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5 Hypersensitivity

The document outlines hypersensitivity reactions, categorizing them into four types: Type I (IgE-mediated), Type II (IgG-mediated), Type III (immune complex-mediated), and Type IV (cell-mediated). It details the mechanisms, clinical examples, and diagnostic methods associated with each type, emphasizing the harmful effects of excessive immune responses. The document serves as a comprehensive guide for understanding the immunological basis of allergies and autoimmune disorders.

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10 views32 pages

5 Hypersensitivity

The document outlines hypersensitivity reactions, categorizing them into four types: Type I (IgE-mediated), Type II (IgG-mediated), Type III (immune complex-mediated), and Type IV (cell-mediated). It details the mechanisms, clinical examples, and diagnostic methods associated with each type, emphasizing the harmful effects of excessive immune responses. The document serves as a comprehensive guide for understanding the immunological basis of allergies and autoimmune disorders.

Uploaded by

priya
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Immunopathology Unit

Department of Pathology
College of Medicine &
Medical City
King Saud University
Reference
Kuby Immunology 8th Edition
Chapter 15
Objectives
• To know that hypersensitivity reactions are over and excessive
immune responses that can be harmful to body in four different
ways

• To be familiar with inflammatory processes in Type I


hypersensitivity reaction that mediates allergic inflammation

• To recognize that Type II hypersensitivity deals with immune


responses against antigens that are integral part of cell membrane
and are usually associated with autoimmune disorders

• To know that Type III hypersensitivity reactions are mediated by


immune complexes and cause vasculitis

• To describe Type IV hypersensitivity is a purely cell mediated


immune response associated with chronic inflammation
What is hypersensitivity?

• Protective immunity: desirable reaction

• Hypersensitivity: undesirable reaction

• Undesirable responses can be mediated by


– Antibody binding to antigens (Types I-III)
– Cell mediated reaction to chemicals or proteins
(Type IV)
Gel and Coombs Classification

Type I: IgE Ab Type IV: Cell


Mediated
Immunity

Type II: IgG Type III:


Ab to tissue IgG
antigens Immune
Complexes
Type I: Immediate Hypersensitivity

 Most people will not react to these allergens


but some individuals “atopic” respond by
producing large amounts of IgE in response
to those otherwise harmless substances

 Non-allergic individuals respond to these


allergens by producing IgG antibodies
Type I Hypersensitivity
• Also termed as:
Immediate Hypersensitivity

Allergic reactions

Anaphylactic reactions are severe and


rapidly progressing systemic forms which
can be quickly life threatening

(Occurs within minutes to hours)


Features
- Antibody type: IgE

- Cellular components:
Mast cells, basophiles & eosinophils

- Antigens:
Also known as allergens
(antigens with low molecular weight &
highly soluble)
Allergens
 Some of the allergens involved in type I
hypersensitivity are: pollens, dust mite
allergens, animal dander, nuts, shellfish,
various drugs etc
Type I reactions occur in two phases

• Phase I :
- Sensitization phase
- Sensitization phase .
First contact
Type
Allergen Ienter with
Reaction allergens
occur
tissues in 2 phases:
, induce an
immune response . B – cells transform
to plasma cells & produce IgE.

- - IgE bind to receptors


Challenge phaseon Mast cells and
basophiles ( F c ЄRI - high affinity receptors).
Subsequent contact
individuals becomewith
: allergens

“ Sensitized . “
Type I Hypersensitivity (Immediate)

Sensitization

Challenge
Primary and Secondary Mediators

October 8, 2019 Med 1 12


Allergy is a systemic disorder

Nose
Pharynx
Allergic rhinitis
Lungs
Esophagus Asthma
Food allergy
Stomach

Skin

Eczema
Urticaria
Allergic dermatitis
Allergy: Rhinitis, Eczema & Conjunctivitis

Normal nose
* Injected allergens:

Hymenoptera (bees, wasps, ants) sting venom


enters the blood stream

 Systemic inflammation

 Anaphylactic shock
(life - threatening)

 Anaphylactoid reactions:-
Are non - IgE mediated
may result from contrast media or
local anesthetics
Diagnosis of Allergy
Skin Prick test

1. Skin prick test (SPT)

2. Specific IgE measurement


(RAST)

3. Elimination / Provocation test


(Food allergy)
Type II Hypersensitivity Reactions

• Features:-
- IgG (or IgM)
- Antigens: bound to
cell membranes
(Self antigens)
- Exogenous antigens
(microbial)

- Complement
activation
(Invariable)
Clinical examples:

Glomerulonephritis
(anti-glomerular
basement membrane)

Mis-matched blood
transfusion
Diagnosis

- Detection of antibodies and antigens by


Immunofluoresence in tissue biopsy specimens
e.g. kidney, skin etc.
Type III: Immune complex
hypersensitivity
 When an antigen reacts with an antibody the
product they form is called an immune complex
which is capable of inducing an inflammatory
response

 Immune complexes are deposited in tissues like


kidneys (nephritis), joints (arthritis) or blood
vessels (vasculitis)
Type III Hypersensitivity
(immune–complex mediated)

• Features
Antibody (IgG/ or IgM) + Antigen (soluble)

- Immune – Complex formation

- Complement activation

- Attraction of inflammatory cells


Type III Reactions
Type III Hypers. Reactions
Clinical examples:
Glomerulonephritis: Rheumatoid arthritis, SLE
Diagnosis of Type III Hypers.
Reactions

Demonstration of specific immune


complexes in the blood or tissues by:
Immunofluoresence
Type IV hypersensitivity reactions
(Delayed Hypersensitivity)

• Features
• Cell mediated immune response
– Antigen dependent T cell (CD4 generally
and CD8 occasionally) activation via MHC
Class I or II
• Activated macrophages
• Delayed onset (2-4 days)
• Abnormal cellular response
– (Granuloma formation)
Mediators released by TDTH cells
Development of
DTH Response

Sensitization
phase:
1-2 week period

Effector phase:
24-72 hours

Effector cells
(activated macs)
act non-specifically
Pathophysiology of Contact dermatitis.
Type IV clinical examples:

Contact dermatitis

TB granuloma
(persistent antigen)
Diagnosis (Type IV)

1. Delayed skin test (Mantoux test)

2. Patch test (Contact dermatitis)

3. Lymphocyte transformation test


Skin Patch Test
Take Home Message
• 1. Type I (IgE), II (IgG) and III (IgG)
hypersensitivity reactions are mediated by
antibodies whereas Type IV hypersensitivity
reaction is a cell mediated immune response.

• 2. Hypersensitivity reactions are undesirable,


excessive, and aberrant immune responses
associated with disorders such as allergy,
autoimmunity and chronic inflammation.

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