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Hypersensitivity Reactions (Types I, II, III, IV) April 15, 2009

Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

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Page 1: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Hypersensitivity Reactions (Types I, II, III, IV)

April 15, 2009

Page 2: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Inflammatory response - local, eliminates antigenwithout extensively damaging the host’s tissue.

Hypersensitivity - immune & inflammatory responses that are harmful to the host (von Pirquet, 1906)

Page 3: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura
Page 4: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

- Type I

Produce effectormolecules

Capable ofingesting foreignParticles

Association withparasite infection

Page 5: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Modified fromAbbas, Lichtman & Pillai, Table 19-1

Page 6: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Type I hypersensitivity response

Page 7: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

IgE

VL

CL

VH

Cε1

Normal serum level = 0.0003 mg/ml

Binds to mastcell

Page 8: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Binds Fc region of IgE

Intracellularsignal trans.

Link

Page 9: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Initiation of degranulation

Page 10: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura
Page 11: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Larche et al. Nat. Rev. Immunol 6:761-771, 2006

Page 12: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura
Page 13: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura
Page 14: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Abbas, Lichtman & Pillai,19-8

Page 15: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura
Page 16: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Factors in the development of allergic diseases

• Geographical distribution• Environmental factors - climate, air

pollution, socioeconomic status• Genetic risk factors• “Hygiene hypothesis”

– Older siblings, day care– Exposure to certain foods, farm animals– Exposure to antibiotics during infancy

• Cytokine milieu

Adapted from Bach, JF. N Engl J Med 347:911, 2002. Upham & Holt. Curr Opin Allergy Clin Immunol 5:167, 2005Also: Papadopoulos and Kalobatsou. Curr Op Allergy Clin Immunol 7:91-95, 2007

Page 17: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura
Page 18: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

IgE-mediated diseases in humans

• Systemic (anaphylactic shock)• Asthma

– Classification by immunopathological phenotype can be used to determine management strategies

• Hay fever (allergic rhinitis)• Allergic conjunctivitis• Skin reactions• Food allergies

Page 19: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Diseases in Humans (I)

• Systemic anaphylaxis - potentially fatal - due to food ingestion (eggs, shellfish, peanuts, drug reactions) and insect stings - characterized by airway obstruction and a sudden fall in blood pressure.

Page 20: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Diseases in Humans (II)Bronchial asthma

• Chronic inflammation– Intermittent & reversible airway obstruction– Chronic bronchial inflammation with

eosinophil infiltration– Bronchial smooth muscle hypertrophy and

hyperreactivity• Dominated by the presence of eosinophils,

CD4+ T lymphocytes (Th2), and a largeproportion of CD4+ NKT cells expressing an invariant T cell receptor that recognizesglycolipid antigens.

Page 21: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

National Heart Lung Blood Institute

Page 22: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Kumar et al, Robbins and Cotran Pathologic Basis of Disease

Page 23: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura
Page 24: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Anti-IL-13 -reduce mucus overproductionand eosinophilia

Anti-chemokinereceptors: CCR3, CCR4, CCR8 on Th2cells.

Anti-RANTES or-eotaxin abs toprevent recruitment ofeosinophils

Mediators and treatment of asthma

19-10

Page 25: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Targeting Syk

Page 26: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Diseases in Humans (III)• Upper respiratory tract

– Allergic rhinitis (hay fever) - reactions to plant pollen or house dust mites in the upper respiratory tract - mucosal edema, mucus secretion, coughing, sneezing, difficult in breathing - also associated with allergic conjunctivitis. Some evidence that asthma can develop in patients who have allergic rhinitis. Treatment - antihistamines

• Gastrointestinal tract– Result from release of mediators from intestinal mucosal and

submucosal mast cells following sensitization through the g.I. route of exposure - enhanced peristalsis, increased fluid secretion from intestinal cells, vomiting, and diarrhea. This is not the same as an anaphylactic response. Reactions usually begin in childhood - often remit in late childhood or in adulthod.

• Skin– Urticaria (wheal and flare) - mediated by histamine. – Eczema - late-phase reaction to allergen in the skin -

inflammation - can be treated with steroids.

Page 27: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Urticaria

Copyright Slice of Life & Suzanne S. Stensaas - obtained from PEIR, Dept. of Pathology, UAB

Page 28: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Atopic Eczema

Copyright Slice of Life & Suzanne S. Stensaas - obtained from PEIR, Dept. of Pathology, UAB

Page 29: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Radioallergosorbent Test (RAST)

Page 30: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

1st study of allergen-specific immunotherapy:

Noon, L. Prophylactic inoculation against hay feverLancet I, 1572-1573 (1911)

Page 31: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Desensitization/Allergen-Specific Immunotherapy

Subcutaneous or sublingual administration

Page 32: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Peanut Flour May Ease Peanut Allergyfrom WebMD — a health information Web site for patients

February 24, 2009. Eating a tiny bit of peanut flourevery day may increase peanut tolerance in childrenwho are allergic to peanuts, a new study shows.

