Allergy Mechanisms and Type I Hypersensitivity
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Questions and Answers

What is the primary mechanism behind a Type I hypersensitivity reaction?

  • Cytotoxic T-cell activation
  • IgG mediated complement activation
  • Immune complex deposition in tissues
  • IgE mediated mast cell degranulation (correct)

Which type of hypersensitivity reaction is uniquely mediated by T-cells, rather than antibodies?

  • Type I
  • Type III
  • Type II
  • Type IV (correct)

What is the role of TH2 cells in the context of an allergic reaction?

  • Secreting interleukins, promoting IgE production, and mediating the humoral immune response (correct)
  • Activating cytotoxic T-cells
  • Suppressing the immune response
  • Directly killing infected cells

What distinguishes an allergen from other antigens?

<p>They are antigens that cause an abnormal immune response. (A)</p> Signup and view all the answers

Which of these best defines the term 'Atopy'?

<p>A predisposition for an IgE-mediated response (A)</p> Signup and view all the answers

In the case of a wasp sting reaction, what is the primary reason for the observed oedema?

<p>Mast cell degranulation and histamine release causing vasodilation and increased permeability (C)</p> Signup and view all the answers

What is the mechanism of action of Chlorpheniramine?

<p>H1 histamine antagonist (C)</p> Signup and view all the answers

What is the aim of the hypersensitisation immunotherapy?

<p>Decrease or eliminate the body’s immune response to a specific allergen (B)</p> Signup and view all the answers

Which cytokine is primarily responsible for the differentiation of naive T-helper cells into TH2 cells during an allergic reaction?

<p>IL-4 (A)</p> Signup and view all the answers

What is the primary role of IL-5 in the context of an allergic response?

<p>Activating and recruiting eosinophils (C)</p> Signup and view all the answers

Which of the following best describes the function of the FcεR1 receptor?

<p>It binds to the constant region of IgE antibodies on mast cells and basophils. (D)</p> Signup and view all the answers

During degranulation, which preformed mediator activates the complement system?

<p>Tryptase and chymase (C)</p> Signup and view all the answers

Which newly synthesized mediator is most potent at causing smooth muscle contraction of the airways in an allergic reaction?

<p>Leukotrienes C4 and D4 (D)</p> Signup and view all the answers

What direct effect does histamine have on blood vessels during an allergic response?

<p>Vasodilation (B)</p> Signup and view all the answers

Which of these occurs first in an immediate hypersensitivity reaction, after initial exposure to the allergen?

<p>Class switching of B cells to produce IgE antibodies. (A)</p> Signup and view all the answers

Which of the following is NOT a function of histamine during an allergic reaction?

<p>Vasoconstriction. (A)</p> Signup and view all the answers

What is the primary mechanism by which leukotrienes and cytokines contribute to the late-phase allergic response?

<p>Migration of leukocytes, particularly eosinophils, to the site of inflammation. (C)</p> Signup and view all the answers

Which of the following best describes the action of H1 antihistamines in reducing hypotension and oedema?

<p>By preventing vasodilation and reducing the effects of increased vascular permeability. (D)</p> Signup and view all the answers

A patient with rhinitis and urticaria is prescribed a second-generation antihistamine. Which of the following drugs would be most appropriate?

<p>Fexofenadine (D)</p> Signup and view all the answers

What is the primary pharmacological effect of H2 antihistamines?

<p>Reducing gastric acid production in the stomach. (D)</p> Signup and view all the answers

Which of the following explains why first-generation H1 antihistamines are more likely to cause sedation?

<p>They have a greater central effect and cross the blood brain barrier. (A)</p> Signup and view all the answers

A patient experiencing motion sickness is seeking medication. Which of the following would be the most appropriate first-generation H1 antihistamine?

<p>Promethazine (C)</p> Signup and view all the answers

How do H1 antihistamines alleviate the sensation of pruritus (itching)?

<p>By competing with histamine for H1 receptors on peripheral nociceptors. (D)</p> Signup and view all the answers

What aspect of glucocorticoids makes them useful in treating inflammation?

