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• W2103171938 abstract "It has been suggested that a false-negative delayed hypersensitivity skin reaction (DHR) to Trichophyton quinckeanum may result from an immediate hypersensitivity skin reaction (IHR) either by “washing” the antigen out of the skin or by “neutralization” of the antigen by the ingress of serum antibodies.1Hunziker N Brun R. Lack of delayed reaction in presence of cell-mediated immunity in trichophyton hypersensitivity.Arch Dermatol. 1980; 116: 1266-1268Crossref PubMed Scopus (13) Google Scholar Other studies with tetanus antigen have not shown this effect.2Fairshter RD Thornton DB Gottschalk HR Slater LM Galant SP. In vivo and in vitro cell-mediated immunity to tetanus toxoid in adults.J Allergy Clin Immunol. 1980; 66: 452-457Abstract Full Text PDF PubMed Scopus (28) Google Scholar In chronic fatigue syndrome (CFS), a variety of immunologic abnormalities have been reported including a high incidence of atopy3Steinberg P McNutt BJ Marshall P Schenck C Lurie N Pheley A et al.Double-blind placebo-controlled study of the efficacy of oral terfenadine in the treatment of chronic fatigue syndrome.J Allergy Clin Immunol. 1996; 97: 119-126Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar and hypoergia or anergy.4Lloyd AR Wakefield D Boughton CR Dwyer JM. Immunological abnormalities in the chronic fatigue syndrome.Med J Aust. 1989; 151: 122-124PubMed Google Scholar If an interaction exists between IHR and DHR, this could be important in the interpretation of hypoergia and anergy.METHODSPatientsThirty patients with CFS, 18 years of age or older, were recruited from the registry of the Minnesota Regional CFS Research Program established at Hennepin County Medical Center, Minneapolis, Minn., in 1988.5Peterson PK Schenck CH Sherman R. Chronic fatigue syndrome in Minnesota.Minn Med. 1991; 74: 21-26PubMed Google Scholar A diagnosis of CFS was established after thorough medical, psychometric, and psychiatric evaluations did not establish another explanation for chronic fatigue and after the other criteria for a case definition of CFS were met.6Holmes GP Kaplan JE Gantz NM Kormaroff AL Schonberger LB Straus SE et al.Chronic fatigue syndrome: a working case definition.Ann Intern Med. 1988; 108: 387-389Crossref PubMed Scopus (1405) Google ScholarSkin testingAll patients had not received antihistamines, tricyclic antidepressants, and corticosteroids for at least 30 days before testing.DHR testing was done with five standardized antigens: tetanus (neat; Sclavo Labs, Wayne, N.J.), mumps (neat; Connaught, Swiftwater, Pa.), Candida albicans (1:100; Miles Labs, West Haven, Conn.), Trichophyton mentagrophytes (1:1000, Greer Labs, Lenoir, N.C.), and tuberculin (5 tuberculin units; Connaught, Swiftwater, Pa.). Phosphate-buffered saline was used as a negative control. Intradermal tests were done by injecting 0.1 ml through a no. 27 tuberculin syringe. IHRs were read at 15 minutes. The wheal and erythema were outlined with a fine-tip pen. The longest diameters connecting the inner margins of the pen outlines were measured, and at the midpoint of each line, a perpendicular diameter (orthogonal diameter) was drawn. Results of IHR tests were considered positive if the net mean wheal or erythema diameter (mean wheal or erythema diameter = largest + midpoint orthogonal diameter ÷ 2) was 3 or more mm larger than that of the phosphate-buffered saline control. Intradermal tests were read at 48 hours, and results were considered positive if the net mean induration diameter (mean induration diameters ÷ 2 was ≥5 mm).Statistical methodsA Student’s t test was used to compare the overall skin reactions between the two groups.RESULTSDemographicsThe demographic features of the 30 study participants showed that 23 of 30 (77%) were women. The 30 subjects ranged in age from 19 to 74 years (mean age, 36.2 years).Delayed