Chapter 15

Chapter 15
Hypersensitivity Reactions
Dr. Capers
Kindt • Goldsby • Osborne
Sixth Edition
Chapter 15
Hypersensitivity Reactions
Copyright © 2007 by W. H. Freeman and Company
Hypersensitivity – responding
inappropriately to an antigen
 Inflammatory response can have
deleterious effects
○ Tissue injury
○ Disease
○ death
Hypersensitivity Reactions
May develop in course of humoral OR
cell-mediated response
○ Immediate hypersensitivity
 Anaphylactic
 Antibody-antigen complexes
 Manifests in minutes
○ Delayed-type hypersensitivity
 May occur in days
Type I – IgE-Mediated Hypersensitivity
Induced by antigens referred to as
 Induces humoral response but induces
high secretion of IgE
○ Fc portion of IgE binds with Fc receptors on
mast cells and basophils
○ Degranulation occurs
Type I
Type 1
Common components
 Allergens
○ Atopy – hereditary predisposition to development of
immediate hypersensitivity reactions to common antigens
- Allows nonparasitic antigens to induce IgE response
 IgE
○ Normally lowest of all antibody classes in serum
○ Half-life is 2-3 days but once bound to mast cells or
basophils, can last for weeks
 Mast cells and basophils
 IgE binding receptors
○ High affinity
○ Low affinity
 Atopic individuals have higher amount of soluble IgE receptor that
has been shown to increase IgE production by B cells
IgE cross-linkage initiates degranulation
Once cross-linkage
of antigen has
signaling result in
mast cell
○ Cooperation among
protein and lipid
rearrangement of the
Pharmacologic agents that mediate Type I
Primary mediators
 Made before and stored in granules
 Histamine, proteases, eosinophil
chemotactic factor, heparin
Secondary mediators
 Synthesized after
 Platelet-activating factor, leukotrienes,
prostaglandins, bradykinins, some cytokines
and chemokines
 Formed by decarboxylation of amino acid
 Major component of granules
 Effects observed in minutes
 Contraction of smooth muscle (intestinal and
bronchial), increase permeability of venules,
increased mucus secretion by goblet cells
Leukotrienes and prostaglandins
 Effects longer to become apparent
 Effects longer lasting than histamine
 Bronchoconstriction, vascular permeability,
mucus production
Type 1 can be systemic or localized
Systemic anaphylaxis
 Quick, can be fatal
 Respiration labored, blood pressure drops,
bronchiole constriction, edema, shock
 Epinephrine treats, relaxes smooth muscle
and increases cardiac output (prevents
vascular collapse)
Type 1 can be systemic or
Localized Hypersensitivity Reactions
○ Allergic Rhinitis
 Most common, “hay fever”
○ Asthma
 Triggered like hay fever but doesn’t happen in nasal
cavity, happens in lower respiratory tract
○ Food allergies
 Hives, vomiting
○ Atopic dermatitis
 Allergic eczema
Inflammatory disease
Induce expression of
adhesion molecules
on endothelial cells for
eosinophils and
○ Cause significant
injury because of toxic
enzymes, cytokines
○ Notice sloughing of the
ciliated columnar
epithelial cells lining
the bronchiole
Clinical Methods to detect Type 1
Skin testing
Checking serum
level of IgE
Control of Type 1
Avoiding contact
 Immunotherapy
○ Subcutaneous injections of allergens
 Causes shift to IgG production instead of IgE
○ Monoclonal anti-human IgE
Drug therapies
Type II – Antibody-Mediated Cytotoxic
Transfusion Reactions
 Due to exposure to microorganisms in gut,
individuals have antibodies to blood types not
their own
 Antibody attaches to RBC and initiates
complement system to lyse RBC
 After lysis:
○ Hemoglobin detected in plasma, starts to filter
through kidneys and found in urine
○ Hemoglobin converted to bilirubin – toxic at high
○ Fever, chills, blood clotting
Type II – Antibody-Mediated Cytotoxic
Hemolytic disease of newborn
 Rh+ fetus, Rh- mother
 IgG antibodies cross placenta
 Some of these antibodies may be anti-Rh antibodies
- Can have severe consequences
 Antibodies against ABO blood groups produce less
consequences, can be easily treated
 Rhogam shot
○ Given to mother
○ Anti-Rh antibodies bind to fetal cells that might
have entered mother’s system during birthing
process, facilitates clearing before there is a B cell
Type III – Immune complex-mediated
Complexing of antigen plus antibody
facilitates phagocytosis and clearing of
 Large amounts of these complexes can
lead to tissue damage
Type III can be localized
Injection of antigen intradermally or
subcu into animal that has high level of
antibody for that antigen
○ Arthus reaction
○ Bug bites
Type III can be generalized
Serum sickness
○ After receiving antiserum (serum from another
animal that may contain antitoxins for treatment)
Use of monoclonal antibodies for use of
cancer treatment
○ Patient developed antibody against mouse
monoclonal antibody
Autoimmune diseases
 Lupus, Rheumatoid arthritis
Drug reactions
 Penicillin, sulfonamides
Infectious disease
Type IV – Delayed-type Hypersensitivity
Some subpopulations of TH cells encounter
antigen, secrete cytokines and induce localized
inflammatory response
Most cases are not detrimental
Type IV
Sensitization phase and Effector phase of DTH
Prolonged DTH can lead to formation of granuloma
Tuberculosis test is done this way
Type IV – contact dermatitis