Delayed Hypersensitivity Skin Reactions in the Elderly

Abstract

A delayed hypersensitivity response to skin tests was observed in 47 healthy elderly participants in a geriatric screening clinic. Forty-four subjects (94 per cent) reacted to at least one antigen. It was concluded that anergy is uncommon in the healthy elderly and should not be considered a normal aging phenomenon.Data regarding the incidence of anergy or delayed hypersensitivity skin reactions in an ambulant elderly population appear to be conflicting. Four have shown that from 0 to 36 per cent of healthy elderly persons are anergic. We defined anergic patients as follows: those in whom there was no reaction to any of five skin test antigens with at least 6 mm of induration. To further investigate cell-mediated immunity in the elderly, we performed a series of five skin tests on a group of ambulant elderly patients seen in a hospital screening clinic. PATIENTS AND METHODSForty-seven subjects were drawn from among 50 elderly patients seen consecutively in a geriatric screening clinic at Mount Zion Hospital; three patients refused to participate. The 47 subjects had the following characteristics: All were aged 60 or older, were ambulant, and had not been under the care of a physician or been hospitalized during the preceding year. No nursing home residents were included. The mean age was 70 years; 26 subjects were in the 60-69 age group, 18 in the 70-79 group, and three in the 80+ group. There were 31 women and 16 men. Thirty-three (70 per cent) were Caucasian, six (13 per cent) had Spanish surnames, six (13 per cent) were Asian, and two (4 per cent) were Negro. A medical history was obtained from each patient, and a complete physical examination and laboratory analyses (complete blood count, serum biochemical determinations, and urinalysis) were performed.Five antigens were used: Candida 1/100 (Hollister-Stier), mumps skin test antigen (Eli Lilly), coccidioidin 1/100 (Berkeley Biologicals), Trichophyton 1/100 (Hollister-Stier), and tuberculin 5 TU purified protein derivative (PPD). Each antigen (0.1 ml) was injected intradermally. Reactions were read 48 hours later by two physicians, following Sokol's model as described by Bates et al.s Induration measuring 0.6 mm or more in diameter was considered a positive result; this included tuberculin reactions. RESULTSSkin test results are listed in Tables 1 and 2. One patient who had had a severe tuberculin skin reaction in the past was not tested with PPD, but data are included for the four other antigens. Only three patients (6 per cent) showed no reactions with the skin tests and were considered anergic. Their ages were 63, 64, and 79 years. In the 79-year-old subject, a 40-mm area of erythema, but no induration, developed in response to Trichophyton. Another of the anergic patients, who had undergone a mastectomy for breast cancer three years previously, was hypercalcemic. Of the 14 positive results with PPD skin tests, 13 showed an induration larger than 10 mm; of these patients, all but two were Caucasian. DISCUSSIONThis study was undertaken to investigate delayed...

Anergy Testing in Nursing Home Residents

“…Although the elderly group responded to fewer antigens, it must be emphasized that 93% of our chronically ill aged subjects had one or more positive DCH responses, indicating that cellular‐mediated immunity is still functional. This high percentage of reactivity is similar to other studies where five or more antigens were used 4–6 …”

“…A battery of at least four to six antigens has been recommended to prevent a false diagnosis of anergy 7,8 . Lichtenstein et al 6 reported that 94% of an elderly population reacted to at least one DCH antigen when a total of five antigens were applied. When Cohn et al 4 used eight antigens in 29 elderly nursing home residents, all but one had at least one positive response.…”

The Immune Status of Healthy Centenarians

“…The immunocompetence of aging experimental animals and humans has been studied by many investigators 3–25 . Although there are significant changes in other components of the immune system (see below), the major defects appear to arise in the T‐lymphocyte population 10,14,16–20 .…”

“…Cells from aged experimental animals or humans are less capable of eliciting graft‐versus‐host reactions 27 in response to allogeneic lymphocytes 27 and soluble antigens 26 . In addition, some reports suggest that delayed hypersensitivity in response to Candida albicans , PPD (purified protein derivative), and mumps 21 is also impaired. This latter point, however, is contested by other investigators.…”

Persistent Cutaneous Cellular Immune Responsiveness in a Nursing Home Population

“…Numerous authors have observed decreased cutaneous delayed hypersensitivity in the elderly 1–7 . These studies have had uncertain applicability to the nursing home population, since they have examined either healthy older persons in the community or hospitalized patients, or have used only a limited number of antigens.…”