Chapter 15 Hypersensitivity Reactions, Allergies Dr. Capers immunology

Kindt • Goldsby • Osborne Kuby IMMUNOLOGY 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 allergens 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 IgE Mast cells and basophils 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 occurred, intracellular signaling result in mast cell degranulation Cooperation among protein and lipid kinases, phosphatases, rearrangement of the cytoskeleton

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

Histamine Formed by decarboxylation of amino acid Histidine 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 Localized Hypersensitivity Reactions (Atopy) 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

Asthma Inflammatory disease Induce expression of adhesion molecules on endothelial cells for eosinophils and neutrophils Cause significant injury because of toxic enzymes, cytokines Notice sloughing of the pseudostratified 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 Drug therapies Subcutaneous injections of allergens Causes shift to IgG production instead of IgE Monoclonal anti-human IgE Drug therapies

Type II – Antibody-Mediated Cytotoxic Hypersensitivity 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 (hemoglobinuria) Hemoglobin converted to bilirubin – toxic at high levels Fever, chills, blood clotting

Type II – Antibody-Mediated Cytotoxic Hypersensitivity 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 response

Type III – Immune complex-mediated hypersensitivity Complexing of antigen plus antibody facilitates phagocytosis and clearing of antigen 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

Chronic Inflammation Causes: Infections Continuing physical damage to tissue Obesity autoimmunity