Type I Hypersensitivity and Allergic Reactions

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Questions and Answers

What role do eosinophils and neutrophils play in late phase reactions?

They secrete proteases that cause tissue damage.

What characterizes systemic anaphylaxis upon re-exposure to an allergen?

It is characterized by edema in tissues, a drop in blood pressure, respiratory distress, and urticarial rash.

How do airborne allergens affect the eyes and upper airways in localized anaphylaxis?

They cause red, itchy, tearing eyes and increase mucus secretion, leading to nasal congestion, coughing, and sneezing.

What symptoms arise from bronchial asthma related to localized anaphylaxis?

<p>Symptoms include difficulty in breathing and wheezing due to smooth muscle contraction and inflammation.</p> Signup and view all the answers

What is the principal purpose of conducting an allergy skin test?

<p>To determine the causative allergens involved in hypersensitivity reactions.</p> Signup and view all the answers

Describe the procedure of the allergy skin test.

<p>Allergens are applied by pricking the skin with sterile lancets on the forearm or back.</p> Signup and view all the answers

In what ways can food or drug allergens manifest within the gastrointestinal tract?

<p>They can cause abdominal cramps, pain, diarrhea, vomiting, or potentially lead to skin reactions like urticaria.</p> Signup and view all the answers

What immediate effects occur during the degranulation of mast cells in systemic anaphylaxis?

<p>Immediate release of mediators results in severe vasodilatation and drop in blood pressure.</p> Signup and view all the answers

What is the role of IgE antibodies in Type I hypersensitivity?

<p>IgE antibodies bind to mast cells and basophils, leading to sensitization and triggering degranulation upon subsequent exposure to the allergen.</p> Signup and view all the answers

What physiological mediators are released during the degranulation of mast cells?

<p>Physiological mediators such as histamine, leukotrienes, and prostaglandins are released during mast cell degranulation.</p> Signup and view all the answers

How does genetic predisposition influence Type I hypersensitivity reactions?

<p>Genetic predisposition determines an individual's susceptibility to developing allergic reactions upon exposure to allergens.</p> Signup and view all the answers

What is the immediate response in Type I hypersensitivity upon re-exposure to an allergen?

<p>The immediate response involves cross-linking of IgE antibodies by the allergen, which triggers mast cell degranulation within minutes.</p> Signup and view all the answers

What types of substances can act as allergens in Type I hypersensitivity?

<p>Common allergens include plant pollen, certain foods, bee venom, and medications like penicillin.</p> Signup and view all the answers

Describe the late-phase reaction in Type I hypersensitivity.

<p>The late-phase reaction involves the recruitment of leukocytes, mainly eosinophils and neutrophils, stimulated by cytokines released from mast cells.</p> Signup and view all the answers

What is the significance of T helper 2 (TH2) cells in Type I hypersensitivity?

<p>TH2 cells secrete interleukins that activate B cells to produce IgE antibodies, playing a crucial role in the allergic response.</p> Signup and view all the answers

What happens to the vascular system during a Type I hypersensitivity reaction?

<p>Vasodilation and increased vascular permeability occur, leading to symptoms such as swelling and redness at the site of the reaction.</p> Signup and view all the answers

What role does the Fc region of antibodies play in ADCC?

<p>The Fc region of antibodies binds to Fc receptors on NK cells, macrophages, or neutrophils, promoting cell killing through the release of perforins and granzymes.</p> Signup and view all the answers

How does the C3b protein function in the immune response?

<p>C3b acts as an opsonin that enhances phagocytosis by marking pathogens for destruction by immune cells.</p> Signup and view all the answers

What is the clinical consequence of transfusing incompatible ABO blood types?

<p>Transfusing incompatible blood groups can cause hemolysis of red blood cells due to pre-existing antibodies, leading to serious transfusion reactions.</p> Signup and view all the answers

Describe the mechanism behind hemolytic disease of the newborn.

<p>Hemolytic disease occurs when a Rh-negative mother produces antibodies against Rh-positive fetal blood cells, leading to fetal red blood cell destruction in subsequent pregnancies.</p> Signup and view all the answers

What is the purpose of the Coombs' test in diagnosing hemolytic disease?

<p>The Coombs' test detects antibodies bound to the surface of red blood cells, confirming the presence of an immune-mediated hemolytic process.</p> Signup and view all the answers

How does exchange transfusion help a newborn with hemolytic disease?

