Tuberculin purified protein derivative (PPD) is an intradermally administered skin-test antigen used to screen individuals for latent tuberculosis infection (LTBI) to prevent them from developing active tuberculosis (TB) disease or to screen for persons who are infected with Mycobacterium tuberculosis (have active TB disease) that would benefit from treatment. Purified protein derivative (PPD) tuberculin is isolated from culture media filtrates of a human strain of M. tuberculosis and is clinically bioequivalent in potency to the standard PPD-S (5 TU per 0.1mL) of the U.S. Public Health Service, National Centers for Disease Control; each lot of manufactured product is tested prior to release, ensuring lot-to-lot consistency and potency. In the U.S., tuberculosis testing should be performed in clearly defined high-risk groups, which include health care workers, persons with HIV infection, close contacts of persons with known or suspected TB, foreign-born persons, persons who were recently infected with M. tuberculosis, persons with high-risk substance abuse (injection of illicit drugs), or persons with a history of inadequately treated TB, among others. The Mantoux tuberculin skin test, which consists of an intradermal injection of exactly 0.1 mL (5 units) of tuberculin PPD, is used to determine whether a person is infected with M. tuberculosis and is considered the standard testing method. Multiple puncture tests (MPTs) should not be used to determine whether a person is infected. Once an individual has become sensitized to mycobacterial antigens, the skin test appears to stimulate or activate previously sensitized T cells to evoke a delayed hypersensitivity reaction at the site of the PPD administration. Tuberculin purified protein derivative, PPD was first approved in the US as Tubersol in August 1956. A second PPD skin test, Aplisol, was approved in October 1972.
General Administration Information
For storage information, see the specific product information within the How Supplied section.
NOTE: Health care providers should record in the patient's permanent medical record the name of the product, manufacturer, lot number, dose, administration date, and the test results in millimeters of induration.
-Inform the patient, parent, guardian, or responsible adult of the benefits and risks of the skin test.
-If a tuberculin skin test has been previously given, question the patient, parent, or guardian about any symptoms or signs of an adverse reaction.
-Report any adverse event to the Food and Drug Administration (FDA) MEDWATCH Program at http://www.fda.gov/medwatch/ or by telephone at 1-800-332-1088. Depending on the adverse reaction, a subsequent dose may be contraindicated.
-Health care professionals should take appropriate precautions to prevent allergic reactions in recipients of the skin test. The health care professional should have immediate availability of epinephrine (1:1000) injection and other agents used in the treatment of severe anaphylaxis in the event of a serious allergic reaction.
-Instruct patient or responsible adult of the need to return for reading of the test.
Route-Specific Administration
Injectable Administration
-Administer only via the intradermal route; do not inject intravenously, intramuscularly, or subcutaneously.
-Visually inspect parenteral products for particulate matter and discoloration prior to administration. Discard vial if particulate matter or discoloration are present.
-After initial entry into the vial, the multidose vial may be stored at 2-8 degree C (35-46 degree F) for up to 30 days; protect from light and do not freeze. Discard any multidose vial not used within the 30 day time period.
-Do not mix tuberculin purified protein derivative, PPD with any other product in the same syringe.
Other Injectable Administration
Intradermal Administration
-The preferred injection site is the volar or dorsal surface of the forearm. Select an area about 4 inches below the elbow that is free of lesions and away from veins.
-Cleanse injection site and the diaphragm of the vial stopper with separate 70% alcohol swabs. Allow both to dry before administration.
-Use a sterile 0.5-1 ml tuberculin syringe with a 1/4 to 1/2 inch, 26-27 gauge needle for administration of the skin test. A separate syringe and needle is REQUIRED for each patient.
-Insert the needle through the vial stopper and withdrawal 0.1 ml (5 Tuberculin Units). Take care to avoid air bubbles within the syringe.
-With the bevel of the needle pointing upward, insert the needle into the epidermal layers of the skin. If the intradermal injection is performed correctly, a pale 6-10 mm bleb will appear over the injection site.
