Hyper Sensitivity

8/10/2019 Hyper Sensitivity

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H YPERSEN SITIVITY

NUR FADZLINA BINTI ZABRI

082013100006SERIAL NO 4


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Introduction

A state of altered reactivity in which thebody reacts with an exaggerated

immune response to a foreign agent


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Five types of hypersensitivity raections :

Type I (Anaphylactic) Reactions

Type II (ytotoxic) Reactions Type III (Immune omplex) Reactions

Type I!(ell"#ediated) Reactions

Type ! ($timulatory Type)


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Type III / Im m une Com plex Disease Antigen and antibodies form complex and

escape phagocytosis%

The immune complexes deposited onbasement membrane of blood vessel%

Activate complements and inducein&ammation%

'g : $ystemic upus 'rythematosus ($')Rheumatoid Arthritis (RA)


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Type IV / Cell M ediated Reaction or DelayedHypersensitivity

#ediated by macrophages that are activatedby T ells

Allergens are ta*en up by A+s and

presented to T cell% +roliferation of T cell some migrate to the

allergen entry into the body%

$ecreted cyto*ines that activate

macrophages induce in&ammatory reactions% 'g : s*in test for tuberculosis%


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Type V / Stim ulatory type

A modi,cation of Type IIhypersensitivity reaction

Antibodies interact with antigens oncell surface

ell proliferation and di-erentiation


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TYPE III / IM M !E C"M P#E$ RE%CTI"!

Deposition of antien!anti"o#$ %o&p'e( intiss)es * +as%)'a, en#ot-e'ia' s),fa%es.

A%ti+ation of %o&p'e&ent an# in/'t,ationof po'$&o,p-on)%'ea, 'e)%o%$tes

Tiss)e #a&ae

I&&)ne %o&p'e( ,ea%tion


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ocali.ed /ue to

antibodyexcess

Arthus

reaction

0enerali.ed /ue to antigen

excess

$erumsic*ne

ss


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i& %rt'us reaction

1ith in2ection intense local edema andhemorrhagic necrosis develop

Tissue damage due to antigen"antibodycomplex formed at e3uivalence or slightantibody excess

These complex activates complement

Attract neutrophils at the local site

eucocyte"platelet thrombi formed which reduceblood supply% Tissue necrosis occur

A,t-), ,ea%tion%an "e passi+e'$t,ansfe,,e# it-se,a %ontainin

-i- tit,e ofanti"o#ies *I

I.


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#echanism(pictures)


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linical types4

a) 5ypersensitivity pneumonitis

Inhalation of exogenous antigen may leadto allergic alveolitis such as farmers lung

aused by inhalation of spores ofthermophilic actinomycetes

6agassosis due to allergy of sugar caneproducers to the product

heese"washers disease by inhaling ofpenicillium casei spores


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b) 5ypersensitivity due to internal antigens

iving ,larial worms are harmless but thedead one may cause ,lariasis

6y initiating in&ammatory reaction

/apsone therapy in leprematous leprosy

may also release bacterial antibody eads to high level of antibody production


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ii& Serum sic(ness

$ingle in2ection of high concentration of foreignserum

Antibodies to foreign serum reach high enoughbut still excess antigen remains in the circulatingblood

Immune complexes get deposited on the

endothelial lining of blood vessel

#assive complement activation leads to fall incomplement concentration


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haracteri.ed by :

Fever

7rticariaArthralgia

ymphadenopathy

$plenomegaly

Immune complex disease :+oststreptococcal glomerulonephritis

'ndocarditis

5epatitits 6

/engue hemorrhagic fever

#alaria$ystemic upus 'rythematosus ($')

Rheumatoid Arthritis (RA)


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TYPE IV / DE#%YED "R CE## M EDI%TEDRE%CTI"!

Reaction is mediated by sensiti.ed T"lymphocytes which on contact withspeci,c antigen

/elayed hypersensitivity occurs within89"; hours of antigen challenge

It is not antibody mediated hence it

cannot be passively transferred byserum

an be transferred by lymphocytes ortransfer factor


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Types :Tuberculin infection type

ontact dermatitis type

0ranulomatous type


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i& Tu)erculin in*ection type

$mall dose of tuberculin is in2ectedintradermally in a person sensiti.ed totuberculoprotein

An erythema and induration occurs at thesite of in2ection

In2ection site is in,ltrated by large numbersof lymphocytes and


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7seful indicator for delayed hypersensitivity

to bacillus /evelops in many infections with bacteria

fungi and parasite

!arious s*in test are done to detect delayedtype of hypersensitivity examples :

epromin test ? positive in tuberculoid leprosy

Frei test ? positive in lymphogranuloma venereum(+!)

