TB test - potential antaphylactic reaction

Mandychelle79, ASN, RN · Jun 6, 2011

I just saw a closed thread about a nurse who had swelling, itching two hours post TB test. I had a similar reaction to the test, which was administered in employee health. I received the test and then went across the hall to have my ID photo taken. At that time, I mentioned that I felt odd and my arm tingled. I asked aloud, "I wonder if I am alergic to the test." Looked at the arm and it looked normal. I shruged it off, drove 2 hrs home, and then found the arm had was swollen and red--limited to the arm only. Returned to employee health and was told from that time on I could not have the test.
After a few years, I tried the test again and was under observation for a number of hours--just in case. No alergic response. Since then, I have had numerous tests without the alergic reaction and they were all negative.
QUESTION: Has anyone else had such a reaction?

I did not to the TB test, But I have reacted like that to a Flu Shot. But have had them since with no issue

Esme12, ASN, BSN, RN · Jun 6, 2011

The thread was probably closed because we can't give medical advice. Immunizations years ago were very different that they are now. Localized reactions are VERY common as well as low grade temps. Anaphylaxis is a life threatening reaction to an allergen......

http://www.nlm.nih.gov/medlineplus/ency/article/000844.htm

Immuinizations were at one time made more from live cells and preservatives were used that are no longer used. Immunizations are more hypoallergenic than ever. TB has a preservative called PHENOL as does the MMR if given a 2 step TB test.

http://www.nationaltbcenter.edu/

You need to seek medical attention if you are having a reaction or see an allergist/immunologist to test/treat any allergies......I hope this helps

chicookie, BSN, RN · Jun 6, 2011

My first and only TB test was positive and most of my forearm was red, warm to touch (it was super hot to me) and swollen from the elbow down. They actually had to hunt down an infectious disease doctor to read it to be sure. He said I was allergic to it but it was still positive. *shrugs* I haven't had another one.

It is my understanding that an allergic reaction is rare. Anything strange that happens with it should always be checked by a medical professional that knows what they are doing.

LadyinScrubs, ASN, RN · Jun 6, 2011

immunizations years ago were very different that they are now. localized reactions are very common as well as low grade temps. anaphylaxis is a life threatening reaction to an allergen......[/quote]
should have given a timeframe: 3 years ago. i am very much aware of the issues with anaphylaxis; i have one allergy--very odd anaphylactic allergy--and this test would definitely not have that allergen. [oh, where or where is that epipen and has its used date expired....].
just curous how many others may have had such a response.

Esme12, ASN, BSN, RN · Jun 6, 2011

immunizations years ago were very different that they are now. localized reactions are very common as well as low grade temps. anaphylaxis is a life threatening reaction to an allergen......[/quote]
should have given a timeframe: 3 years ago. i am very much aware of the issues with anaphylaxis; i have one allergy--very odd anaphylactic allergy--and this test would definitely not have that allergen. [oh, where or where is that epipen and has its used date expired....].
just curous how many others may have had such a response.
like i said........rections to tb/phenol are very common.....opt for a cxr instead.

KatieMI, BSN, MSN, RN · Jun 6, 2011

The thing injected during "TB test" has, basically, two components: TB bacterial lipoprotein and the solution which stabilizes and preserves it. The lipoprotein itself is expected to cause T-cells mediated local reaction (so-called IV type) in case of previous sensitization (i.e. contact with these bacteria leading to immune responce, the bacteria being either pathogenic or BCG type used for vaccination). These reactions take at the very least 24 hours to develop. As far as I know, this substance itself cannot cause anaphylaxy and type I allergic reactions in general because of its high lipid content.

If something shows at the palce of injection in just a couple of hours, then it most probably should be I type reaction (associated with release of histamin and anaphylaxis) on components of the solution or something which was around there at the time of injection. The solution, of course, is supposed to be free from any substances commonly causing allergies, but this question is really a tricky one. For example, aforementioned (and quite ubiquitous) preservative phenol theoretically cannot cause allergic reactions at all because its molecule isn't big and complex enough. But in reality it can cause both non-antibody associated histamin release (which is, technically, not an allergy but looks just like one) and true allergic reactions caused by complexes made of phenol with other substances. Cotton balls used during the injection may be contaminated with latex. In some people components of cosmetics (such as avobenzone) and sunlight can increase production of oxygen radicals which, in turn, cause local release of histamin after every minor skin injury.

These reactions might be rare, but I would suggest seeing a good allergologist ASAP. Better to be safe than sorry!