-No dressing is required. Use gauze to lightly dab away any bleeding at the injection site; do not press down as this may disrupt the test.
-If the injection is accidentally given subcutaneously or if a significant quantity of the tuberculin purified protein derivative, PPD leaks from the injection site, immediately repeat the test at a site located >= 5 cm from the initial injection.
Local injection site reactions have occurred following administration of tuberculin purified protein derivative, PPD. Some erythema may be present at the injection site, but does not indicate a positive reaction to the skin test (see Therapeutic monitoring). Other, uncommon or infrequent, and less severe reactions occurring at the injection site may include mild discomfort or pain, erythema, pruritus, and localized rash. Cold packs and/or topical steroids may be used for symptomatic relief of an injection site reaction. Up to 3 days after administration of the test, recipients may also experience injection site hemorrhage and hematoma. In highly sensitive persons, a strong reaction to the skin test may result in skin necrosis, ulceration or skin ulcer, and/or vesiculation or vesicular rash. Scarring may occur in some individuals with strong reactions. Such reactions are very rare, but patients that experience these severe reactions should not be retested with tuberculin purified protein derivative, PPD (see Contraindications).
Rare, systemic anaphylactoid reactions have occurred following administration of tuberculin purified protein derivative, PPD. These reactions usually develop within 24 hours and included symptoms such as edema, angioedema, generalized rash (unspecified), fever, pruritus, and urticaria. Recipients have also experienced episodes of syncope, occasionally with loss of consciousness and injury, that in some cases were associated with seizure-like, tonic-clonic movements. In addition, cases of upper respiratory stridor, requiring treatment with epinephrine and steroids, and dyspnea have been reported following administration of the Tubersol brand PPD test; a causal relationship to Tubersol could not be established.
Use of the tuberculin purified protein derivative, PPD is contraindicated in patients with a previous allergic reaction to the diagnostic agent or any of its components. Further, because of the potential for an exacerbated injection site reaction, the tuberculin skin test should not be administered to any person who has previously experienced severe cutaneous reactions such as vesiculation, ulceration, or necrosis. With any biologic product, the prescriber or health care professional should take precautions to prevent allergic reactions. The health care professional should have immediate availability of epinephrine (1:1000) injection and other agents used in the treatment of severe anaphylaxis in the event of a serious allergic reaction. Prior to administration, the health care personnel should inform the patient, parent, guardian, or responsible adult of the benefits and risks to the patient. The patient or responsible adult should report any adverse reaction to their health care provider. Information about the adverse event should then be reported by the health care provider to the Food and Drug Administration (FDA) MEDWATCH Program at http://www.fda.gov/medwatch/ or by telephone at 800-332-1088.
Tuberculin purified protein derivative, PPD is only indicated for intradermal administration; do not give via intravenous administration, intramuscular administration, or subcutaneous administration. If given by any route other than intradermally or if a significant portion of the dose leaks out from the injection site, repeat the test immediately at least 5 cm from the original injection site. Prior to administration, health care personnel should inform the patient, parent, guardian, or responsible adult of the benefits and risks. The responsible adult should report any adverse reaction to the health care provider. Information about the adverse event should then be reported by the health care provider to the Food and Drug Administration (FDA) MEDWATCH Program at http://www.fda.gov/medwatch/ or by telephone at 800-332-1088.
Patients suffering significant immunosuppression may not have an adequate antibody response to tuberculin purified protein derivative, PPD skin test. Immunosuppressed persons may include patients with generalized neoplastic disease; diseases affecting the lymphoid organs (Hodgkin lymphoma, lymphoma, chronic leukemia, sarcoidosis); or an immune system compromised by corticosteroid therapy with greater than physiologic doses, alkylating drugs, antimetabolites, or radiation therapy. Reactivity to the tuberculin skin test may be suppressed for up to 5 or 6 weeks after discontinuation of corticosteroids or immunosuppressive agents. Short-term (less than 2 weeks) corticosteroid therapy or intra-articular, bursal, or tendon injections with corticosteroids should not be immunosuppressive.
