Chapter 13: HYPERSENSITIVITY IgE is primarily synthesized in the lymphoid

tissue of the respiratory and gastrointestinal

Hypersensitivity tracts. Normal levels are in the range of
approximately 150 ng/mL.
- heightened state of immune responsiveness. The regulation of IgE production appears to
- it is an exaggerated response to a harmless be a function of a subset of T cells called
antigen that results in injury to the tissue, type 2 helper cells (Th2).
disease, or even death. The normal immune response to
microorganisms and possible allergens is a
A. Type I reactions,
function of type 1 helper cells (Th1), which
- cell-bound antibody reacts with antigen to
produce interferongamma (IFN-y).
release physiologically active substances.
IFN-y, along with interleukin-12 and
B. Type II reactions
interleukin-18, which are produced by
- are those in which free antibody reacts with
macrophages, may actually suppress
antigen associated with cell surfaces.
production of IgE type antibodies.4
C. Type III hypersensitivity
IL-4 and IL-13
- antibody reacts with soluble antigen to form
complexes that precipitate in the tissues. - responsible for the final differentiation that
D. Type IV hypersensitivity occur in B cells, initiating the transcription of
- sensitized T cells rather than antibody are the gene that codes for the epsilon-heavy
responsible for the symptoms that develop. chain of immunoglobulin molecules
belonging to the IgE class.1,4,5
Immediate hypersensitivity, IL-5 and IL-9
- Types I through III because symptoms - involved in the development of eosinophils
develop within a few minutes to a few hours. IL-4 and IL-9
Delayed hypersensitivity - promote development of mast cells.
- Type IV hypersensitivity because its IL-4, IL-9, and IL-13
manifestations are not seen until 24 to 48 - act to stimulate overproduction of mucus,
hours after contact with antigen. a characteristic of most allergic reactions.
This propensity to secrete cytokines that
promote production of IgE is linked to a gene
TYPE I HYPERSENSITIVITY locus on chromosome 5 that encodes
- short time lag, usually seconds to minutes, cytokines IL-3, IL-4, IL-5, IL-9, IL-13, and
between exposure to antigen and the onset granulocyte-monocyte colony
of clinical symptoms. stimulating factor (GMCSF).
IgE - the key reactant present in type I, or Il-4 and IL-13
immediate sensitivity reactions. - activate transcription of the epsilon gene in
atopic antigens, or allergens - antigens B cells when they bind to specific receptors
that trigger formation of IgE.
Atopy - refers to an inherited tendency to Comparison of Hypersensitivity Reactions
Type I Type II Type III Type IV
respond to naturally occurring inhaled and
ingested allergens with continued production Immune IgE IgG IgG or IgM T cells
of IgE. Mediator
Antigen Heterolo Autologous Autologous Autologous
Carl Wilhelm Prausnitz and Heinz gous or or or
Kstner were the first researchers to show heterologo heterologo heterologo
that a serum factor was responsible for type I us us us
reactions. Compleme No Yes Yes No
Serum from Kstner, who was allergic to fish, nt
Involveme
was injected into Prausnitz. A later exposure
nt
to fish antigen at the same site resulted in an Immune Release Cytolysis Deposits Release of
allergic skin reaction. Mechanis of due to of cytokines
Passive cutaneous anaphylaxis - it m mediato antibody antigen
occurs when serum is transferred from an rs from and antibody
allergic individual to a nonallergic individual, mast compleme complexe
and then the second individual is challenged cells nt s
with specific antigen. and
Although this experiment was conducted in basophil
1921, it was not until 1967 that the serum s
factor responsible, namely IgE, was Examples Anaphyl Transfusio Serum Contact
identified. axis, n sickness, dermatitis
hay reactions, Arthus ,
fever, autoimmu reaction, tuberculin
Triggering of Type I Reactions by IgE food ne lupus test
allergies hemolytic erythemat pneumoni
, anemia, osus tis
asthma HDN