<p>Exchange transfusion replaces the newborn's Rh-positive red blood cells with Rh-negative cells, reducing the number of hemolysed cells and associated complications.</p> Signup and view all the answers

What treatment is given to Rh-negative mothers after delivery of a Rh-positive baby?

<p>Rh-negative mothers are given anti-D antibodies within 72 hours postpartum to neutralize fetal red blood cells in their circulation.</p> Signup and view all the answers

Explain how antibodies targeting normal cellular receptors can lead to diseases like Graves' disease.

<p>Antibodies specific for normal receptors, such as the thyroid stimulating hormone receptor, can interfere with normal cell function, resulting in conditions like Graves' disease.</p> Signup and view all the answers

What is the significance of the wheal size in allergic reactions?

<p>The wheal size helps assess allergen sensitivity as either mild, moderate, or severe reactions.</p> Signup and view all the answers

How do drugs like epinephrine aid in allergic reactions?

<p>Epinephrine relaxes smooth muscles and constricts blood vessels, making it potentially lifesaving during anaphylaxis.</p> Signup and view all the answers

What is the role of specific IgE in allergy diagnosis?

<p>Specific IgE levels indicate sensitivity to particular allergens and can be measured through tests like a radioallergosorbent assay.</p> Signup and view all the answers

Describe one mechanism by which antibodies cause tissue damage in Type II hypersensitivity.

<p>Antibodies enhance phagocytosis of the affected cells by acting as opsonins.</p> Signup and view all the answers

Why is identifying and avoiding allergens crucial in allergy management?

<p>Avoiding allergens is the most effective way to prevent allergic reactions from occurring.</p> Signup and view all the answers

What is allergen-specific immunotherapy and how does it work?

<p>Allergen-specific immunotherapy involves repeated exposure to small doses of allergens to decrease specific IgE and increase IgG levels, promoting tolerance.</p> Signup and view all the answers

How do antihistamines function in the treatment of allergies?

<p>Antihistamines block the binding of histamine to receptors, alleviating allergy symptoms.</p> Signup and view all the answers

What is the initial time frame for observing reactions to allergens after exposure?

<p>Reactions may develop in about 15 to 20 minutes after exposure to the allergen.</p> Signup and view all the answers

What is the underlying mechanism by which autoimmune hemolytic anemia occurs?

<p>It occurs due to the production of autoantibodies against the patient's own red blood cells.</p> Signup and view all the answers

Explain how penicillin can lead to hemolytic anemia.

<p>Penicillin can form a drug-cell complex that triggers an immune response, producing antibodies that lyse red blood cells.</p> Signup and view all the answers

What role do antistreptococcal antibodies play in rheumatic fever?

<p>They cross-react with antigens in the heart muscle, causing inflammation and damage to the heart.</p> Signup and view all the answers

Describe the mechanism of tissue injury in type III hypersensitivity reactions.

<p>Tissue injury occurs through inflammation due to immune complex deposition and complement activation.</p> Signup and view all the answers

What diagnostic tests can be used to identify autoimmune diseases related to type II hypersensitivity?

<p>ELISA can detect circulating antibodies, while immunofluorescence can identify antibodies and complement in lesions.</p> Signup and view all the answers

In which autoimmune condition does antibody binding to cellular receptors interfere with normal receptor function?

<p>Myasthenia gravis is a condition where antibodies inhibit the function of acetylcholine receptors.</p> Signup and view all the answers

What inflammatory effect is caused by immune complexes in type III hypersensitivity?

<p>Immune complexes cause inflammation within blood vessel walls, leading to leukocyte activation and platelet aggregation.</p> Signup and view all the answers

How do anti-inflammatory and immunosuppressive agents help in treating autoimmune diseases?

<p>These agents reduce immune system activity, decreasing inflammation and tissue damage caused by autoantibodies.</p> Signup and view all the answers

What is the primary mechanism behind the development of serum sickness after exposure to foreign serum?

<p>The primary mechanism involves the formation of IgG antibodies against foreign serum proteins, leading to the production of soluble immune complexes.</p> Signup and view all the answers

Describe the Arthus reaction and its common triggers.

<p>The Arthus reaction occurs when immune complexes form at the injection site following repeated subcutaneous antigen exposure, such as insulin or penicillin.</p> Signup and view all the answers

How are immune complex-mediated diseases differentiated between bacterial and viral origins?