<p>Their anti-inflammatory properties. (C)</p> Signup and view all the answers

What is the primary function of negative selection in T cell development within the thymus?

<p>To induce apoptosis or suppress T cells that bind with high affinity to self-peptides. (D)</p> Signup and view all the answers

Which of the following best describes the nature of autoantibodies?

<p>Antibodies that react with self-antigens found in the body. (B)</p> Signup and view all the answers

Which of the following is NOT a commonly identified composition of autoantibodies?

<p>Minerals (A)</p> Signup and view all the answers

What is the typical antibody isotype associated with autoantibodies in most diseases?

<p>IgM (D)</p> Signup and view all the answers

Which of these is LEAST likely to result in an autoimmune issue?

<p>Exposure to a toxic chemical (A)</p> Signup and view all the answers

In the context of autoimmunity, what does the concept of 'molecular mimicry' refer to?

<p>Infectious agents with amino acid sequences or structures similar to host self-antigens, causing cross-reactivity. (A)</p> Signup and view all the answers

How do 'cryptic antigens' contribute to autoimmunity?

<p>By becoming accessible to self-reacting T cells due to tissue damage or changes. (B)</p> Signup and view all the answers

What role do T regulatory cells play in preventing autoimmunity?

<p>They suppress the activity of other T cells, thereby limiting tissue damage. (A)</p> Signup and view all the answers

What is the primary mechanism by which glucocorticoids exert their anti-inflammatory and immunosuppressive actions?

<p>Binding to glucocorticoid receptors, leading to changes in gene transcription. (D)</p> Signup and view all the answers

Which of the following is a short-term effect of glucocorticoid administration?

<p>Decreased vasodilation and decreased capillary permeability. (B)</p> Signup and view all the answers

What is a long-term effect of glucocorticoid use, caused by the binding of the glucocorticoids to cytoplasmic receptors?

<p>Promotion of apoptosis in eosinophils, monocytes and lymphocytes (A)</p> Signup and view all the answers

Which of the following is a consequence of glucocorticoids' inhibition of phospholipase A2?

<p>Decreased production of arachidonic acid derivatives (C)</p> Signup and view all the answers

Besides anti-inflammatory and immunosuppressive actions, which other effects are commonly associated with glucocorticoids?

<p>Reduced sodium excretion and increased potassium excretion. (C)</p> Signup and view all the answers

What is the effect of glucocorticoids on cell apoptosis and fibroblast proliferation?

<p>Stimulate cell apoptosis and inhibit fibroblast proliferation. (A)</p> Signup and view all the answers

In the context of steroid abuse, which effect can be associated with glucocorticoids?

<p>Increased muscle mass and strength. (A)</p> Signup and view all the answers

What is the primary characteristic of superantigens?

<p>They activate a large number of T lymphocytes regardless of their antigen specificity. (B)</p> Signup and view all the answers

Which of these drugs is an example of a locally administered glucocorticoid?

<p>Beclomethasone (A)</p> Signup and view all the answers

What is meant by ‘bystander action’ in the context of autoimmune diseases?

<p>The enhanced presentation of self-antigens leading to an expansion of the immune response towards other self-antigens. (D)</p> Signup and view all the answers

Which of the following factors is NOT typically implicated in the development of autoimmune diseases?

<p>A prolonged period of good health. (B)</p> Signup and view all the answers

Organ-specific autoimmune diseases like Graves’ disease are often easier to diagnose because:

<p>They frequently present with symptoms directly related to the affected organ. (D)</p> Signup and view all the answers

What is a key characteristic of systemic autoimmune diseases?

<p>They can affect multiple organs or systems in the body. (A)</p> Signup and view all the answers

Which symptom is LEAST likely to be associated with autoimmune disorders?

<p>Persistent and specific organ pain. (B)</p> Signup and view all the answers

Why can diagnosing autoimmune disorders be difficult?

<p>People may have multiple autoantibodies and autoimmune disorders and a lack of detectable autoantibodies. (D)</p> Signup and view all the answers

What are the potential complications that can arise from systemic autoimmune diseases?