hypersensitivityAll patients had a positive delayed skin test response to at least one antigen. There was a mean of 2.3 positive skin test responses per patient (range, 1 to 4). The mean induration diameter was 11.7 mm. The percent positive for each antigen is shown in Table I.Table IThe effect of immediate reactivity on the mean 48-hour induration in 30 patients with CFSNegative immediate reactionPositive immediate reactionInduration (mm)Induration (mm)48-hr induration (% positive)NoMeanSDNo.MeanSDC. albicans37119.22.20——T. mentagrophytes10317.74.31——Mumps83129.14.3118.12.3Tuberculin31——0——Tetanus972013.23.6912.64.8Totals*1004711.54.22111.87.5*p = 0.82 (t = 0.23). Open table in a new tab Immediate hypersensitivityOf the 68 positive delayed reactions, 31% were preceded by immediate reactions to one of the five antigens: C. albicans, 0 of 11 (0%); T. mentagrophytes, 1 of 4 (25%); mumps, 11 of 23 (48%); tuberculin, 0 of 1 (0%); and tetanus toxoid, 9 of 29 (31%). There were 11 patients who had immediate reactions without delayed reactions: C. albicans, 5 of 30 (17%); T. mentagrophytes, 5 of 30 (17%); mumps, 12 of 30 (40%); tuberculin, 0 of 30 (0%); and tetanus, 9 of 30 (30%). No significant association was observed between the IHR skin test findings and the DHR skin test results (p = 0.82, t = 0.23) (Table I).DISCUSSIONThe results of our DHR tests have been reported.3Steinberg P McNutt BJ Marshall P Schenck C Lurie N Pheley A et al.Double-blind placebo-controlled study of the efficacy of oral terfenadine in the treatment of chronic fatigue syndrome.J Allergy Clin Immunol. 1996; 97: 119-126Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar The induration measured at 48 hours in DHR appears to be due in large part to the deposition of extracellular fibrin, which clots and gels after cross-linking. The source of the fibrin appears to be extravasated plasma fibrinogen from increased microvascular permeability at the site. The formed fibrin mesh, which is essential to development of induration, also contains inflammatory cells and extravasated plasma and fibronectin.7Askenase PW. Effector and regulatory mechanisms in delayed-type hypersensitivity.in: 4th ed. Allergy: principles and practice. Mosby, St. Louis1993: 362-389Google ScholarSeveral studies have suggested that IHR could influence DHR. Marcussen8Marcussen PV. Relationship of the urticarial to the inflammatory reaction to trichophyton.Arch Dermatol. 1937; 36: 494-514Crossref Scopus (7) Google Scholar showed that a passively transferred IHR blocked or reduced the DHR in patients who had had only a DHR to Trichophyton spp. Hunziker and Brun1Hunziker N Brun R. Lack of delayed reaction in presence of cell-mediated immunity in trichophyton hypersensitivity.Arch Dermatol. 1980; 116: 1266-1268Crossref PubMed Scopus (13) Google Scholar reported that five atopic patients with chronic dermatophytosis who had no DHR to Trichophyton quinckeanum after a strong IHR experienced a strong DHR after trichophyton was injected into the wheal 20 minutes after the first injection.Our observations of 31% of delayed tetanus reactions preceded by IHR and lack of association between IHR and DHR are in agreement with those of Fairshter et al.2Fairshter RD Thornton DB Gottschalk HR Slater LM Galant SP. In vivo and in vitro cell-mediated immunity to tetanus toxoid in adults.J Allergy Clin Immunol. 1980; 66: 452-457Abstract Full Text PDF PubMed Scopus (28) Google Scholar who used tetanus toxoid and reported an IHR in 45% of subjects tested and that the size of the DHR did not differ in those with a preceding IHR.Studies of skin responses to Trichophyton spp. in patients suggest that, in some, an IHR precedes the 24-hour DHR.9Woodfolk JA Slunt JB Deuell B Hayden ML Platts-Mills TAE. Definition of a Trichophyton protein associated with delayed hypersensitivity in humans.J Immunol. 