HYPERSENSITIVI

TY
BY
ARIF MOHIDDIN
1ST MDS
DEPARTEMENT OF ORAL PATHOLOGY

CONTENTS :

Introduction
Definition
Types

of Hypersensitivity

of Hypersensitivity

Diseases

caused by the Immune responses

Conclusion
References

INTRODUCTION :
Immunity :
Immune

Resistance to disease

System : Collection of cells , Tissues

and Molecules that mediate resistance to

infections.
Immune

Responses : Coordinated reactions of

these cells and molecules to infections , microbes.

These immune responses serve the
important function , host defence as capable of
causing tissue injury and disease which include
Hypersensitivity Reactions.

DEFINITION :

Refers

to a condition in which immune

response
results in excessive reactions leading to tissue

damage , disease or even death in the

sensitised
Host.
The

term Hypersensitivity was coined by

VON PIRQUET in 1905.

 Hypersensitivity

occurs in certain individuals

who
have contact with antigen & when exposed to
Second dose of the same antigen , allergy
occurs in them .
The

initial dose of antigen sensitizes the

immune system by Sensitizing B or T cells.
Sensitizing Dose.

The

Second dose of antigen that is responsible

for causing allergy is - Shocking Dose.

CLASSIFICATION :
Hypersensitivity

reactions are classified into

Two main types .

1] Immediate Hypersensitivity
- Occurs in few minutes to few Hours
.
- Antibody mediated.
2] Delayed Hypersensitivty
- Occurs slowly , after 24 hours and
reaches peak after 48 72 hours .
- Mediated by T cells.

COOMBS & GEL [ 1963] Classification :

TYPES :
- Type I

[Anaphylaxis ] Antibody Mediated

- Type II [Cytotoxic/Cytolytic] Ab Mediated

- Type III [ Immune complex ] - Ab Mediated
- TYPE IV [ Delayed Type ] - Cell Mediated
- Type V [ Stimulatory Type] Ab Mediated
- Type VI [ Antibody dependent CMC]

DISTINGUISHING FEATURES :
Immediate Type

Delayed Type

Appears and Recedes Rapidly

Appears slowly in 24-72 hrs and

lasts longer.

Antibody Mediated

Cell Mediated

Easy but short lived

Difficult but long lasting

TYPE I Hypersensitivity
Immediate

Hypersensitivity is a rapid , IgE

antibody and Mast cell Mediated vascular and
Smooth muscle Reaction .

Often
Occur

followed by Inflammation.

in individuals on Encounter with certain

foreign antigens to which they have been
exposed previously.

 Type

I Reaction also called Anaphylactic

Reaction.

Anaphylaxis

- Derived from Greek

- Ana = Against
- Phylaxis = Protection

Anaphylaxis

term used when the

manifestations of allergic reaction are Severe.

It

occurs quickly when a large shocking dose of

antigen is introduced after one/ more
sensitizing doses.

Features of Anaphylaxis :

Anaphylaxis

occurs within a few seconds to

few minutes following shocking dose of

Antigen .
Cytotrophic

IgE antibody is Responsible.

Tissues or Organs Which are affected in

anaphylaxis are called Target organs or
shock organs .

 Sequence

of Events :

First Exposure to ANTIGEN

Antigen activation of T Helper cells

and Stimulate B- cells

Production of IgE
IgE binds with Fc receptors
of Mast cells
[ Sensitizing dose ]

Repeat exposure to Allergen

Activation of Mast cell
Release of Mediators
Vasoactive amines,

Cytokines

Lipid Mediators
- Vascular dilatation
- Smooth muscle
contraction

- Inflammation

Activated Mast cells :

Types of Anaphylaxis :
Systemic

anaphylaxis :-

Schultz Dale phenomenon :

- Guinea pigs were given sensitizing dose of
antigen . After some time uterus / ileum was
isolated & kept in Ringer solution .
- Shocking dose of same antigen was added to the
bath , the organ contracted vigorously .