<p>Vasculitis and anaemia. (A)</p> Signup and view all the answers

Flashcards

Hypersensitivity

An abnormal immune response that can cause harm to the body, occurring only in sensitized individuals who have been previously exposed to the allergen.

Allergen

A substance that causes an allergic reaction, typically a small protein with protease activity.

Sensitization

The process by which the immune system becomes sensitized to an allergen. This involves initial exposure and development of antibodies.

Type I Hypersensitivity

A type of immune response characterized by the release of histamine and other inflammatory mediators, leading to immediate allergic reactions.

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TH2 Cells

A distinct type of CD4+ T cell that plays a crucial role in humoral immune responses, particularly against extracellular parasites and bacterial infections.

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Atopy

A predisposition to developing IgE-mediated allergic reactions.

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Periorbital Oedema

A term that refers to swelling around the eyes.

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Lip Oedema

A term that refers to swelling of the lips.

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Late Phase Allergic Reaction

The late phase of an allergic reaction, occurring 2-24 hours after exposure, characterized by leukocyte migration (mainly eosinophils) and the release of substances like peroxidases causing further tissue damage.

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Antihistamines

Drugs that block the action of histamine, a chemical released during allergic reactions.

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H1 Antihistamines

Antihistamines that target H1 receptors, found in various locations like smooth muscle, vascular endothelial cells, and the CNS.

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Generations of H1 Antihistamines

First-generation H1 antihistamines have more central effects and are often used as sedatives, while second-generation H1 antihistamines have less central effect and are more commonly used for allergic reactions.

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H2 Antihistamines

Antihistamines that target H2 receptors, primarily found in the stomach, and are used to reduce gastric acid production.

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Glucocorticoids

Drugs like corticosteroids that have a broad range of effects, including anti-inflammatory, immunosuppressive, and endocrine effects.

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Effects of Glucocorticoids

The ability of glucocorticoids to reduce inflammation, suppress the immune system, and affect hormones and metabolism.

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Adverse Effects of Glucocorticoids

The potential adverse effects of glucocorticoids, such as increased risk of infections, bone thinning, and hyperglycemia.

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What are antigen-presenting cells (APCs)?

A type of immune cell that presents antigens to T cells, initiating an immune response.

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What is a TH2 cell?

A specific type of T helper cell that plays a crucial role in allergic reactions. It is activated by the binding of allergens to IgE receptors on mast cells.

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What is IgE?

An antibody that specifically binds to allergens and triggers the release of inflammatory mediators by mast cells, leading to allergy symptoms.

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What are mast cells?

A type of immune cell that contains granules filled with inflammatory mediators, such as histamine. These cells are activated by allergens bound to IgE receptors on their surface, triggering the release of these mediators.

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What is degranulation?

The process by which mast cells release their granules containing inflammatory mediators, such as histamine, upon activation by allergens.

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What is histamine?

A chemical mediator released by mast cells that causes smooth muscle contraction, vasodilation, and increased vascular permeability, leading to the characteristic symptoms of allergies.

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What are leukotrienes?

A group of lipids that are involved in allergic reactions. One type, leukotriene C4 and D4, causes strong smooth muscle contraction in airways, contributing to breathing difficulties.

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What is Prostaglandin D2 (PDG2)?

A type of prostaglandin that contributes to allergic reactions by causing bronchospasms, increased vascular permeability, and vasodilation.

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How do glucocorticoids work?

Glucocorticoids have an immediate effect on vasodilation, but their main anti-inflammatory and immunosuppressive actions involve binding to glucocorticoid receptors and altering gene transcription.

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What are the main uses of glucocorticoids?

Glucocorticoids are used for hormone replacement in conditions like Addison's disease, for managing both acute and chronic inflammation (e.g., rheumatoid arthritis), and for suppressing the immune system.

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Where are local glucocorticoids used?

Glucocorticoids can be applied locally to treat skin conditions (dermatoses) and asthma.

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How are glucocorticoids administered?

Glucocorticoids can be applied topically, injected locally, inhaled, taken orally, or administered via injection (intramuscular, subcutaneous, intravenous).

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How do glucocorticoids affect vasodilation?