#antoux test ? for Tuberculosis

5istoplasmin test ? +ositive in histoplasmosis

+atch test ? poison ivy


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ii& Contact derm atitis type

@ic*elchromium

picryl chloridecosmetics

soapsantibiotics$*in intact with a range of sensiti.ingmaterials

These substance acts as hapten

ell mediated is induced in s*in whenchemical is applied on an in&ammed area%

angerhans cells carry these antigens toregional lymph node

T"lymphocytes are sensiti.ed


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$ensiti.ed lymphocytes releaselympho*ines

ause super,cial in&ammation of thes*in

haracteri.ed by redness induration

vesiculation within ;8"89 hours

The dermis is in,ltrated predominantlyby lymphocytes and few macrophages


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Hapten + tissue protein ,com plete anti-en sensiti.ed T lym p'ocytes


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/etection by patch test

$uspected allergen is applied on a smallarea of s*in under the adherent dressing

$ensitised individual develops itching in 8"Bhours


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ii& ranulom atous type

Results from persistence ofmicroorganisms or other particleswithin the macrophages which cell isunable to destroy

$hows granuloma containingepitheloid cells giant cells and

macrophages 'g : #itsuda reaction to leprosy

antigens

Cther example : rohns disease


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DT t$pe Rea%tion

ti&e

5'ini%a'

appea,an%e

Antien

ontact 89"9hours

'c.ema 'pidermaleg : nic*el

rubberpoison ivy

Tuberculin 89";hours

ocalhardeningand

swelling

Intradermal useddiagnostica

lly

0ranulomatous

8 wee*s 5ardening eg: in s*inor lung

+ersistentAg or Ag"Ab

complexes


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TYPE V / STIM #%T"RY TYPE

#odi,cation of Type ll hypersensitivityreaction

Antibodies interact with antigens on

cell surface ead to cell proliferation and

di-erentiation

Antigen"antibody reaction enhancesthe activity of a-ected cell


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'xample :

0raves disease

thyroid hormone are produced in excess

ong acting thyroid stimulating (AT$)antibody is an autoantibody to thyroidmembrane antigen

AT$ D T$5 receptor on thyroid cell

surface and produce the same e-ect asT$5

5ence excessive secretion of thyroidhormone


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SH0 %RT1M %! RE%CTI"!

@ot an immune response

It has super,cial resemblance of

hypersensitivity reaction ls a rare reaction of a body to

particular types of toxins calledendotoxins which cause thrombosis

in the a-ected tissue%
http://en.wikipedia.org/wiki/Endotoxinshttp://en.wikipedia.org/wiki/Thrombosishttp://en.wikipedia.org/wiki/Biological_tissuehttp://en.wikipedia.org/wiki/Biological_tissuehttp://en.wikipedia.org/wiki/Thrombosishttp://en.wikipedia.org/wiki/Endotoxins


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1 S t$p-i isin7e%te#

int,a#e,&a''$

5emorrhagicnecrotic lesion is

developed

Initial intradermal(preparatory)

in2ection causeaccumulation of

leucocyte

Release oflysosomal en.ymedamage capillary

wall

2 Sa&e /'t,ateis in7e%te#

int,a+eno)s'$afte, 24 -o),s

Intravenous(provocative)

in2ection thereoccurs intravascular

clotting

The thrombileading to necrosis

of vessel walls andhemorrhage


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6oth preparatory andprovocative doses are given

intravenously

Animal dies within


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ontact with large3uantities oflipopolysaccharide

endotoxin

'xcessive releaseof cyto*ine (T@Fand I


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This mechanism operate in certainclinical conditions such as Fulminating meningococcal septicemia

Acute hemorrhagic adrenal necrosisfound in overwhelming infections(1aterhouse"Friederichsen $yndrome)

@eisseria meningitidis endotoxin


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RE2ERE!CES

Textboo* of #icrobiology 9th'ditionby Ananthanarayan and +ani*ers

Textboo* of #icrobiology by +rof% +6ave2a

Immunology International 'dition th'dition by /avid #ale Gonathan

6rosto- Text 6oo* of #icrobiology by +%

ha*raborty

I@T'R@'T

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Hyper Sensitivity