Tuberculin purified protein derivative, PPD skin test (Tubersol) should not be used in patients with documented active tuberculosis (TB) or a clear history of treatment of TB. Presence of an infection may impair cell mediated immunity resulting in depressed reactivity to the tuberculin purified protein derivative, PPD skin test. Health care providers are advised to be cognizant of false negative tuberculin reactions in patients with a current viral infection (herpes infection, measles, mumps, varicella), bacterial infection, fungal infection, overwhelming tuberculosis, or in patients receiving vaccination with certain live virus vaccines. It is recommended to perform the tuberculin skin test before, simultaneously at a separate site, or 4-6 weeks after administration of a live vaccine (see Drug Interactions).
Depressed reactivity to the tuberculin purified protein derivative, PPD skin test may occur in patients with a concurrent disease or condition that impairs cell mediated immunity. A false negative tuberculin reaction may occur in patients with diabetes mellitus; chronic renal failure; in patients with severe protein malnutrition (weight loss >= 10% ideal body weight) resulting from malabsorption syndrome, total gastrectomy, or jejunoileal bypass; or in patients with stress related conditions such as surgery, burns, mental illness, or graft-versus-host reactions.
Persons with asymptomatic or symptomatic human immunodeficiency virus (HIV) infection may have an inadequate antibody response to the tuberculin purified protein derivative, PPD skin test. Results from the skin test become less reliable in HIV infected persons as the CD4 count decreases and progresses to acquired immunodeficiency syndrome (AIDS); therefore, testing should be conducted as soon as possible after diagnosis of HIV. Further, because active tuberculosis (TB) can develop rapidly in HIV infected persons, periodic skin testing is recommended for those patients with HIV who are at continued high risk of TB exposure.
Use of the tuberculin purified protein derivative, PPD is indicated in every age group; however neonates and infants < 6 weeks of age, because their immune system has not fully matured, may not response to the skin test resulting in false negative reactions. Therefore, tuberculin skin tests measuring >= 5 mm in infants and young children exposed to active cases of tuberculosis are considered positive. Further, children < 4 years of age who have been exposed to persons at risk of acquiring tuberculosis are considered positive if the skin test induration measures >= 10 mm. For all other children with minimal risk, an induration measuring >=15 mm is considered positive.
Sensitivity to the tuberculin purified protein derivative, PPD skin test may decrease over time and with advanced age. Geriatric patients may not fully respond to the test until after 72 hours; therefore, measuring induration after 48 hours may not be advisable. A skin test induration of >= 10 mm is considered positive in geriatric patients who reside in a nursing home or other long-term care facility.
Tuberculin skin testing is considered valid and safe throughout pregnancy. Use tuberculin purified protein derivative (PPD) during pregnancy only if clearly needed. It is not known whether tuberculin PPD can cause fetal harm or affect the reproductive system. However, the risk of unrecognized tuberculosis and the postpartum contact between a mother with active disease and an infant leaves the infant in grave danger of tuberculosis and complications such as tuberculous meningitis. Although there have not been any reported adverse effects upon the fetus recognized as being due to tuberculosis skin testing, the prescribing physician will want to consider if the potential benefits outweigh the possible risks for performing the tuberculin test on a pregnant woman or a woman of childbearing age, particularly in certain high risk populations. Animal reproduction studies have not been conducted with tuberculin PPD.
Use caution when administering tuberculin purified protein derivative (PPD) to a breast-feeding woman. It is not known whether tuberculin PPD is excreted in human milk.
