HX4 Pharm 11
HX4 Pharm 11
HX4 Pharm 11
Explain the immunological mechanisms underlying type IV hypersensitivity reaction. Describe the principal causes and symptoms associated with type IV hypersensitivity reactions.
Type IV Hypersensitivity
Type IV hypersensitivity is also known as delayed
type hypersensitivity
It is different from the other 3 types of
hypersensitivity as it represents tissue damage resulting from inappropriate cell-mediated immunity reactions
Clinical conditions - tuberculosis, leprosy, contact dermatitis
Type IV hypersensitivity
Type IV Hypersensitivity
T-lymphocytes and subsequently the release of soluble cytokines from the T lymphocytes which activate macrophages
Activated macrophages may differentiate into giant cells and develops into granulomantous
hypersensitivity
Type IV Hypersensitivity
Within the type IV response there are 4 different
Type IV Hypersensitivity
i.
Jones-mote reaction - induced by contact with allergen but is characterized by the infiltration of basophils into the inflammatory site. - the factors which cause this particular component of the reaction are unknown
Type IV Hypersensitivity
iii. Tuberculin reaction This type of hypersensitivity is the basis of the Mantoux Test ( 72 hours- check for hard at
injection site)
The basis of tuberculin response is the re-
activation of antigen-specific memory T cells within the dermal layer of the skin
Type IV Hypersensitivity
iii. Tuberculin reaction (cont) T cells produce TNF- local vascular endothelial cells induce infiltration of neutrophils into the skin Predominant infiltrating cells mononuclear leukocytes (lymphocytes and monocytes) reaching a peak at about 48 hours
Type IV Hypersensitivity
iii. Tuberculin reaction (cont) Characteristic induration is a result of combination of large number cells with oedema Signs of reaction resolve after 5-7 days In contrast to infection with constant source of infection, reaction progresses to granulomatous lesion
Type IV Hypersensitivity
iv. Granulomatous reaction
Alternative name for granulomatous hypersensitivity is chronic inflammation Hallmark of chronic inflammation is mononuclear cells (monocytes, macrophages, lymphocytes) This type of DTH has most severe consequences due to presence of often extensive tissue damage
Type IV Hypersensitivity
iv. Granulomatous reaction (cont)
2 types of granuloma:
- foreign-body granuloma: initiated by inert foreign bodies - immune granuloma: T cell-mediated reaction to immunogenic particles
Type IV Hypersensitivity
References
Roderick Nairn and Matthew Helbert. Immunology for Medical
Wakelin and Mark Zuckerman. Medical Microbiology. 3rd Edition, Elsevier Mosby. 2004.
Marjorie Kelly Cowan and Kathleen Park Talaro. Microbiology A