NAME OF DRUG
aspergillus skin test

CLASSIFICATION
Diagnostic agent

INDICATIONS

•  the test is used to establish the absence of cell-mediated immunity (anergy)

RECONSTITUTION AND STABILITY

• refrigerate 
• stable for 20 minutes only once drawn up in syringe - administer as soon as possible to minimize reduction in potency by adsorption 
• open vials stable x 30 days in fridge

COMPATIBILITY

• do not mix with other drugs

ROUTES OF ADMINISTRATION

• intradermal - preferred site is anterior surface of the upper and lower arm

VH & HSC ADMINISTRATION POLICY

C- Must be administered by Physician Exception: TB unit, Employee Health Centre and UBC Hospital where the nurses have been trained to administer and interpret this test

DOSAGE

• 0.1 mL intradermal using Mantoux technique (see patient care guidelines T-300)
• Interpretation: 
  • read test site in 48-72 hours
  • a response of >5mm induration is considered an intact cutaneous delayed-type hypersensitivty response and the patient should be considered non-anergic

POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION

• vesiculation, ulceration or necrosis may appear at the test site in highly sensitive individuals; application of ice packs may provide symptomatic relief 
• hypersensitivity reaction (urticaria, shortness of breath, anaphylaxis)

IMPORTANT IMPLICATIONS

• anergy testing utilizes those antigens to which an individual has likely been exposed in the past and to which a positive reaction would be expected 
• there is a possible loss of reactivity in elderly patients, those with suppressed immune systems due to illness (HIV) or medications (corticosteroids, chemotherapy), or recent administration of viral vaccines
• topical steroids should be discontinued at the skin test site for at least 2-3 weeks before skin testing 
• topical local anaesthetics may suppress the flare response and should be avoided in skin test sites

Sept 2002