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The delay in onset of the erythema and induration seen in our patient is consistent with a delayed hypersensitivity reaction to hirudin.
Mantoux testing elicits a delayed hypersensitivity reaction to a previously sensitized antigen (a T-lymphocyte function), and it is generally accepted as a valid in vivo indicator of a patient's level of cell-mediated immunity.
Lymphocytes from an animal in which delayed hypersensitivity reaction has been induced when exposed in vitro to the sensitizing antigen, release biological effector molecules.

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