For tuberculosis diagnosis (e.g., diagnosis of latent tuberculosis infection (LTBI) or tuberculosis (TB) disease):
Intradermal dosage:
Adults, Adolescents, Children, Infants, and Neonates: Inject 0.1 ml [5 tuberculin units (TU)] intradermally into the volar or dorsal surface of the forearm. After a period of 48-72 hours, inspect the injection site for induration; erythema at the injection site has no diagnostic value. Measure and record the diameter of induration in millimeters (mm); a lack of induration should be recorded as 0 mm. Apositive reaction is determined by the induration size and the patient's medical history (see Therapeutic Monitoring). A positive reaction to the skin test does not necessarily indicate the presence of active disease; additional tests are needed to confirm diagnosis of tuberculosis. Conversely, not all infected persons will have a delayed hypersensitivity reaction to the tuberculin skin test. Certain patients populations (such as geriatrics, neonates and infants < 6 weeks of age, immunosuppressed persons, and persons with active infection) may have a decreased response to the skin test (see Precautions).
-two-step method:
NOTE: The two-step method is preferred for the initial screening in adults who will undergo routine tuberculin skin testing. Use of the two-step method helps distinguish between a boosted reaction and skin test conversion.
Intradermal dosage:
Adults: Inject 0.1 ml [5 tuberculin units (TU)] intradermally into the volar or dorsal surface of the forearm.After a period of 48-72 hours, inspect the injection site for induration. If the first skin test is negative, a second 0.1 ml intradermal test is given 1-4 weeks later. The injection site is again inspected after 48-72 hours. A positive reaction (>= 10 mm) to the second test indicates a past or old infection. If the second test was negative, any future positive skin test should indicate a skin test conversion.
Therapeutic Drug Monitoring:
The reaction to the skin test should be read by a health care provider 48-72 hours after the injection. The reading should be based upon a measurement of induration (swelling), not erythema. The diameter of the induration should be measured transversely to the long axis of the forearm.
An induration of >= 5 mm is considered positive for:
-HIV-positive persons.
-Persons who have had recent contact with tuberculosis (TB) patients.
-Persons with fibrotic changes on chest X-ray consistent with old healed TB.
-Patients with organ transplants and other immunosuppressed individuals (e.g., receiving equivalent of prednisone >= 15 mg/day for >= 1 month).
An induration of >= 10 mm is considered positive for:
-Recent arrivals to the US (< 5 years) from high-prevalence countries.
-Illicit users of injectable drugs.
-Residents and employees of high-risk congregate settings (e.g., prisons, jails, nursing homes, long-term care facilities, hospitals and other health care facilities, residential facilities for AIDS patients, and homeless shelters).
-Mycobacteriology laboratory personnel.
-Persons with high-risk clinical conditions [e.g., diabetes mellitus, silicosis, high-dose corticosteroid therapy, other immunosuppressive therapy, cancer, hematologic diseases (e.g., leukemia and Hodgkin's disease), end-stage renal disease, intestinal bypass or gastrectomy, low body weight (<= 10% ideal body weight)].
-Children < 4 years or children and adolescents exposed to adults in high-risk categories.
An induration of >= 15 mm is considered positive for:
-Persons with no known risk factors for TB.
Maximum Dosage Limits:
-Adults
5 tuberculin units (TU) or 0.1 ml/dose intradermal.
-Geriatric
5 tuberculin units (TU) or 0.1 ml/dose intradermal.
-Adolescents
5 tuberculin units (TU) or 0.1 ml/dose intradermal.
-Children
5 tuberculin units (TU) or 0.1 ml/dose intradermal.
-Infants
5 tuberculin units (TU) or 0.1 ml/dose intradermal.
-Neonates
5 tuberculin units (TU) or 0.1 ml/dose intradermal.
Patients with Hepatic Impairment Dosing
Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.
Patients with Renal Impairment Dosing
It appears that no dosage adjustments are needed. Cellular immunity may be impaired in patients with chronic renal failure; thus, reactivity to the PPD skin test may be suppressed in these patients (see Contraindications).
*non-FDA-approved indication
Adalimumab: (Moderate) Adalimumab may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of adalimumab therapy.