1996; 156: 1695-1701PubMed Google Scholar In addition to vascular permeability changes resulting from gap formation between endothelial cells, these gaps may induce the expression of adhesion molecules facilitating migration into the site of CD4+ T cells, which promote the DHR.7Askenase PW. Effector and regulatory mechanisms in delayed-type hypersensitivity.in: 4th ed. Allergy: principles and practice. Mosby, St. Louis1993: 362-389Google Scholar Even though extravasation of fluid caused by increased vascular permeability occurs in IHR, our results suggest that either the extravascular fluid removes an insignificant amount of antigen, or if a significant amount is removed, that upregulation of the DHR, as a consequence of the extravasation compensates for the loss. It has been suggested that a false-negative delayed hypersensitivity skin reaction (DHR) to Trichophyton quinckeanum may result from an immediate hypersensitivity skin reaction (IHR) either by “washing” the antigen out of the skin or by “neutralization” of the antigen by the ingress of serum antibodies.1Hunziker N Brun R. Lack of delayed reaction in presence of cell-mediated immunity in trichophyton hypersensitivity.Arch Dermatol. 1980; 116: 1266-1268Crossref PubMed Scopus (13) Google Scholar Other studies with tetanus antigen have not shown this effect.2Fairshter RD Thornton DB Gottschalk HR Slater LM Galant SP. In vivo and in vitro cell-mediated immunity to tetanus toxoid in adults.J Allergy Clin Immunol. 1980; 66: 452-457Abstract Full Text PDF PubMed Scopus (28) Google Scholar In chronic fatigue syndrome (CFS), a variety of immunologic abnormalities have been reported including a high incidence of atopy3Steinberg P McNutt BJ Marshall P Schenck C Lurie N Pheley A et al.Double-blind placebo-controlled study of the efficacy of oral terfenadine in the treatment of chronic fatigue syndrome.J Allergy Clin Immunol. 1996; 97: 119-126Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar and hypoergia or anergy.4Lloyd AR Wakefield D Boughton CR Dwyer JM. Immunological abnormalities in the chronic fatigue syndrome.Med J Aust. 1989; 151: 122-124PubMed Google Scholar If an interaction exists between IHR and DHR, this could be important in the interpretation of hypoergia and anergy. METHODSPatientsThirty patients with CFS, 18 years of age or older, were recruited from the registry of the Minnesota Regional CFS Research Program established at Hennepin County Medical Center, Minneapolis, Minn., in 1988.5Peterson PK Schenck CH Sherman R. Chronic fatigue syndrome in Minnesota.Minn Med. 1991; 74: 21-26PubMed Google Scholar A diagnosis of CFS was established after thorough medical, psychometric, and psychiatric evaluations did not establish another explanation for chronic fatigue and after the other criteria for a case definition of CFS were met.6Holmes GP Kaplan JE Gantz NM Kormaroff AL Schonberger LB Straus SE et al.Chronic fatigue syndrome: a working case definition.Ann Intern Med. 1988; 108: 387-389Crossref PubMed Scopus (1405) Google ScholarSkin testingAll patients had not received antihistamines, tricyclic antidepressants, and corticosteroids for at least 30 days before testing.DHR testing was done with five standardized antigens: tetanus (neat; Sclavo Labs, Wayne, N.J.), mumps (neat; Connaught, Swiftwater, Pa.), Candida albicans (1:100; Miles Labs, West Haven, Conn.), Trichophyton mentagrophytes (1:1000, Greer Labs, Lenoir, N.C.), and tuberculin (5 tuberculin units; Connaught, Swiftwater, Pa.). Phosphate-buffered saline was used as a negative control. Intradermal tests were done by injecting 0.1 ml through a no. 27 tuberculin syringe. IHRs were read at 15 minutes. The wheal and erythema were outlined with a fine-tip pen. The longest diameters connecting the inner margins of the pen outlines were measured, and at the midpoint of each line, a perpendicular diameter (orthogonal diameter) was drawn. Results of IHR tests were considered positive if the net mean wheal