Esme12, ASN, BSN, RN · Jun 6, 2011

The thing injected during "TB test" has, basically, two components: TB bacterial lipoprotein and the solution which stabilizes and preserves it. The lipoprotein itself is expected to cause T-cells mediated local reaction (so-called IV type) in case of previous sensitization (i.e. contact with these bacteria leading to immune responce, the bacteria being either pathogenic or BCG type used for vaccination). These reactions take at the very least 24 hours to develop. As far as I know, this substance itself cannot cause anaphylaxy and type I allergic reactions in general because of its high lipid content.
If something shows at the palce of injection in just a couple of hours, then it most probably should be I type reaction (associated with release of histamin and anaphylaxis) on components of the solution or something which was around there at the time of injection. The solution, of course, is supposed to be free from any substances commonly causing allergies, but this question is really a tricky one. For example, aforementioned (and quite ubiquitous) preservative phenol theoretically cannot cause allergic reactions at all because its molecule isn't big and complex enough. But in reality it can cause both non-antibody associated histamin release (which is, technically, not an allergy but looks just like one) and true allergic reactions caused by complexes made of phenol with other substances. Cotton balls used during the injection may be contaminated with latex. In some people components of cosmetics (such as avobenzone) and sunlight can increase production of oxygen radicals which, in turn, cause local release of histamin after every minor skin injury.
These reactions might be rare, but I would suggest seeing a good allergologist ASAP. Better to be safe than sorry!

Agreed...... Phenol is one of those debated topics like immunizations in general and autism. Phenol is a toxic substance and although theoretically cannot cause allergic reactios there are many who experience terrible reactions......I happen to be one of them.........

http://www.allergy-details.com/chemical-sensitivity/phenol/

http://web.grcc.edu/Pr/msds/physicalscience/ACROS%20ORGANICS%204-tert-Buthylphenol%2097.pdf

http://www.inchem.org/documents/pims/chemical/pim412.htm

Trauma Columnist · Jun 6, 2011

Though we can not give medical advice, what we do always ask is that you f/u with your provider.

Medic/Nurse, BSN, RN · Jun 6, 2011

I was around 11 and had a TB tine test that was "inconclusive" - I then had a traditional injected TB test and had a positive (if positive has redness, whelping and weepy skin from injection site up arm, across back and chest and to waist). The problem was my uncle who had lived with us for a time had confirmed TB - so it was a big deal. I was sent to infectious disease and worked up fully - no sign of active infection. Close monitoring continued for a year or so - but I have NEVER had another TB skin test.

My mother, who was a nurse, declined to have me treated due to me being a child, no active infection and the drugs at that time were very toxic (I understand that some advances have been made).

I also went to an allergist and he could not conclusively determine IF it was an allergy - so he went with probable allergy.

I have NEVER felt the need to find out if I have a allergy or not --- I just refuse on possible positive/possible allergy.

Chest x-ray for me. I've had some employee health folks grumble a bit and make a comment or two - "allergy is not possible" or act all put upon - but, come on - fill out the form fro an x-ray and let's be friends and have a great day - really???

Just be sure and get a copy of the radiology report and keep in your personal file - you may change jobs or pick up a PRN spot and this is wise to have. I keep all certifications and health records (labs, immunizations and history) in a binder, each document is in a sheet protector and I make copies of my certifications on copy proof paper (I caught someone copying others ACLS cards and whiting out a name and adding hers on the copy then copying it - it was not a good event) will allow HR or credentials to see the originals, but leave everything on copy proof paper (you can get it at staples about $20 for a package of 200 sheets or so - not paranoid, but proactive).

I'm allergic to a number of things and had such severe allergies as a child - why tempt fate. Dying from an anaphylactic reaction to a TB test sure would be an idiot way for me to die.

Just refuse - Say no. What are they going to do? Force the issue and demand that you take a TB test? Although we all know that some hospitals policies do not make sense - even an idiot would not risk it.

Good Luck.

Practice SAFE!

:angel:

AnnieOaklyRN, BSN, RN, EMT-P · Jun 6, 2011

A swollen arm is NOT anaphylaxis Anaphylaxis constitutes a severe and life threatening allergic reaction, including edema of the face, lips, throat, airway, respiratory distress, and hypotension....

Happy

Mama of 2 · Jun 7, 2011

three years ago, after having a tb test the injection site felt really weird and began to swell up. then, within two hours it blistered up really bad. i called immediately because i knew something was wrong and this was not a positive reaction. my np checked it the following day and thought i was having a reaction to the preservative in ppd and she thought i would not be able to do the ppd test again without the same reaction. she suggested waiting a few weeks and trying it on the other arm to see what happens. i was not thrilled about this but i didn’t want to have to do chest x-rays for the rest of my life! after having the follow up injection i was required to sit and wait just as you did as the nurse monitored the site and surprise...no reaction! since then i have had to do annual two-step tests as required by my school and i have had no reaction.

after doing some research about the reaction...then lack there of...i found articles dating back to 2004 on the fda and cdc sites about incidences of individuals receiving td intradermally instead of ppd. i really have to wonder if the ma (who is a very scattered person i might add) injected something other than ppd. google ppd and td error and you can find the articles.

i don’t know what happened in your case but have you considered that it might have been some kind of medication error?

anyhow, here is another thread on the topic about another error with administration of ppd: https://allnurses.com/general-nursing-discussion/severe-reaction-ppd-472332.html