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ALLERGY

Pediatric Case Series Evaluating a Standardized Candida albicans Skin Test Product

Associate Professor, Department of Pharmacy Practice, School of Pharmacy and Allied Health Professions, Creighton University, Omaha, NE; Manager, Pediatric Drug Information Service, Children's Hospital, Omaha

Jeanette M Manley, MT (ASCP) SM

Lead Medical Technologist, Microbiology, Pathology Department, Children's Hospital, Omaha

Archana Chatterjee, MD PhD

Assistant Professor, Pediatric Infectious Disease Division, School of Medicine, Creighton University; Hospital Epidemiologist, Children's Hospital, Omaha

Nancy E Cornish, MD

Pathologist and Director of Microbiology, Pathology Department, Children's Hospital, Omaha

Reprints: Linda K Ohri PharmD, Department of Pharmacy Practice, School of Pharmacy and Allied Health Professions, 2500 California Plaza, Creighton University, Omaha, NE 68178-0117, fax 402/280-1268, lohri{at}creighton.edu

BACKGROUND: A ready-to-use, standardized Candida albicans skin test product (Candin) first became available in 1995. As of April 6, 2004, no published reports have been found describing efficacy or safety with pediatric use of this reagent.

OBJECTIVE: To present a case series describing experience with use of Candin to assess 78 pediatric cases for delayed-type hypersensitivity.

METHODS: The standardized C. albicans reagent was one of up to 4 antigens used to evaluate patients' cellular immunity. Candin was used with purified protein derivative tuberculosis testing for 76 patients (4 mo–16 y of age) and for anergy testing alone in 2 cases. Candin was used with at least one other skin test reagent for 24 subjects.

RESULTS: Fifty-three of 78 subjects (68%) responded to at least one skin test antigen. Candin had an overall response rate of 64% (50/78). There was a response to Candin in 54% (13/24) of subjects with multiple reagents applied, the highest rate of any antigen used. There was a 27% (3/11) positive Candin response for subjects <1 year of age; this compared with 21% and 23% in 2 published reports on use of nonstandardized tests for this age group. No adverse events were associated with use of Candin.

CONCLUSIONS: Candin testing gives similar or better response rates compared with published data on older, nonstandardized C. albicans reagents and other anergy test antigens used in this case series. It should be used in combination with multiple other control antigens to most effectively assess for anergy, particularly in infants, as well as in patients recognized to be immune deficient.

Key Words: anergy, antigen, Candida albicans, Candin, cell-mediated immunity, children, delayed-type hypersensitivity

Published Online, April 14, 2004. www.theannals.com, DOI 10.1345/aph.1D518