Each child went home with instructions to eat 5 mg of peanut flour mixed with yogurt each day, graduallyadding more peanut flour over the next six weeks.

Page 33: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Protective role of IgE

Abbas & Lichtman 14-4

Page 34: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Type II hypersensitivity

• Mediated by abs directed towards antigens present on cell surfaces or the extracellular matrix (type IIA) or abs with agonistic/antagonistic properties (type IIB).

• Mechanisms of damage:– Opsonization and complement- and Fc receptor-

mediated phagocytosis– Complement- and Fc receptor-mediated

inflammation– Antibody-mediated cellular dysfunction

Page 35: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Kumar et al. Robbins and Cotran Pathologic Basis of Disease

Examples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Page 36: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Kumar et al. Robbins and Cotran Pathologic Basis of Disease

Examples: pemphigus vulgaris, Goodpasture syndrome

Page 37: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Kumar et al. Robbins and Cotran Pathologic Basis of Disease. Elsevier 2005.

Page 38: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Kumar et al. Robbins and CotranPathologic Basis of Disease. Elsevier2005

Page 39: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Kumar et al. Robbins and Cotran Pathologic Basis of Disease. Elsevier 2005.

Page 40: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Kumar et al. Robbins and Cotran Pathologic Basis of Disease

Examples: Graves disease (hyperthyroidism), myastheniagravis

Page 41: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Non-autoimmune type II reactions

• Transfusion reactions (ABO incompatibility

• Hemolytic disease of the newborn (erythroblastosis fetalis)

Page 42: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura
Page 43: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura
Page 44: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Type III hypersensitivity (immune complex disease)

Mechanisms ofAb deposition

Effector mechanismsof tissue injury

Abbas and Lichtman, Cellular and Molecular Immunology (5th edition). Elsevier 2003.

Page 45: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Serum sickness - a transient immune complex-mediated syndrome

Page 46: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Arthus reaction

Peaks @ 4-8 hoursVisible edemaSevere hemorrhageCan be followed by

ulceration

Page 47: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Formation of circulating immune complexes contributes to the pathogenesis of:

• Autoimmune diseases– SLE (lupus nephritis), rheumatoid arthritis

• Drug reactions– Allergies to penicillin and sulfonamides

• Infectious diseases– Poststreptococcal glomerulonephritis,

meningitis, hepatitis, mononucleosis, malaria, trypanosomiasis

Page 48: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Kumar et al. Robbins and Cotran Pathologic Basis of Disease. Elsevier 2005.

Page 49: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Kumar et al. Robbins and Cotran Pathologic Basis of Disease. Elsevier 2005.

Page 50: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Balkwill & Rolph, Germ Zappers, Cold Spring Harbor Laboratory Press, 2001

Page 51: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Balkwill & Rolph, Germ Zappers, Cold Spring Harbor Laboratory Press, 2001

Page 52: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Type IV hypersensitivity (DTH)

Kumar et al. Robbins and Cotran Pathologic Basis of Disease. Elsevier 2005

(Th1)

IFN-γ, LT, IL-2, IL-3, GM-CSF, MIFIL-8, MCP-1

Page 53: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura
Page 54: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Autoimmune diseases mediatedby direct cellular damage

Top - Goldsby et al, Figure 20-1- Hashimoto’s thyroiditisBottom - Goldsby et al, Figure 20-3 - Type I diabetes

Page 55: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura
Page 56: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura
Page 57: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura
Page 58: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura
Page 59: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Clinical and patch test appearances of contact hypersensitivity

Roitt 24.2

Page 60: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Tuberculin-type hypersensitivity reaction

Roitt 24.8

Page 61: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

DTH in the skin

Kumar et al. Robbins and Cotran Pathologic Basis of Disease. Elsevier 2005.

Page 62: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Uses of tuberculin-type reactions

Demonstration of past infection with a microorganism.

Assessment of cell-mediated immunity.

Page 63: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

APC/IL-12

CD4+Th1 (IL-2)/IFN-γ

Monocytes

Page 64: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

The importance of TNF-α in the formation ofgranulomas

Roitt 24.17

Page 65: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Diseases associated with granuloma formation:

• Leprosy• Tuberculosis• Schistosomiasis• Sarcoidosis• Crohn’s disease

Page 66: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Saunders and Britton. Immunol. Cell Biol. 85: 103-111, 2007.

Page 67: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Chemokine expressionin tissues fromM. tuberculosis-infectedindividuals

Saunders & Britton. Immunol. Cell Bioll. 85:103-111, 2007

Page 68: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Tuberculosis

Roitt 24.23

Page 69: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Sarcoidosis (lymph node)

Roitt 24.25

Page 70: Hypersensitivity Reactions (Types I, II, III, IV)njms.rutgers.edu/sgs/olc/mci/prot/2009/Hypersensitivities09.pdfExamples: autoimmune hemolytic anemia, autoimmune thrombocytopenic purpura

Skin Reactions

Roitt 23.9

Immediate Arthus DTH