 Localised

Anaphylaxis :

Applicaion of small dose of antigen on

mucosal
surface such as Conjunctiva , Nasal mucosa ,
Respiratory tract Leads to
- Rhinorrhoea
- Conjunctivitis
- Bronchospasm

Eg : Wheal & flare reaction

Angiodema :

Causes :
Foods
Medications
Latex proteins
Idiopathic

Clinical aspects :
Clinical Aspects

Manifestations

Allergic rhinitis, Sinusitis [Hay fever]

Increased mucus secretion

Bronchial Asthma

Smooth muscle contraction & inflammation

and tissue injury caused by Late phase.

Anaphylaxis

Fall in BP caused by vascular dilatation &

airway obstruction due to laryngeal odema

TREATMENT :

Anaphylaxis

- Epinephrine
Bronchial

Asthma
- Corticosteroids

Type II [ Cytotoxic ] Reaction:

Cytotoxic

reactions Mediated by IgG or IgM

Directed against antigens on the surface of cells

resulting in Cell Damage .
Antibodies

bind to an antigen on the cell surface and

cause
- Phagocytosis of the cell through opsonic
or Imune adherence.
- cytotoxicity by Natural Killer Cells
- Lysis through activation of Complement
System

Examples :
- Isoimmune Reaction :
ABO transfusion
Erythroblastosis foetalis

RH Factor Incompatibility :

Type III [ Immune Complex ] Reaction:

It

is Characterized by deposition of Ag Ab
complexes in tissues

Activation

of Complement system.

Infiltration by polymorphonuclear leucocytes ,

platelets
Leading to tissue damage

Mechanism :

When

Antigen combines with antibody

complexes are formed .

Normally these are removed by monocytes &

macrophages.

Inefficient in removing Smaller complexes

formed in antigen excess

Those

complexes deposited in vascular

endothelial surfaces causing immune complex
diseases.

Examples :
Arthus

Reaction :

- The tissue damage due to Ag Ab complexes

formed at equivalence or slight antibody
excess.
- Activate complement system and attract
neutrophils at the site.
- leukocyte platlet thrombi formed
- Reduced blood supply
- Tissue Necrosis.

Serum sickness :
Systemic

form of type III hypersensitivity

It

appears following a single injection of

concentration of foreign serum.

Antibodies

to serum develop within 7-12 days.

Immune complexes deposited o epithelial

lining of blood vessels in various parts of body.

Inflammatory
Tissue

damge

infiltration

Type IV [ Delayed / cell mediated ] :

This

reaction is mediated by sensitised Tlymphocytes

On

contact with specific antigen , Release

Lymphokines that cause biological effects on

Macrophages, leucocytes and tissue cells .
Tissue

damaging mediated by T lymphocytes.

Types :

Tuberculin type :
-

A small amount of tuberculin injected in a

sensidized individual .

with in 24 -72 hours

- After intra dermal injection of PPD in a

sensitized individual an Erythema
and induration at the site of injection

 Contact

Dematitis :

Due to repeated contact with a wide

range of sensitizing materials such as:
- Drugs : Pencillin
- Metals : Nickel , Chromium
- Simple Chemicals : Soaps , Hair dyes

RECURRENT APHTHOUS STOMATITIS :

T cell mediated

Tumour

necrosis factor is on of the most

important cytokine implied in the development
of new apthous ulcers in patients.

Type V [ Stimulatory type ] Reaction:

It

is a modification of Type II hypersensitivity

reaction .
Antibodies

interact with antigens on cell surface

that leads to cell proliferation and differentiation

instead of inhibition / killing .
Ag-

Ab reaction enhances the activity of affected

cell.

Eg: Graves disease

Type VI [ ADCC ] Reaction:

It

is mediated through natural killer cells.

Target

cells coated wth low concentration

of Abs are killed by NK cells through an

extra cellular non phagocytic mechanism.

 Mechanism

Ags after introduction into body attaches to

the
target cell & induce Ab production.

These Ab combine with specific Ags form

complexes on target cells.

NK cells combines with these complexes via

Fc fragment of Ab & causes lysis of Target ells.

CONCLUSION :

Knowledge

regarding basic part of

immumnology and related part like
hypersensitivity provides us an insight to
understand etiopathogenisis occuring in
certain disease conditions to have better
diagnosis , prognosis ..

References:

Basic immunology Abul. K.ABBAS

Second Edition

Text Book of Medical Microbiology

- Dr. Imtiyaz WANI

Robbins

Basic Pathology Ninth Edition