or erythema diameter (mean wheal or erythema diameter = largest + midpoint orthogonal diameter ÷ 2) was 3 or more mm larger than that of the phosphate-buffered saline control. Intradermal tests were read at 48 hours, and results were considered positive if the net mean induration diameter (mean induration diameters ÷ 2 was ≥5 mm).Statistical methodsA Student’s t test was used to compare the overall skin reactions between the two groups. PatientsThirty patients with CFS, 18 years of age or older, were recruited from the registry of the Minnesota Regional CFS Research Program established at Hennepin County Medical Center, Minneapolis, Minn., in 1988.5Peterson PK Schenck CH Sherman R. Chronic fatigue syndrome in Minnesota.Minn Med. 1991; 74: 21-26PubMed Google Scholar A diagnosis of CFS was established after thorough medical, psychometric, and psychiatric evaluations did not establish another explanation for chronic fatigue and after the other criteria for a case definition of CFS were met.6Holmes GP Kaplan JE Gantz NM Kormaroff AL Schonberger LB Straus SE et al.Chronic fatigue syndrome: a working case definition.Ann Intern Med. 1988; 108: 387-389Crossref PubMed Scopus (1405) Google Scholar Thirty patients with CFS, 18 years of age or older, were recruited from the registry of the Minnesota Regional CFS Research Program established at Hennepin County Medical Center, Minneapolis, Minn., in 1988.5Peterson PK Schenck CH Sherman R. Chronic fatigue syndrome in Minnesota.Minn Med. 1991; 74: 21-26PubMed Google Scholar A diagnosis of CFS was established after thorough medical, psychometric, and psychiatric evaluations did not establish another explanation for chronic fatigue and after the other criteria for a case definition of CFS were met.6Holmes GP Kaplan JE Gantz NM Kormaroff AL Schonberger LB Straus SE et al.Chronic fatigue syndrome: a working case definition.Ann Intern Med. 1988; 108: 387-389Crossref PubMed Scopus (1405) Google Scholar Skin testingAll patients had not received antihistamines, tricyclic antidepressants, and corticosteroids for at least 30 days before testing.DHR testing was done with five standardized antigens: tetanus (neat; Sclavo Labs, Wayne, N.J.), mumps (neat; Connaught, Swiftwater, Pa.), Candida albicans (1:100; Miles Labs, West Haven, Conn.), Trichophyton mentagrophytes (1:1000, Greer Labs, Lenoir, N.C.), and tuberculin (5 tuberculin units; Connaught, Swiftwater, Pa.). Phosphate-buffered saline was used as a negative control. Intradermal tests were done by injecting 0.1 ml through a no. 27 tuberculin syringe. IHRs were read at 15 minutes. The wheal and erythema were outlined with a fine-tip pen. The longest diameters connecting the inner margins of the pen outlines were measured, and at the midpoint of each line, a perpendicular diameter (orthogonal diameter) was drawn. Results of IHR tests were considered positive if the net mean wheal or erythema diameter (mean wheal or erythema diameter = largest + midpoint orthogonal diameter ÷ 2) was 3 or more mm larger than that of the phosphate-buffered saline control. Intradermal tests were read at 48 hours, and results were considered positive if the net mean induration diameter (mean induration diameters ÷ 2 was ≥5 mm). All patients had not received antihistamines, tricyclic antidepressants, and corticosteroids for at least 30 days before testing. DHR testing was done with five standardized antigens: tetanus (neat; Sclavo Labs, Wayne, N.J.), mumps (neat; Connaught, Swiftwater, Pa.), Candida albicans (1:100; Miles Labs, West Haven, Conn.), Trichophyton mentagrophytes (1:1000, Greer Labs, Lenoir, N.C.), and tuberculin (5 tuberculin units; Connaught, Swiftwater, Pa.). Phosphate-buffered saline was used as a negative control. Intradermal tests were done by injecting 0.1 ml through a no. 27 tuberculin syringe. IHRs were read at 15 minutes. The wheal and erythema were outlined with a fine-tip pen. The