<p>In bacterial origins, such as post-streptococcal glomerulonephritis, immune complexes primarily form in the kidneys, while in viral conditions, chronic hepatitis is commonly associated with immune complex formation.</p> Signup and view all the answers

What role does complement component C3 play in the diagnosis of immune complex diseases?

<p>Complement component C3 levels may fall significantly during acute immune complex responses and can be detected through single radial immunodiffusion.</p> Signup and view all the answers

Discuss the role of corticosteroids in the treatment of immune complex diseases.

<p>Corticosteroids are used to limit inflammation and mitigate tissue damage associated with immune complex formation.</p> Signup and view all the answers

What is the key difference between Type IV hypersensitivity and other types of hypersensitivity reactions?

<p>Type IV hypersensitivity does not involve antibodies but is mediated by T cells and macrophages.</p> Signup and view all the answers

How do CD4+ helper T cells contribute to tissue damage in Type IV hypersensitivity reactions?

<p>CD4+ helper T cells recognize antigens presented by macrophages and secrete cytokines that promote inflammation and further T cell proliferation.</p> Signup and view all the answers

What is farmer's lung and how is it related to immune complex formation?

<p>Farmer's lung is a hypersensitivity pneumonitis caused by deposition of immune complexes in the lungs after inhalation of mold spores or pigeon feces.</p> Signup and view all the answers

Flashcards

What is an allergen?

A substance that triggers an allergic reaction in the body upon re-exposure. Examples include pollen, certain foods, bee venom, and penicillin.

How quickly does a Type I hypersensitivity reaction occur?

The reaction occurs within minutes of re-exposure to the allergen.

What happens to the allergen once it enters the body?

Antigen-presenting cells digest the allergen and present it to T helper 2 cells (TH2 cells).

What do TH2 cells do in a Type I hypersensitivity reaction?

TH2 cells release Interleukins 4, 5, and 13, which activate B cells to produce IgE antibodies.

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What happens after IgE antibodies are produced?

IgE antibodies attach to mast cells and basophils. This makes the individual sensitized.

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What triggers the release of inflammatory mediators?

The allergen binds to IgE antibodies on mast cells, cross-linking them and causing degranulation.

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What inflammatory mediators are released in a Type I hypersensitivity reaction?

The mediators released from degranulation include histamine, leukotrienes, heparin, prostaglandins, and platelet-activating factor (PAF).

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What are the effects of the inflammatory mediators released in a Type I hypersensitivity reaction?

These mediators cause smooth muscle contractions, vasodilation, increased vascular permeability, increased mucus secretion, and stimulation of nerve endings, leading to symptoms like itching and pain.

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Type I Hypersensitivity (Immediate Hypersensitivity)

A type of hypersensitivity reaction characterized by a rapid and excessive immune response to an allergen. It involves the activation of mast cells and basophils, leading to the release of histamine and other inflammatory mediators.

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Mast Cells

Specialized cells that release histamine and other inflammatory mediators, leading to the symptoms of Type I hypersensitivity reactions.

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Anaphylaxis

A severe, life-threatening allergic reaction that involves widespread vasodilation, bronchospasm, and a drop in blood pressure.

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Atopy

A localized allergic reaction that typically involves specific tissues and organs.

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Allergy Skin Test

A diagnostic test used to identify specific allergens that trigger allergic reactions.

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Cross-linking of IgE

A process where a substance (allergen) binds to IgE antibodies attached to mast cells, triggering their degranulation and the release of histamine and other inflammatory mediators.

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Bronchial Asthma

A medical condition characterized by recurrent episodes of wheezing, shortness of breath, chest tightness, and coughing, often triggered by allergens.

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Allergic Rhinitis (Hay Fever)

A condition characterized by inflammation and swelling of the nasal passages, often triggered by allergens.

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Wheal Reaction

A small, round, inflamed area that appears after skin contact with an allergen.

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Allergic Reaction

A type I hypersensitivity reaction involving IgE antibodies, mast cells, histamine release, and localized inflammation.

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Total Serum IgE Test

A test that measures the level of IgE antibodies in the blood, which can indicate an allergic tendency.

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Specific IgE Test

A test that measures the level of IgE antibodies specific to a particular allergen.

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Allergen Avoidance

Avoiding contact with an allergen is the best way to prevent an allergic reaction.

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Allergen Specific Immunotherapy

A treatment involving repeated small doses of an allergen to build tolerance and reduce allergic reactions.

