Anergy

Anergy is defined as a depression in the delayed hypersensitivity response. This impaired immune function can be demonstrated using simple skin tests against several common recall antigens including mumps, Candida, and purified protein derivative. Intradermal injections are given in the forearm and the reaction is measured 48 h later, with 10 mm of induration taken as positive and no response to any antigen considered anergic. Eight per cent of a random population are anergic, but this is significantly increased in postoperative patients with anergy related to the extent of the surgical procedure. The test is easy, inexpensive, and widely used, and some studies suggest that it can predict postoperative septic complications. However, delayed hypersensitivity skin tests do not correlate well with other tests of lymphocyte function, the results are altered by age, and drugs and responsiveness can be impaired by repeat testing. Furthermore, it is not clear which cells are being tested as the response requires antigen processing/presentation, activation of memory and helper T cells, and soluble mediator release.

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