longest diameters connecting the inner margins of the pen outlines were measured, and at the midpoint of each line, a perpendicular diameter (orthogonal diameter) was drawn. Results of IHR tests were considered positive if the net mean wheal or erythema diameter (mean wheal or erythema diameter = largest + midpoint orthogonal diameter ÷ 2) was 3 or more mm larger than that of the phosphate-buffered saline control. Intradermal tests were read at 48 hours, and results were considered positive if the net mean induration diameter (mean induration diameters ÷ 2 was ≥5 mm). Statistical methodsA Student’s t test was used to compare the overall skin reactions between the two groups. A Student’s t test was used to compare the overall skin reactions between the two groups. RESULTSDemographicsThe demographic features of the 30 study participants showed that 23 of 30 (77%) were women. The 30 subjects ranged in age from 19 to 74 years (mean age, 36.2 years).Delayed hypersensitivityAll patients had a positive delayed skin test response to at least one antigen. There was a mean of 2.3 positive skin test responses per patient (range, 1 to 4). The mean induration diameter was 11.7 mm. The percent positive for each antigen is shown in Table I.Table IThe effect of immediate reactivity on the mean 48-hour induration in 30 patients with CFSNegative immediate reactionPositive immediate reactionInduration (mm)Induration (mm)48-hr induration (% positive)NoMeanSDNo.MeanSDC. albicans37119.22.20——T. mentagrophytes10317.74.31——Mumps83129.14.3118.12.3Tuberculin31——0——Tetanus972013.23.6912.64.8Totals*1004711.54.22111.87.5*p = 0.82 (t = 0.23). Open table in a new tab Immediate hypersensitivityOf the 68 positive delayed reactions, 31% were preceded by immediate reactions to one of the five antigens: C. albicans, 0 of 11 (0%); T. mentagrophytes, 1 of 4 (25%); mumps, 11 of 23 (48%); tuberculin, 0 of 1 (0%); and tetanus toxoid, 9 of 29 (31%). There were 11 patients who had immediate reactions without delayed reactions: C. albicans, 5 of 30 (17%); T. mentagrophytes, 5 of 30 (17%); mumps, 12 of 30 (40%); tuberculin, 0 of 30 (0%); and tetanus, 9 of 30 (30%). No significant association was observed between the IHR skin test findings and the DHR skin test results (p = 0.82, t = 0.23) (Table I). DemographicsThe demographic features of the 30 study participants showed that 23 of 30 (77%) were women. The 30 subjects ranged in age from 19 to 74 years (mean age, 36.2 years). The demographic features of the 30 study participants showed that 23 of 30 (77%) were women. The 30 subjects ranged in age from 19 to 74 years (mean age, 36.2 years). Delayed hypersensitivityAll patients had a positive delayed skin test response to at least one antigen. There was a mean of 2.3 positive skin test responses per patient (range, 1 to 4). The mean induration diameter was 11.7 mm. The percent positive for each antigen is shown in Table I.Table IThe effect of immediate reactivity on the mean 48-hour induration in 30 patients with CFSNegative immediate reactionPositive immediate reactionInduration (mm)Induration (mm)48-hr induration (% positive)NoMeanSDNo.MeanSDC. albicans37119.22.20——T. mentagrophytes10317.74.31——Mumps83129.14.3118.12.3Tuberculin31——0——Tetanus972013.23.6912.64.8Totals*1004711.54.22111.87.5*p = 0.82 (t = 0.23). Open table in a new tab All patients had a positive delayed skin test response to at least one antigen. There was a mean of 2.3 positive skin test responses per patient (range, 1 to 4). The mean induration diameter was 11.7 mm. The percent positive for each antigen is shown in Table I. *p = 0.82 (t = 0.23). Immediate hypersensitivityOf the 68 positive delayed reactions, 31% were preceded by immediate reactions to one of the five antigens: C. albicans, 0 of 11 (0%); T. mentagrophytes, 1 of 4 (25%); mumps, 11 of 23 (48%); tuberculin, 0 of 1 (0%); and tetanus toxoid, 9 of 29 (31%). There were 11 