Delayed Cutaneous Hypersensitivity Tests and Lymphopenia as Activity Markers in Sarcoidosis

doi:10.1378/chest.121.4.1239

Chest

Volume 121, Issue 4, April 2002, Pages 1239-1244

https://doi.org/10.1378/chest.121.4.1239 Get rights and content

Study objectives

To evaluate new and already known biological markers of activity in patients with sarcoidosis.

Design

A 10-year prospective clinical evaluation, including a battery of delayed cutaneous hypersensitivity tests (DCHTs) and other markers of activity.

Setting

Outpatient department of a university teaching hospital.

Patients

Forty patients with biopsy-proven sarcoidosis were prospectively evaluated every 6 months. In this study, only the visits that fulfilled the situation of active period (AcP) or of asymptomatic period (AsP) were taken into account. Twenty-one visits were considered to be in the AcP, and 26 were considered to be in the AsP. Seven patients were studied both in the AcP and the AsP.

Interventions

DCHTs and blood sample extraction every 6 months.

Measurements and results

The mean diameter of the cutaneous wheal for each antigen (AG) was lower in the AcP group than in the AsP group (candidine, p < 0.0001; tuberculin, p < 0.0009; trichophytin, p < 0.02; streptokinase-streptodornase, p < 0.001). Also, the mean (± SD) diameter for the four AGs taken together was lower in the AcP group (2.3 ± 4.2 mm) than in the AsP group (16.8 ± 9.3 mm; p < 0.0001). The mean serum angiotensin-converting enzyme (S-ACE) value was higher in the AcP group than in the AsP group (p < 0.02). A low lymphocyte count and a percentage of the lymphocyte count (< 20%) also were detected more frequently in the AcP group than in the AsP group (p < 0.02 and p < 0.0001, respectively).

Conclusions

DCHTs appear to be a simple, reliable, and easily performed marker of inflammatory activity in sarcoidosis patients. Furthermore, serum total and differential lymphocyte count and the S-ACE level proved to be useful inflammatory markers in this study.

Section snippets

Study Population

The study protocol was prospectively applied for a period of 10 years to a series of 40 patients with biopsy-proven sarcoidosis, who were consecutively included in the study during this period. In each patient, this protocol was applied both at diagnosis and every 6 months during follow-up.

Clinical Evaluation

At each clinical visit, all patients were asked about their clinical manifestations and the findings of the following examinations that had been performed during the previous 30 days were assessed:

Results

The clinical features of patients belonging to the AcP or the AsP groups are shown in Table 1. Biochemical and hematologic parameters are shown in Table 2. With respect to the DCHTs (Table 3), their positivity was lower in the AcP than in the AsP, taking into account quantitative data (ie, mean diameter) and qualitative data (No. of positive tests) and considering the AGs separately (ie, the single-AG evaluation) or together (ie, global evaluation).

The percentages of periods (ie, appointments)

Discussion

The results of the present study show that the response to a DCHT, both qualitatively and quantitatively evaluated, is significantly lower during clinically active periods of the disease than in asymptomatic clinical situations. This difference exists both for each individual AG and for the sum of the four AGs (p < 0.0001) [Table 3]. Further, in the seven patients who throughout the follow-up period were studied both in AcPs and in AsPs, the difference for the sum of the four AGs was also lower

Conclusion

The results of the present study make it advisable to perform DCHTs as an activity marker in patients with sarcoidosis. S-ACE elevation and lymphopenia are also useful parameters that can be used in addition to DCHT results in the determination of disease activity. Other studies with longer follow-up periods should be conducted to determine whether the maintenance of repeatedly negative results during the follow-up of DCHTs implies a worsening in the clinical evolution of the disease.

ACKNOWLEDGMENT

We thank Tina Guerrero (graduate student in Mathematics) for help with statistical analysis of the data, Christine O'Hara for help with the English version of the article, and Rosa Llòria for editorial assistance.

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: This research was supported by a grant from the Fundació Catalana de Pneumologia (FUCAP) and was presented in part at the 1998 International Conference of the American Thoracic Society in Chicago, IL.

^†: These authors contributed equally to the design of the study and to the writing of the article.

View full text

Chest

Clinical InvestigationsSARCOIDOSISDelayed Cutaneous Hypersensitivity Tests and Lymphopenia as Activity Markers in Sarcoidosis

Study objectives

Design

Setting

Patients

Interventions

Measurements and results

Conclusions

Section snippets

Study Population

Clinical Evaluation

Results

Discussion

Conclusion

ACKNOWLEDGMENT

J Invest Dermatol

Clin Chest Med

Sarcoidosis

Am Rev Respir Dis

Current concepts of the pathogenesis of sarcoidosis

Am Rev Respir Dis

Bronchopulmonary sarcoidosis

Am Rev Respir Dis

Pulmonary sarcoidosis: a disease characterized and perpetuated by activated lung T lymphocytes

Ann Intern Med

Consensus conference: activity of sarcoidosis; third WASOG meeting, Los Angeles, USA, September 8–11, 1993

Eur Respir J

A study of the cutaneous reactions to oidiomycin, trichophytin and mumps skin test antigens in patients with sarcoidosis

Yale J Biol Med

Altered immunologic reaction in sarcoidosis

Ann Intern Med

Clinical Investigations
SARCOIDOSIS
Delayed Cutaneous Hypersensitivity Tests and Lymphopenia as Activity Markers in Sarcoidosis