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Type II Hypersensitivity

A type of hypersensitivity reaction involving antibodies (IgM or IgG) reacting with antigens on cell surfaces, leading to cell destruction.

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Opsonization

Antibodies act like 'tags' that signal immune cells to engulf and destroy target cells, contributing to tissue damage in type II hypersensitivity.

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Antibody-dependent cell-mediated cytotoxicity (ADCC)

Antibodies bind to Fc receptors on immune cells like NK cells, macrophages, or neutrophils, triggering the release of cytotoxic molecules like perforins and granzymes, leading to target cell destruction.

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What is C3b?

A component of the complement system that coats microbes, making them more attractive for phagocytosis by immune cells.

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What does the C5b678 complex do?

A complex of complement proteins that forms pores in cellular membranes, leading to cell lysis and death.

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How can antibodies interfere with cell function?

Antibodies that bind to specific receptors on cells can disrupt normal function, leading to diseases like Graves' disease (thyroid stimulating hormone receptor) or myasthenia gravis (acetylcholine receptor).

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What is alloimmune hemolysis?

The process of red blood cell destruction due to immune system incompatibility, often triggered by blood transfusions or during pregnancy.

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How does incompatibility in the ABO system affect blood transfusions?

ABO antigens on red blood cells are unique to each individual, causing reactions if mismatched blood types are transfused.

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What is hemolytic disease of the newborn?

When a Rh-negative mother carries a Rh-positive fetus, maternal antibodies are activated, potentially causing hemolysis of fetal red blood cells.

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What is the Coombs' test?

A test used to detect antibodies bound to red blood cells, often used to diagnose alloimmune hemolysis.

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Autoimmune Hemolytic Anemia, Thrombocytopenia, or Granulocytopenia

A type of autoimmune reaction where antibodies attack the patient's own red blood cells, platelets, or granulocytes, leading to their destruction. This can occur as a part of an autoimmune disease or be triggered by drugs.

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What is the mechanism of Autoimmune Hemolytic Anemia, Thrombocytopenia, or Granulocytopenia?

Antibodies mistakenly attack antigens on cells, leading to cell destruction. The antibodies can be against red blood cells, platelets, or granulocytes.

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Type III Hypersensitivity Reaction

Immune complexes (antigen-antibody-complement) are formed and deposited in tissues, causing inflammation and damage. The antigen can be exogenous (from outside the body) or endogenous (from within the body).

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What type of antibody is mainly involved in Type III hypersensitivity?

IgG antibodies are the primary type involved in Type III hypersensitivity.

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What happens to immune complexes in Type III hypersensitivity?

Immune complexes are normally removed by phagocytes but can accumulate in certain conditions, leading to their deposition in tissues, often in the skin, joints, and kidneys.

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What is the major mechanism of tissue injury in Type III hypersensitivity?

Inflammation in blood vessel walls is triggered by complement activation and leukocyte attachment to immune complexes, leading to tissue damage. Platelet aggregation and micro-thrombi formation further contribute to damage.

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What is the general approach to treating Type III hypersensitivity reactions?

Inflammation, immunosuppression, and symptomatic treatment are used to manage autoimmune conditions like those involving Type III hypersensitivity.

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What are common diagnostic tests for Type III hypersensitivity?

ELISA and immunofluorescence are used to detect circulating antibodies and complement in the lesions to diagnose Type III hypersensitivity.

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Immune complex-mediated hypersensitivity (Type III)

An immune response characterized by the formation of immune complexes that deposit in tissues, leading to inflammation and tissue damage.

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Serum sickness

A condition caused by the deposition of immune complexes in small arteries, mainly in the skin, kidneys, and joints, leading to vasculitis, nephritis, and arthritis.

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Arthus reaction

A localized reaction that occurs after repeated subcutaneous injections of an antigen, leading to the formation of immune complexes at the injection site and resulting in local vasculitis and necrosis.

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Farmer's lung

A hypersensitivity pneumonitis caused by the deposition of immune complexes in the lungs after repeated inhalation of mold spores or pigeon feces.

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Type IV hypersensitivity reaction (delayed-type hypersensitivity)

A type of hypersensitivity reaction that involves the interaction of T cells and macrophages, without the participation of antibodies.

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CD4+ helper T cells

The key cell type involved in Type IV hypersensitivity reactions, responsible for recognizing antigen in a complex with MHC II and secreting cytokines that activate other immune cells.

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Macrophages

Cells that engulf and process antigens, presenting them to T cells in the context of MHC II, and releasing cytokines that contribute to the inflammatory response in Type IV hypersensitivity.