patients who had immediate reactions without delayed reactions: C. albicans, 5 of 30 (17%); T. mentagrophytes, 5 of 30 (17%); mumps, 12 of 30 (40%); tuberculin, 0 of 30 (0%); and tetanus, 9 of 30 (30%). No significant association was observed between the IHR skin test findings and the DHR skin test results (p = 0.82, t = 0.23) (Table I). Of the 68 positive delayed reactions, 31% were preceded by immediate reactions to one of the five antigens: C. albicans, 0 of 11 (0%); T. mentagrophytes, 1 of 4 (25%); mumps, 11 of 23 (48%); tuberculin, 0 of 1 (0%); and tetanus toxoid, 9 of 29 (31%). There were 11 patients who had immediate reactions without delayed reactions: C. albicans, 5 of 30 (17%); T. mentagrophytes, 5 of 30 (17%); mumps, 12 of 30 (40%); tuberculin, 0 of 30 (0%); and tetanus, 9 of 30 (30%). No significant association was observed between the IHR skin test findings and the DHR skin test results (p = 0.82, t = 0.23) (Table I). DISCUSSIONThe results of our DHR tests have been reported.3Steinberg P McNutt BJ Marshall P Schenck C Lurie N Pheley A et al.Double-blind placebo-controlled study of the efficacy of oral terfenadine in the treatment of chronic fatigue syndrome.J Allergy Clin Immunol. 1996; 97: 119-126Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar The induration measured at 48 hours in DHR appears to be due in large part to the deposition of extracellular fibrin, which clots and gels after cross-linking. The source of the fibrin appears to be extravasated plasma fibrinogen from increased microvascular permeability at the site. The formed fibrin mesh, which is essential to development of induration, also contains inflammatory cells and extravasated plasma and fibronectin.7Askenase PW. Effector and regulatory mechanisms in delayed-type hypersensitivity.in: 4th ed. Allergy: principles and practice. Mosby, St. Louis1993: 362-389Google ScholarSeveral studies have suggested that IHR could influence DHR. Marcussen8Marcussen PV. Relationship of the urticarial to the inflammatory reaction to trichophyton.Arch Dermatol. 1937; 36: 494-514Crossref Scopus (7) Google Scholar showed that a passively transferred IHR blocked or reduced the DHR in patients who had had only a DHR to Trichophyton spp. Hunziker and Brun1Hunziker N Brun R. Lack of delayed reaction in presence of cell-mediated immunity in trichophyton hypersensitivity.Arch Dermatol. 1980; 116: 1266-1268Crossref PubMed Scopus (13) Google Scholar reported that five atopic patients with chronic dermatophytosis who had no DHR to Trichophyton quinckeanum after a strong IHR experienced a strong DHR after trichophyton was injected into the wheal 20 minutes after the first injection.Our observations of 31% of delayed tetanus reactions preceded by IHR and lack of association between IHR and DHR are in agreement with those of Fairshter et al.2Fairshter RD Thornton DB Gottschalk HR Slater LM Galant SP. In vivo and in vitro cell-mediated immunity to tetanus toxoid in adults.J Allergy Clin Immunol. 1980; 66: 452-457Abstract Full Text PDF PubMed Scopus (28) Google Scholar who used tetanus toxoid and reported an IHR in 45% of subjects tested and that the size of the DHR did not differ in those with a preceding IHR.Studies of skin responses to Trichophyton spp. in patients suggest that, in some, an IHR precedes the 24-hour DHR.9Woodfolk JA Slunt JB Deuell B Hayden ML Platts-Mills TAE. Definition of a Trichophyton protein associated with delayed hypersensitivity in humans.J Immunol. 