Hypersensitivi TY: BY Arif Mohiddin 1 MDS Departement of Oral Pathology

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

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HYPERSENSITIVI

caused by the Immune responses

System : Collection of cells , Tissues

and Molecules that mediate resistance to

Responses : Coordinated reactions of

these cells and molecules to infections , microbes.

to a condition in which immune

damage , disease or even death in the

term Hypersensitivity was coined by

VON PIRQUET in 1905.

occurs in certain individuals

initial dose of antigen sensitizes the

Second dose of antigen that is responsible

reactions are classified into

Two main types .

COOMBS & GEL [ 1963] Classification :

[Anaphylaxis ] Antibody Mediated

- Type II [Cytotoxic/Cytolytic] Ab Mediated

Appears and Recedes Rapidly

Appears slowly in 24-72 hrs and

Easy but short lived

Difficult but long lasting

Hypersensitivity is a rapid , IgE

in individuals on Encounter with certain

I Reaction also called Anaphylactic

- Derived from Greek

term used when the

occurs quickly when a large shocking dose of

occurs within a few seconds to

few minutes following shocking dose of

IgE antibody is Responsible.

Tissues or Organs Which are affected in

First Exposure to ANTIGEN

Antigen activation of T Helper cells

Repeat exposure to Allergen

Activated Mast cells :

Schultz Dale phenomenon :

Applicaion of small dose of antigen on

Eg : Wheal & flare reaction

Allergic rhinitis, Sinusitis [Hay fever]

Increased mucus secretion

Smooth muscle contraction & inflammation

Fall in BP caused by vascular dilatation &

Type II [ Cytotoxic ] Reaction:

reactions Mediated by IgG or IgM

Directed against antigens on the surface of cells

bind to an antigen on the cell surface and

Type III [ Immune Complex ] Reaction:

Infiltration by polymorphonuclear leucocytes ,

Antigen combines with antibody

Normally these are removed by monocytes &

Inefficient in removing Smaller complexes

complexes deposited in vascular

- The tissue damage due to Ag Ab complexes

form of type III hypersensitivity

appears following a single injection of

to serum develop within 7-12 days.

Immune complexes deposited o epithelial