Ado-Trastuzumab emtansine: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Albuterol; Budesonide: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Aldesleukin, IL-2: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Alemtuzumab: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Antineoplastic Agents: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Arsenic Trioxide: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Atezolizumab: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Avelumab: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Azacitidine: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Azelastine; Fluticasone: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Bacillus Calmette-Guerin Vaccine, BCG: (Major) Bacillus Calmette-Guerin Live, BCG administration may cause tuberculin purified protein derivative, PPD sensitivity. As tuberculin sensitivity is a valuable aid in the diagnosis of tuberculosis, determination of the tuberculin reactivity by PPD skin testing is advisable before BCG Live administration.
Beclomethasone: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Belinostat: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Bendamustine: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Betamethasone: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Bevacizumab: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Bexarotene: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Bleomycin: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Blinatumomab: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Brentuximab vedotin: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Budesonide: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Budesonide; Formoterol: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Budesonide; Glycopyrrolate; Formoterol: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Busulfan: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Cabazitaxel: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Calaspargase pegol: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Capecitabine: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Carboplatin: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Carmustine, BCNU: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Cemiplimab: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Cetuximab: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Chlorambucil: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Ciclesonide: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Cisplatin: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Cladribine: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Clofarabine: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Corticosteroids: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Cortisone: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Cyclophosphamide: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Cytarabine, ARA-C: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Dacarbazine, DTIC: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Dactinomycin, Actinomycin D: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Daratumumab: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Daratumumab; Hyaluronidase: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Daunorubicin Liposomal; Cytarabine Liposomal: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Daunorubicin: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Decitabine: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Decitabine; Cedazuridine: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Deflazacort: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Denosumab: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Dexamethasone: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Dinutuximab: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Docetaxel: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Dostarlimab: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Doxorubicin Liposomal: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Doxorubicin: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Durvalumab: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Elotuzumab: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Epirubicin: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Eribulin: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Estramustine: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Etanercept: (Moderate) Etanercept has not been found to act as a general immunosuppressant; however, the patient's underlying disease state may result in immunosuppression. Patients receiving ertanercept may have a decreased immunologic response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of ertanercept therapy.
Etoposide, VP-16: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Everolimus: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Floxuridine: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Fludarabine: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Fludrocortisone: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Flunisolide: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Fluorouracil, 5-FU: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Fluticasone: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Fluticasone; Salmeterol: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Fluticasone; Umeclidinium; Vilanterol: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Fluticasone; Vilanterol: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Formoterol; Mometasone: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Gemcitabine: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Gemtuzumab Ozogamicin: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Hydrocortisone: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Hydroxyurea: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Ibritumomab Tiuxetan: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Idarubicin: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Ifosfamide: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Infliximab: (Moderate) Infliximab may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of infliximab therapy.
Inotuzumab Ozogamicin: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Interferon Alfa-2b: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Iobenguane I 131: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Ipilimumab: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Irinotecan Liposomal: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Irinotecan: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Ixabepilone: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Lomustine, CCNU: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Loncastuximab Tesirine: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Lutetium Lu 177 dotatate: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Measles Virus; Mumps Virus; Rubella Virus; Varicella Virus Vaccine, Live: (Minor) Temporary suppression to the tuberculin purified protein derivative, PPD with the rubella virus vaccine live has been demonstrated. If a tuberculin test is to be done, it is recommended to place the PPD either before or at the same time as the vaccine. (Minor) The measles vaccine live can temporarily suppress tuberculin purified protein derivative, PPD, skin sensitivity. Administer a tuberculin test either before or simultaneously with vaccine receipt.
Measles/Mumps/Rubella Vaccines, MMR: (Minor) Temporary suppression to the tuberculin purified protein derivative, PPD with the rubella virus vaccine live has been demonstrated. If a tuberculin test is to be done, it is recommended to place the PPD either before or at the same time as the vaccine. (Minor) The measles vaccine live can temporarily suppress tuberculin purified protein derivative, PPD, skin sensitivity. Administer a tuberculin test either before or simultaneously with vaccine receipt.