1996; 156: 1695-1701PubMed Google Scholar In addition to vascular permeability changes resulting from gap formation between endothelial cells, these gaps may induce the expression of adhesion molecules facilitating migration into the site of CD4+ T cells, which promote the DHR.7Askenase PW. Effector and regulatory mechanisms in delayed-type hypersensitivity.in: 4th ed. Allergy: principles and practice. Mosby, St. Louis1993: 362-389Google Scholar Even though extravasation of fluid caused by increased vascular permeability occurs in IHR, our results suggest that either the extravascular fluid removes an insignificant amount of antigen, or if a significant amount is removed, that upregulation of the DHR, as a consequence of the extravasation compensates for the loss. The results of our DHR tests have been reported.3Steinberg P McNutt BJ Marshall P Schenck C Lurie N Pheley A et al.Double-blind placebo-controlled study of the efficacy of oral terfenadine in the treatment of chronic fatigue syndrome.J Allergy Clin Immunol. 1996; 97: 119-126Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar The induration measured at 48 hours in DHR appears to be due in large part to the deposition of extracellular fibrin, which clots and gels after cross-linking. The source of the fibrin appears to be extravasated plasma fibrinogen from increased microvascular permeability at the site. The formed fibrin mesh, which is essential to development of induration, also contains inflammatory cells and extravasated plasma and fibronectin.7Askenase PW. Effector and regulatory mechanisms in delayed-type hypersensitivity.in: 4th ed. Allergy: principles and practice. Mosby, St. Louis1993: 362-389Google Scholar Several studies have suggested that IHR could influence DHR. Marcussen8Marcussen PV. Relationship of the urticarial to the inflammatory reaction to trichophyton.Arch Dermatol. 1937; 36: 494-514Crossref Scopus (7) Google Scholar showed that a passively transferred IHR blocked or reduced the DHR in patients who had had only a DHR to Trichophyton spp. Hunziker and Brun1Hunziker N Brun R. Lack of delayed reaction in presence of cell-mediated immunity in trichophyton hypersensitivity.Arch Dermatol. 1980; 116: 1266-1268Crossref PubMed Scopus (13) Google Scholar reported that five atopic patients with chronic dermatophytosis who had no DHR to Trichophyton quinckeanum after a strong IHR experienced a strong DHR after trichophyton was injected into the wheal 20 minutes after the first injection. Our observations of 31% of delayed tetanus reactions preceded by IHR and lack of association between IHR and DHR are in agreement with those of Fairshter et al.2Fairshter RD Thornton DB Gottschalk HR Slater LM Galant SP. In vivo and in vitro cell-mediated immunity to tetanus toxoid in adults.J Allergy Clin Immunol. 1980; 66: 452-457Abstract Full Text PDF PubMed Scopus (28) Google Scholar who used tetanus toxoid and reported an IHR in 45% of subjects tested and that the size of the DHR did not differ in those with a preceding IHR. Studies of skin responses to Trichophyton spp. in patients suggest that, in some, an IHR precedes the 24-hour DHR.9Woodfolk JA Slunt JB Deuell B Hayden ML Platts-Mills TAE. Definition of a Trichophyton protein associated with delayed hypersensitivity in humans.J Immunol. 1996; 156: 1695-1701PubMed Google Scholar In addition to vascular permeability changes resulting from gap formation between endothelial cells, these gaps may induce the expression of adhesion molecules facilitating migration into the site of CD4+ T cells, which promote the DHR.7Askenase PW. Effector and regulatory mechanisms in delayed-type hypersensitivity.in: 4th ed. Allergy: principles and practice. Mosby, St. Louis1993: 362-389Google Scholar Even though extravasation of fluid caused by increased vascular permeability occurs in IHR, our results suggest that either the extravascular fluid removes an insignificant amount of antigen, or if a significant amount is removed, that upregulation of the DHR, as a consequence of the extravasation compensates for the loss." @default.
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• W2103171938 title "Influence of immediate hypersensitivity skin reactions on delayed reactions in patients with chronic fatigue syndrome☆☆☆★★★" @default.
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