PPD/Mantoux Test Reactions

[SES4]

Hello. I am posting because this past week I experienced what was deemed an allergic reaction to the PPD/Mantoux test. This is the second time that this has happened.

Progression: Late in the first day and most of the second it appeared and felt as if it were going to end up being a positive result (red and felt kinda' like a pencil eraser). By the end of the second day and into the third it became apparent it was a pretty severe allergic reaction to the test. After oral and topical Benadryl and ice it died down and the color has died down but nonetheless it is persisting.

Is anybody else allergic to the PPD? And if so did you just simply get a chest film done to avoid said situation from happening again? Or did you simply continue getting the PPD done prepared for an allergic reaction and simply just dealt with it until it subsided?

 

[JPINFV]

Have you ever had or been exposed to TB?

 

[Markhk]

Some employers will take the results of the QUANTIFERON-TB GOLD test as an alternative to the PPD...QTF-Gold is a blood test. The test is much less of a headache interpretation wise.

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5415a4.htm

Not every doc office will do it though because it requires the mint vacutainer to go on ice and some testing labs don't have the tech to do it because it's pretty expensive.

 

[Aidey]

I've been told I'm allergic to it. Over the course of a year I worked 3 jobs that all required PPD testing, and no one would take anyone else's results. I ended up having 5 tests in something like 10 months, and after the last one I ended up with a huge, mildly swollen red rash on my arm. My employer sent me to a doc, who determined it was an allergic reaction. They didn't do a chest x-ray, and instead gave me a letter saying it was negative.

In the future though I have a feeling I'm going to end up having to get chest x-rays.

 

[HNcorpsman]

you need to talk to your doctor... was the induration (raised part) more than 5mm??? if so you are a tuberculin reactor... you need to start taking INH, probably should get a chest x-ray as well. quick question... were you ever given the BCG vaccine? if so, it is possible that you have a false-positive reaction... talk to your doc...

 

[emtjack02]

I have heard good things about the "new" (in my area although it's been out for a while now) blood test that was already talked about. I believe that for healthcare workers to be positive there needs to be a 10mm induration.

 

[marineman]

I have a slight reaction to one of the brands they use (I forget the name). Request the other one next time. Aplisol is the one that I don't have a reaction to.

 

[Ridryder911]

As described the site is measured and documented. The usual response is to have a titer drawn and a chest x-ray performed. In my state, one has to be cleared by the Department of Health and immediately offered medication treatment (one can refuse) until the final test results are interpreted. Once cleared, they have a acknowledgement that they are negative and are followed up in 6 months (as we require every 6 months testing).

I have two employees last month that had a + reaction and both are simply allergic to the testing material.


R/r 911

 

[SES4]

PPD Update

Thank you everyone!

A few answers to your inquiries

As to the question of exposure to TB: I have no idea honestly. With our patient population I would not be shocked if I have though.

Induration: It was slightly and I mean VERY slightly under 5mm.

Basically at this point they have recommended that I look into the blood test and have written a letter stating that I had an allergic reaction to the PPD. I am leaning toward seeing my own private M.D. and requesting that he send me for a chest x-ray so that I do not have to deal with this again. The chest x-ray PLUS the blood test should be sufficent for future proof that I am TB negative.

 

[Ridryder911]

Thank you everyone!

A few answers to your inquiries

As to the question of exposure to TB: I have no idea honestly. With our patient population I would not be shocked if I have though.

Induration: It was slightly and I mean VERY slightly under 5mm.

Basically at this point they have recommended that I look into the blood test and have written a letter stating that I had an allergic reaction to the PPD. I am leaning toward seeing my own private M.D. and requesting that he send me for a chest x-ray so that I do not have to deal with this again. The chest x-ray PLUS the blood test should be sufficent for future proof that I am TB negative.

Chances are you will have to have a letter as well from your Health Department as Tb is regarded a communicable disease and every + reaction has to be recorded and followed up. Most states require a follow up as again it is a required information for possible communicable disease.

R/r 911

 

[SES4]

Chances are you will have to have a letter as well from your Health Department as Tb is regarded a communicable disease and every + reaction has to be recorded and followed up. Most states require a follow up as again it is a required information for possible communicable disease.

R/r 911

I should clarify: It did not remain indurated though. By the third day (they checked the test site each day to monitor progress and because I made them ha ha) it was gone. So they are stating that it was an allergic reaction. I have a history though of anaphalaxysis and I am nervous to continutally expose myself to something that I am clearly allergic to.

 

[mycrofft]

Mighty minor allergy.

Mine never indurates and stays red for about six months. I'm deemed a negative with a reaction to the solution (unlikely, I have had it on my hands and not reacted) or to the materials besides the protein (more likely).

If you go out in public you ARE exposed to people who test positive. Period. The degree of exposure, their degree of communicability, mode of exposure (oral, nasal, gastric), and whether a droplet exposure was in high UV such as sunlight all make a difference.

If you test positive, are clinically negative and CXR negative, you are not contagious for now. Annual CXR recommended. Chemoprophylaxis...see your MD and ask her/his opinion.

If your "positive" test was not indurated, it was probably nergative unless it was given wrong (IM) or your immune system cannot muster a reaction.

Serial testing with modern PPD does not cause false positives like the old PPD used to.

Mantoux test is no longer standard, but might be used to expeditiously surveil large groups of people or where there is not enough money for PPD.

If you work in an ER, or in corrections or other high exposure rate areas, chances are very good you will test some degree of "positive" before you die, but there is little chance you will go on to develope the rest of the disease.

 

[HotelCo]

I just ask my doctor for a chest X-ray. Not because I'm allergic to the mantoux, but because it's more convenient for me. (Don't have to go back in and get it re-checked)

 

[Markhk]

Just remember though that the CXR isn't a one-off thing. Most employers will require an annual CXR to make sure that latent TB hasn't become active, along with a survey (i.e. "Do you cough blood up", "do you get night sweats", "how do you feel about consumption..." ).

 

[JPINFV]

"how do you feel about consumption...

That's a weak question.

 

[mycrofft]

Oh, I agree.

"How do you feel about consumption??!"
There!

 

[SES4]

consumption is sooooo yummy!

lmao. Riiigghht!