Mechlorethamine, Nitrogen Mustard: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Melphalan Flufenamide: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Melphalan: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Mercaptopurine, 6-MP: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Methotrexate: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Methoxsalen: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Methylprednisolone: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Midostaurin: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Mitomycin: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Mitotane: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Mitoxantrone: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Mogamulizumab: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Mometasone: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Moxetumomab pasudotox: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Nanoparticle Albumin-Bound Paclitaxel: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Necitumumab: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Nelarabine: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Nivolumab: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Nivolumab; Relatlimab: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Obinutuzumab: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Ofatumumab: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Olaratumab: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Olopatadine; Mometasone: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Omacetaxine: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Oxaliplatin: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Paclitaxel: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Panitumumab: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Panobinostat: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Pegaspargase: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Pembrolizumab: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Pemetrexed: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Pentostatin: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Pertuzumab: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Pertuzumab; Trastuzumab; Hyaluronidase: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Porfimer: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Pralatrexate: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Prednisolone: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Prednisone: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Procarbazine: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Ramucirumab: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Rituximab: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Rituximab; Hyaluronidase: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Romidepsin: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Streptozocin: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Tagraxofusp: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Talimogene Laherparepvec: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Temozolomide: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Temsirolimus: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Thioguanine, 6-TG: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Thiotepa: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Topotecan: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Trabectedin: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Trastuzumab: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Trastuzumab; Hyaluronidase: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Tretinoin, ATRA: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Triamcinolone: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Trifluridine; Tipiracil: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Venetoclax: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Vinblastine: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Vincristine Liposomal: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Vincristine: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Vinorelbine: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Vorinostat: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Ziv-Aflibercept: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
The tuberculin purified protein derivative, PPD skin test is used to identify individuals infected with Mycobacterium tuberculosis. Once a person becomes infected with the mycobacteria, their immune system produces T lymphocytes that are sensitized to mycobacterial antigens. The T lymphocytes take 2-10 weeks to develop and remain within the circulatory system for years. The tuberculin skin test appears to stimulate or activate previously sensitized T cells to evoke a delayed hypersensitivity reaction at the site of PPD administration. The delayed hypersensitivity reaction involves vasodilation, edema, and infiltration of lymphocytes, basophils, monocytes, and neutrophils into the injection site. As a result, individuals previously infected with M. tuberculosis will develop a measurable induration 48-72 hours after initiation of the skin test. However, not all infected individuals produce a measurable response to the test. Patients with concurrent diseases or medical conditions that can impair cell mediated immunity may have a false negative tuberculin reaction (see Contraindications).
Tuberculin purified protein derivative, PPD is administered via the intradermal route. Administration of the tuberculin skin test helps to identify persons infected with Mycobacterium tuberculosis through the development of a delayed hypersensitivity reaction resulting in a measurable induration at the injection site. In infected individuals, a significant delayed hypersensitivity reaction begins to occur after 5-6 hours with maximal reaction occurring after 48-72 hours. Some infected individuals, because of an impaired cellular immunity, will not develop a reaction to the skin test (see Contraindications). Repeat testing of uninfected persons will not cause sensitization to tuberculin.
-Special Populations
Renal Impairment
Cellular immunity may be impaired in patients with chronic renal failure; thus, reactivity to the tuberculin purified protein derivative, PPD skin test may be suppressed in these patients (see Contraindications).
Pediatrics
Infected neonates and infants < 6 weeks of age may not develop a delayed hypersensitivity reaction to tuberculin purified protein derivative, PPD because their immune system has not fully developed (see Contraindications). Tuberculin sensitivity develops anywhere from 3 week to 3 months after initial infection in older infants and children.
Geriatric
Sensitivity to tuberculin purified protein derivative, PPD often decreases with time and advanced age. In the geriatric population, reaction to the skin test may develop more slowly with maximal induration not being achieved until after 72 hours (see Contraindications).