Glucocorticoids cause a decrease in vasodilation and capillary permeability, leading to reduced fluid leakage and swelling at the site of inflammation.

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How do glucocorticoids affect leukocyte migration?

Glucocorticoids inhibit the migration of leukocytes (white blood cells) to inflammatory sites, reducing the inflammatory response.

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How do glucocorticoids affect certain immune cells?

Glucocorticoids promote apoptosis (programmed cell death) in eosinophils, monocytes, and lymphocytes, reducing their numbers in the inflammatory environment.

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How do glucocorticoids affect arachidonic acid derivatives?

Glucocorticoids inhibit the production of arachidonic acid derivatives, which are mediators of hypersensitivity reactions, by blocking phospholipase A2.

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Negative Selection

A process where T cells in the thymus are eliminated if they strongly bind to self-antigens presented by MHC molecules, ensuring that the immune system doesn't attack the body's own cells.

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Autoantibodies

Antibodies that mistakenly target the body's own tissues or cells. They can cause autoimmune disorders by damaging healthy cells.

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Molecular Mimicry

The mechanism that describes how an infectious agent might share similar amino acid sequences with self-antigens, leading to the immune system attacking the body's own cells. This occurs when antibodies or T cells mistakenly attack self-antigens because they recognize them as foreign.

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Cryptic Antigens

In the context of autoimmunity, these are proteins normally hidden from the immune system that become exposed after tissue damage or stress, triggering the immune response against them. The immune system recognizes these exposed proteins incorrectly, leading to autoimmune reactions.

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Genetic Predisposition to Autoimmunity

The predisposition for developing autoimmune disorders due to genetic factors. Some genes can increase the risk of developing certain autoimmune diseases.

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Immune Memory

The process by which the immune system reacts to an antigen it has encountered previously. Subsequent exposures to the same antigen trigger a faster and stronger immune response.

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Self-tolerance

The ability of the immune system to distinguish between self-antigens (belonging to the body) and non-self antigens (foreign). This helps prevent autoimmunity.

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What are super-antigens?

Proteins produced by microorganisms (bacteria, mycoplasma, or virus-infected cells) that bind to T cell receptors without regard for specific antigens. They stimulate a large number of T lymphocytes, acting as potent immune-stimulating molecules.

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What is bystander action?

The phenomenon where the enhanced processing and presentation of self-antigens by immune cells leads to the expansion of the immune response towards different self-antigens. This contributes to diseases like systemic autoimmune diseases.

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What is epitope spreading?

The process of bystander action can lead to the immune system targeting other parts of the body. This process is called epitope spreading.

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What are autoimmune diseases?

Autoimmune diseases develop when the immune system mistakenly attacks the body's own tissues and organs. This can involve multiple organs or systems, leading to various signs and symptoms.

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What are the causes of autoimmune diseases?

Autoimmune diseases are thought to arise from a combination of genetic predisposition and environmental triggers. These triggers could include infections, chemical exposure, or hormonal imbalances.

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What are the symptoms of autoimmune diseases?

Autoimmune diseases affect different organs and systems, leading to a wide range of symptoms. These symptoms can be systemic, affecting multiple parts of the body.

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What are the challenges of diagnosing autoimmune diseases?

Autoimmune diseases can be challenging to diagnose due to their non-specific symptoms and the presence of multiple autoantibodies. The diagnosis often involves identifying the specific organ or system affected and the presence of associated antibodies.

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What are organ-specific autoimmune diseases?

Some autoimmune diseases primarily affect a single organ, such as the thyroid, making diagnosis easier. These are termed organ-specific autoimmune diseases.

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Study Notes

Abena Naylor Case Study

  • A 31-year-old female experienced periorbital and lip edema after a wasp sting.
  • Her blood pressure and heart rate were elevated.
  • After receiving intramuscular (IM) drugs, her blood pressure returned to normal, but the edema persisted.
  • She was concerned that this episode might lead to rheumatoid arthritis.

