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Delayed hypersensitivity skin testing in nutritional assessment.

B S Linn1

  • 1Veterans Administration Medical Center, Miami, Florida 33125.

The American Surgeon
|November 1, 1987
PubMed
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Skin testing aids nutritional assessment, but antigen number impacts accuracy. A seven-antigen test better identifies malnutrition and avoids misclassifying well-nourished patients, preventing unnecessary medical interventions.

Area of Science:

  • Clinical Nutrition
  • Immunology
  • Oncology

Background:

  • Decreased immunity, indicated by anergy or reduced skin test responses, is linked to malnutrition.
  • Conventional skin testing methods for nutritional assessment have limitations including variable antigen strength, injection techniques, and subjective evaluation.
  • The number and type of antigens used in skin testing can influence results, potentially leading to contradictory findings.

Purpose of the Study:

  • To compare the diagnostic accuracy of skin testing using three, four, or seven antigens for nutritional assessment in hospitalized cancer patients.
  • To evaluate the relationship between skin test results and other established nutritional indices, such as the Protein Energy Malnutrition Scale.

Main Methods:

  • Fifty hospitalized male cancer patients were assessed using a 23-item Protein Energy Malnutrition Scale.

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  • Patients were categorized as well-nourished (60%) or malnourished (40%).
  • Skin testing was performed using batteries of three, four, or seven antigens, and results were compared with nutritional status and other indices.

    • Main Results:

    • The number of antigens used did not significantly affect the identification of malnourished patients.
    • A smaller antigen battery (three or four antigens) misclassified normal patients as malnourished twice as often compared to a seven-antigen battery.
    • Misclassification of well-nourished individuals as malnourished can lead to unnecessary and costly interventions like total parenteral nutrition.

    Conclusions:

    • A seven-antigen skin testing protocol is more reliable for nutritional assessment in hospitalized cancer patients than smaller antigen batteries.
    • Utilizing a larger antigen set reduces the risk of misclassifying well-nourished patients, thereby avoiding potentially harmful and expensive interventions.
    • Optimizing skin testing protocols is crucial for accurate nutritional assessment and appropriate patient management.