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Cell-mediated immunity

A type of immune response that involves the activation of T cells and macrophages, usually leading to chronic inflammation and tissue damage. Common examples include contact dermatitis, tuberculosis, and graft rejection.

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Study Notes

Type I Hypersensitivity Reaction (Immediate Hypersensitivity)

  • Type I hypersensitivity involves IgE antibodies and mast cells.
  • Allergic reactions occur within minutes of re-exposure.
  • Allergens trigger allergic reactions in the body.
  • Allergens can be various substances like pollen, foods, bee venom or serum proteins.
  • Antigen-presenting cells process the allergen.
  • Helper T2 cells (TH2) receive and activate B cells.
  • Activated B cells release IgE antibodies.
  • IgE antibodies bind to mast cells and basophils.
  • Sensitization occurs.
  • Subsequent exposure to the same allergen triggers degranulation.
  • This releases various mediators including histamine, leukotrienes, heparin, prostaglandins, and platelet-activating factor (PAF).
  • Effects include smooth muscle contraction, vasodilation, and increased vascular permeability.
  • Other effects are increased mucus secretion, itching and pain.

Clinical Presentations

  • Systemic anaphylaxis involves widespread edema, fainting, respiratory distress, and a drop in blood pressure.
  • Localized anaphylaxis (atopic) affects the respiratory passages, digestive tract, and skin.
  • Symptoms include difficulty breathing, wheezing, bronchial asthma, red itchy eyes, and tearing.
  • Symptoms may include skin rash, itching, and pain.
  • Food or drug allergies may lead to abdominal pain, cramps, vomiting, diarrhea, and a reaction on the skin.

Diagnosis

  • Allergy skin tests are performed to identify causative allergens.
  • Common allergens include pollen, molds, tree pollen, plant or weed pollen, cat/animal dander and common substances.
  • Skin prick tests are used, where allergens are pricked into the skin.
  • Allergy blood tests measure total serum IgE levels or specific IgE antibodies against specific allergens by radioallergosorbent assay (RAST).

Management

  • Avoiding allergens is the most effective way to prevent reactions.
  • Drugs (epinephrine) can relieve symptoms by relacing smooth muscles andconstricting blood vessels.
  • Antihistamines block histamine binding to receptors.
  • Corticosteroids reduce inflammation.
  • Mast cell stabilizers (sodium cromoglycate) inhibit mast cell degranulation.

Allergen Specific Immunotherapy

  • Recommended when medications fail.
  • Involves repeated subcutaneous allergen administration in small doses.
  • Aims to change the T-cell response from Th2 dominance to Th1 dominance.
  • May increase the production of IgG antibodies to neutralize allergens.

Antibody-mediated Type II Hypersensitivity Reaction (Cytotoxic)

  • Antibodies react with antigens on cell surfaces.
  • This triggers cell lysis, inflammation, and tissue damage.

Alloimmune Hemolysis

  • ABO incompatibility is the most common cause of transfusion reactions.
  • Mismatched blood transfusions can cause severe reactions with rapid lysis of transfused blood cells.
  • Rh factor incompatibility can lead to hemolytic disease of the newborn.

Autoimmune Hemolytic Anemia (and Granulocytopenia, Thrombocytopenia)

  • Autoantibodies against the body's own red blood cells, platelets, or granulocytes are produced.
  • Leads to destruction of these cells.

Type III Hypersensitivity Reaction (Immune Complex-Mediated)

  • Immune complexes (antigen-antibody) form.
  • These complexes deposit in tissues.
  • Often causes inflammation, vasculitis and/or tissue damage.
  • Arthus reaction is a localized type III hypersensitivity.

Type IV Hypersensitivity Reaction (Delayed-Type)

  • T cell-mediated response.
  • Granulomatous diseases show infection symptoms such as tuberculosis or leprosy and lead to delayed hypersensitivity where granulomas are found.

Skin Tests

  • Tuberculin test detects previous exposure to Mycobacteria tuberculosis or prior vaccinations.
  • Contact dermatitis is a delayed type reaction from direct contact to a substance.

Other Syndromes

  • Other related syndromes include rheumatic fever, goodpasture's syndrome and graft rejection.

Autoimmune Diseases

  • Results from autoreactive T cells attacking self antigens.
  • Chronic inflammatory responses happen in this autoimmune response, causing symptoms and/or organ damage.

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