Terms and Definitions

  • Periorbital: Edema around the eyes.
  • Chlorpheniramine: A histamine reverse agonist (H1).
  • Hydrocortisone: A glucocorticoid nuclear receptor agonist.
  • Epipen: An auto-injector containing adrenaline.
  • Hypersensitisation: Allergen immunotherapy aimed at diminishing the body's immune response to an allergen.

Hyper-sensitivity

  • An abnormal immune response causing potential harm to the body.
  • It occurs only in sensitized individuals.
  • Categorized into four types:
    • Type I: Immediate allergic reactions (e.g., food, asthma, anaphylaxis).
    • Type II: Cytotoxic reactions involving antibodies targeting specific tissues (e.g., autoimmune hemolytic anemia).
    • Type III: Immune complex-mediated reactions causing tissue damage.
    • Type IV: Delayed reactions mediated by T-cells (e.g., delayed hypersensitivity).
  • Causes include infections and environmental/self-antigens.

Allergen in Wasp Bite

  • Allergen: Substance triggering an immune response.
  • Often small proteins (containing protease).
  • Usually mediates TH2 immune response.
  • TH2 cells: A sub-type of T-cells involved in immune responses to extracellular parasites and bacterial infections.
  • TH2 response characterized by eosinophils, basophils, and mast cell degranulation (release of inflammatory chemicals).

Sensitization

  • The body's initial exposure and response to an allergen.
  • Antigens bind to receptors on antigen-presenting cells (APCs).
  • Antigens are presented to T-helper cells (TH cells), activating a TH2 response.
  • TH2 cells release cytokines, including IL4, IL5, and IL13.
  • IL4, promotes further TH2 cell activation.
  • IL5, recruits eosinophils.
  • IL13 promotes IgE production and epithelial cell stimulation.
  • IgE is produced and binds to mast cells/basophils, preparing for re-exposure.

Re-exposure - Immediate Reaction

  • Within 5-30 minutes of re-exposure.
  • Allergen cross-links IgE on mast cells/basophils.
  • Degranulation releases preformed mediators (e.g., histamine) and newly synthesized mediators (e.g., cytokines, leukotrienes).
  • Symptoms include smooth muscle contraction, vasodilation, increased vascular permeability, and itch (pruritus).

Re-exposure - Late Reaction

  • 2-24 hours after re-exposure.
  • Involves leukocytes (especially eosinophils)
  • Release of substances causing tissue damage.

Allergic Reactions Treatments

  • Antihistamines (H1/H2):
    • H1: First and second generations, primarily used as anti-allergy drugs (e.g., chlorpheniramine, and fexofenadine).
    • H2: Treat gastric reflux by reducing acid production (e.g., ranitidine, cimetidine).
  • Glucocorticoids:
    • Anti-inflammatory and immunosuppressive effects.
    • Immediate and long-term effects to reduce inflammation.

Anaphylactic Reaction

  • Assess: Airway, breathing, circulation, disability, exposure.
  • Diagnosis: Look for acute onset, skin changes, and exposure to allergen.
  • Call for help: Lie patient flat, raise legs if breathing is impaired.
  • When skills and equipment are available: Establish airway, high-flow oxygen, IV fluid challenge, monitor pulse oximetry, ECG, blood pressure.
  • Treatment: Adrenaline, chlorphenamine, hydrocortisone

Self-Antigens

  • Immune system develops mechanisms to avoid reacting against the body's own components.
  • T-cells (thymocytes) mature in the thymus.
  • Those with receptors for self-antigens are deactivated to prevent autoimmune responses.

Autoantibodies

  • Antibodies that react with self-antigens.
  • Can cause damage to healthy cells.
  • Mechanisms include molecular mimicry, protein changes, cryptic antigens, super-antigens.

Autoimmune Diseases

  • Disorders where the immune system attacks the body's own tissues or cells.
  • Can be organ-specific (affecting a single organ, such as the thyroid) or systemic (affecting multiple organs).
  • Signs/symptoms: often non-specific (e.g., fatigue, fever, rashes).
  • Difficult to identify the cause.

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Description

This quiz explores the principles of Type I hypersensitivity reactions, the role of various immune cells, and mechanisms involved in allergic responses. Test your understanding of allergens, cytokines, and treatment options related to atopic reactions.

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