The use of TheraCys may cause tuberculin sensitivity. Since this is a valuable aid in the diagnosis of tuberculosis, it may be advisable to determine the tuberculin reactivity by testing before treatment......
You are right. My Internist did the "patch test" before I started BCG, because he said from that point on I would test "positive" and he thought it would be a good thing to have in my file, the "positive" was caused by the BCG.
Doesn't BCG cross react with TB on a skin test? Thought I read somewhere that it did, and that those of us who have had it might test positive. If so, anyone who already tests positive on a TB skin test would have a positive reaction to BCG. ??????
Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
Very interesting, Mike. That would have certainly helped you out in the very beginning.
I am sure I would have tested fine, since I did get 24 - only the 24th was a problem. I guess my problem is because my Uro used 100% (or what they consider 100%) for at least 18 of the doses).
We still don't know if it is OK to start out with a lesser amount.
Once a patient shows too much of a reaction, Dr Lamm did tell me that the Uro can also "heat" the BCG.
We go as low as 1%. You can also reduce retention to 30 minutes or less.
I also sometimes give heat inactivated BCG to those who do not tolerate
Don Lamm, MD
I asked Dr. Lamm about the sensitivity testing for determing dose. Here is my question and his response:
Is BCG too risky to use in tiny doses subcutaneously in order to test a patient's sensitivity? It seems like many people drop out (myself included back in 2006) of BCG treatment due to severe reaction. Your research and posting seem to indicate that lower dose strength does not have decreased efficacy. Therefore, it seems like it would make sense to start people on 1% or 5% and then increase if required to get the reaction desired rather than going the other direction of starting high and reducing.
Just wondering if there is some way to test patients (maybe not researched yet?) for thier individual sensitivity to BCG so that urologists could set the dose to the patient and not just by personal preference. I know some start at 50%, 33%, or full. Patients react differently so it seems to make sense to find a way to tune to the individual patient.
Seems like less dropouts would mean more lives saved.
Dr. Lamm Response:
Yes, Mike. I quite routinely give percutaneous BCG. It is not injected, but given by the TINE technique- like a smallpox vaccination. That does provide some measure of immune response.
So folks may want to ask their doctors about this if they are going to start on BCG.