The Mantoux Method is used for skin antigen testing, such as tuberculin skin testing (TST) with purified protein derivative (PPD) and anergy controls such as CANDIN®.1 The Mantoux skin test is administered using a needle and syringe to inject 0.1 mL of liquid tuberculin between the layers of the skin (intradermally), usually on the volar surface of forearm. Inspect the vial for particulates or discoloration, and do not use if present. Site should be prepared for injection with isopropyl alcohol or other disinfectant. The area should be free from any lesions, tattoos, hair, or other skin conditions that prevent clear interpretation of localized responses. Intradermal placement of the needle, bevel up, should produce some resistance to injection. Proper injection will produce blanching of the skin and a defined bleb (wheal) of about 5-10 mm in diameter. Care must be exercised to inject intradermally, as deeper, subcutaneous injections will prevent proper interpretation and intravenous injection could result in a dangerous allergic reaction.
When using an anergy control such as CANDIN® in conjunction with TST, each injection should be at least 2 inches (5 cm) apart, or preferably on separate arms. Each injection site should be properly identified to ensure proper interpretation. The patient should be observed for approximately half an hour in case of an allergic reaction. Any injected antigen has the potential to produce severe allergic reactions or anaphylaxis. Personnel, equipment, and medications needed to treat such reactions should be immediately available including 1:1000 epinephrine for injection. This is not all of the information needed for dosage and administration of CANDIN®. See Full Prescribing Information for additional details. Centers for Disease Control and Prevention.
The injection sites should be examined 48 hours after injection by a trained health care professional and not by the patient. The injection site of a positive reaction will develop over 24-48 hours resulting in an area of redness accompanied by a smaller palpable area of swelling or induration. The response of each injection site is measured across the largest diameter of palpable induration and NOT redness.
When measuring the site of CANDIN® injection, measure the largest diameter of the area of induration first and record. Then measure the orthogonal (perpendicular) diameter and record. The mean of the two measurements, or mean of induration, should be ≥5 mm for a positive CANDIN® response.
For a helpful reference, see the Centers for Disease Control and Prevention