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Allergy and Hypersensitivity Introduction

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Allergy and Hypersensitivity Introduction Allergy and Hypersensitivity Introduction • Generally the immune system is protective • Protective mechanisms may result in severe damages to tissues and may lead to death When? Severe damages may occur when the immune system responded in exaggerated or inappropriate form. Classification • Coombs and Gell classification 1-Type I - immediate ( atopic, or anaphylactic) 2-Type II - antibody-dependent 3-Type III - immune complex 4-Type IV - cell-mediated or delayed Type I - immediate (or atopic, or anaphylactic) • Type I hypersensitivity is an allergic reaction provoked by re-exposure to a specific antigen. • Exposure may be by ingestion, inhalation, injection, or direct contact. • The reaction is mediated by IgE antibodies and produced by the immediate release of histamine, tryptase, prostaglandins and derivatives by basophils and mast cells.. • This causes an inflammatory response leading to an immediate (within seconds to minutes) reaction. • The reaction may be either local or systemic. Symptoms vary from mild irritation to sudden death from anaphylactic shock. • Treatment usually involves epinephrine, antihistamines, and corticosteroids Some examples: • Allergic asthma • Allergic conjunctivitis • Allergic rhinitis ("hay fever") • Anaphylaxis • Angioedema • Urticaria (hives) Type II - antibody-dependent • In type II hypersensitivity, the antibodies produced by the immune response bind to antigens on the patient's own cell surfaces. • The antigens recognized in this way may either be intrinsic ("self" antigen, innately part of the patient's cells) or extrinsic (absorbed onto the cells during exposure to some foreign antigen, possibly as part of infection with a pathogen • IgG and IgM antibodies bind to these antigens to form complexes that activate the classical pathway of complement activation for eliminating cells presenting foreign antigens (which are usually, but not in this case, pathogens). • As a result mediators of acute inflammation are generated at the site and membrane attack complexes cause cell lysis and death. The reaction takes hours to a day. Examples • Autoimmune haemolytic anaemia • Pernicious anemia • Immune thrombocytopenia • Transfusion reactions • Hashimoto's thyroiditis • Graves' disease • Myasthenia gravis • Farmer's Lung • Hemolytic disease of the newborn TYPE III HYPERSENSITIVITY • Also known as immune complex disease • occurs when immune complex (Ag-Ab) are not removed from circulation • These complexes are deposited in various tissues and organs such as: - Kidneys - Joints - Lung - Skin • Immune complex formation may occur as a result of : Autoimmune diseases (RA) Persistence infection (Hepatitis virus) Repeated inhalation of antigenic materials MECHANISM Step 1 Large quantities of soluble antigen-antibody complexes form in the blood and are not completely removed by macrophages. Step 2 These antigen- antibody complexes lodge in the capillaries between the endothelial cells and the basement membrane. Step 3 These antigen- antibody complexes activate the classical complement pathway leading to vasodilatation. Step 4 The complement proteins and antigen-antibody complexes attract leukocytes to the area. Step 5 The leukocytes discharge their killing agents and promote massive inflammation. This can lead to tissue death and hemorrhage. TYPE IV HYPERSENSITIVITY • Type IV hypersensitivity is also known as cell mediated or delayed type hypersensitivity. • The classical example of this hypersensitivity is tuberculin (Montoux) reaction • Reaction peaks 48 hours after the injection of antigen (PPD or old tuberculin). The lesion is characterized by induration and erythema Mechanism: • The mechanism includes T lymphocytes and monocytes and/or macrophages. • Cytotoxic T cells (Tc) cause direct damage whereas helper T (TH1) cells secrete cytokines which activate cytotoxic T cells, recruit and activate monocytes and macrophages, which cause the bulk of the damage • The delayed hypersensitivity lesions mainly contain monocytes and a few T cells. Some clinical examples: • Contact dermatitis (poison ivy rash, for example) • Temporal artheritis • Lepromin test • tuberculin test • Transplant rejection The hypersensitivity reactions Figure 12-2.
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