit
• PPD Sclavo kit
• Tuberculin syringes with
needles
• Distilled water for injection
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Penicillin Skin Testing
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Penicillin Skin Testing
Penicillin is the most common cause of drug induced
anaphylaxis and medication allergy.
Can accurately and safely distinguish between patients
who have IgE-mediated allergy and those who do not.
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Procedure
• 1. Dilute 1 vial of Penicillin with distilled water according to the
instructions written for reconstitution.
• 2. Get 0.2 ml from the reconstituted vial and add 0.9 ml of
distilled water.
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Procedure
3. Inject 0.1 ml intradermally on the volar surface of the forearm
just enough to make a wheal.
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Procedure
4. Mark the area of the wheal using a ballpoint and measure the
size of the wheal or swelling after 30 minutes.
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Interpretation
If the size of the wheal is greater than the original wheal after 30
minutes, the test is POSITIVE.
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Tuberculin Skin Testing
(TST)/ PPD Mantoux Test
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Tuberculin Skin Testing
The Mantoux tuberculin skin test (TST) is one
method of determining whether a person is infected with
Mycobacterium tuberculosis.
Reliable administration and reading of the TST
requires standardization of procedures, training,
supervision, and practice.
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Procedure
1. Reconstitute the PPD Mantoux kit according to the
instructions written on the vial.
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Procedure
2. Inject 0.1 ml intradermally on the volar surface of the
forearm.
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Procedure
2. Inject 0.1 ml intradermally on the volar surface of the
forearm.
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Procedure
3. Encircle the wheal using a ballpoint pen.
4. Measure the diameter size of the induration after 48-72
hours.
“The TST is read by palpating the site of injection to find an
area of induration (firm swelling). The diameter of the
indurated area should be measured across the forearm
(Figure 3.3). Erythema (redness) should not be measured.”
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Procedure
A
B
Induration should be recorded in millimeters, even those classified
as negative. If no induration is found, “0 mm” should be recorded.
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Interpretation
Interpretation
What Are False-Positive Reactions?
Some persons may react to the TST even though they
are not infected with M. tuberculosis.
• Previous TB vaccination with the bacille Calmette-Guérin (BCG)
vaccine
• Infection with nontuberculosis mycobacteria
(mycobacteria other than M. tuberculosis)
• Incorrect measurement or interpretation of reaction
• Incorrect antigen used
What Are False-Negative Reactions?
Some persons may not react to the TST even though they
are infected with M. tuberculosis.
• Anergy
• Recent TB infection (within the past 8 to 10 weeks)
• Very young age (younger than 6 months)
• Recent live-virus measles or smallpox vaccination
• Incorrect method of giving the TST
• Incorrect measuring or interpretation of TST reaction
Special Considerations When Using TST
The booster phenomenon occurs
mainly in previously infected, older
adults whose ability to react to
tuberculin has waned over time.
End of Lecture
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