![References
Justiz VaillaAA, Vashisht R, Zito PM. Immediate Hypersensitivity Reactions.
[Updated 2021 Nov 15]. In: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2022 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK513315/
https://www.osmosis.org/
Marwa K, Kondamudi NP. Type IV Hypersensitivity Reaction. [Updated 2021
Nov 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing;
2022 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK562228/](https://image.slidesharecdn.com/inflammationppt-220906193118-31529936/85/Types-of-Inflammation-ppt-pptx-44-320.jpg)
![References
Bajwa SF, Mohammed RHA. Type II Hypersensitivity Reaction. [Updated
2021 Sep 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing; 2022 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK563264
Usman N, Annamaraju P. Type III Hypersensitivity Reaction. [Updated 2021
Aug 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing;
2022 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK559122/
Essential Pathology For Dental Students ; Authors, Harsh Mohan,
Sugandha Mohan ; Edition, illustrated ; Publisher, JP Medical Ltd, 2011.](https://image.slidesharecdn.com/inflammationppt-220906193118-31529936/85/Types-of-Inflammation-ppt-pptx-45-320.jpg)
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- 1. SLIDESMANIA.COM SLIDESMANIA.COM Types of hypersensitivity reaction Types Of Hypersensitivity Reaction
- 2. SLIDESMANIA.COM SLIDESMANIA.COM Type I - IgE mediated immediate reaction Type II- Antibody-mediated cytotoxic reaction (IgG or IgM antibodies) Type III- Immune complex-mediated reaction Type IV- Cell-mediated, delayed hypersensitivity reaction Introduction
- 4. SLIDESMANIA.COM SLIDESMANIA.COM Depending upon the rapidity, duration and type of the immune response, these 4 types of hypersensitivity reactions are grouped into : i) Immediate type ii) Delayed type
- 5. SLIDESMANIA.COM SLIDESMANIA.COM Type I hypersensitivities include atopic diseases, which are an exaggerated IgE mediated immune responses (i.e., allergic: asthma), and allergic diseases, which are immune responses to foreign allergens (i.e., anaphylaxis). The allergens that result in a type I hypersensitivity may be harmless (i.e., pollen, mites, etc.) or more hazardous such as insect venoms. Type I Anaphylactic Reaction
- 7. SLIDESMANIA.COM SLIDESMANIA.COM Type I Anaphylactic REACTION Etiology & Pathogenesis Signs & symptoms Examples of reaction type Treatment
- 8. SLIDESMANIA.COM SLIDESMANIA.COM Type I hypersensitivity occurs as a result of exposure to an antigen. The response to the antigen occurs in two stages: the sensitization and the effect stage. In the sensitization stage, the host experiences an asymptomatic contact with the antigen. In the "effect" period, the pre-sensitized host is re- introduced to the antigen, which then leads to a type I anaphylactic or atopic immune response . Etiology & Pathogenesis
- 10. SLIDESMANIA.COM SLIDESMANIA.COM Range from mild, local (e.g. urticaria. rhinorrhea, itching) to life-threatening anaphylactic reaction (e.g. cardiac arrhythmia, shock, bronchospasm, laryngeal obstruction) . SIGNS & SYMPTOMS
- 11. Examples Common Type I Hypersensitivity Reactions :- Ingested allergens Foods, dander, bee stings, mold, drugs , pollen . Other allergens :- Latex, lotions, soaps, penicillin Atopic eczema Allergic urticarial Allergic rhinitis Allergic asthma Anaphylaxis Eosinophilic esophagitis
- 12. Medications :- Symptom-based Antihistamines (e.g. H1 blockers), corticosteroids , epinephrine . Other interventions Hypo /de-sensitization Escalating doses of allergen subcutaneously injected over course of years. Treatment
- 13. SLIDESMANIA.COM SLIDESMANIA.COM Type II hypersensitivity reaction refers to an antibody- mediated immune reaction in which antibodies (IgG or IgM) are directed against cellular or extracellular matrix antigens with the resultant cellular destruction, functional loss, or damage to tissues. TYPE II Cytotoxic Reaction
- 14. SLIDESMANIA.COM SLIDESMANIA.COM Type II: Cytotoxic (Cytolytic) reaction
- 15. SLIDESMANIA.COM SLIDESMANIA.COM TYPE II Cytotoxic reaction Signs & symptoms Examples of reaction type II Treatment Etiology & Pathology
- 16. SLIDESMANIA.COM SLIDESMANIA.COM The type II hypersensitivity immune reaction develops in response to modifications of cell surface or matrix- associated antigens generating antigenic epitopes that are regarded as foreign by the immune system. The most common causes include medications like penicillin, thiazides, cephalosporin , and methyldopa. The drug molecule either binds to the surface of cells resulting in a neoantigen or alter the epitopes of the existing self-antigen on the cell surface. Etiology
- 17. SLIDESMANIA.COM SLIDESMANIA.COM In type II hypersensitivity, following exposure to the inciting agent, autoantibodies are produced (IgG & IgM) to the host cells (sensitization phase), promoting a series of pathogenic outcomes (effector phase). The pathophysiology of type II hypersensitivity reactions can be broadly classified into three types :- 1. Cell depletion or destruction without inflammation. 2. Inflammation mediated by complement or Fc receptor. 3. Cellular dysfunction by antibodies. Pathology
- 19. SLIDESMANIA.COM SLIDESMANIA.COM Acute hemolytic transfusion reactions Fevers , chills nausea, vomiting , flank tachycardia chest pain , dyspnea Tremor, insomnia, irritability, weight loss Fatigue , jaundice , hepatosplenomegaly (HSM) Bullous pemphigoid Signs & Symptoms
- 20. SLIDESMANIA.COM SLIDESMANIA.COM Hemolytic disease of the newborn Autoimmune hemolytic anemia C Immune thrombocytopenic Rheumatic fever Goodpasture syndrome Guillain-Barr辿 syndrome Graves' disease Common Type II hypersensitivity reactions
- 21. Medications Corticosteroids Severe reactions may require :- plasmapheresis immunosuppressant Treatment
- 22. SLIDESMANIA.COM SLIDESMANIA.COM An abnormal immune response is mediated by the formation of antigen-antibody aggregates called "immune complexes. They can precipitate in various tissues and trigger the classical complement pathway. Complement activation leads to the recruitment of inflammatory cells that release lysosomal enzymes and free radicals at the site of immune complexes, causing tissue damage. Type III Hypersensitivity Reaction Immune complex-mediated reaction
- 23. LogoType The principle feature that separates type III reactions from other hypersensitivity reactions is that in type III the antigen- antibody complexes are pre- formed in the circulation before their deposition in tissues .
- 25. SLIDESMANIA.COM SLIDESMANIA.COM Type III Hypersensitivity Reaction Etiology & Pathology Signs & Symptoms Examples of reaction type III Treatment
- 27. SLIDESMANIA.COM SLIDESMANIA.COM If triggered by single exposure to antigen , resolves after catabolism of immune complexes acute serum sickness . If repeated/prolonged exposure chronic serum sickness . Common sites of immune complex :- accumulation Blood vessel walls vasculitis Kidneys glomerulonephritis Joints arthritis
- 28. SLIDESMANIA.COM SLIDESMANIA.COM Serum Sickness Post-streptococcal Glomerulonephritis Systemic Lupus Erythematosus Farmers' Lung (Hypersensitivity Pneumonitis) Rheumatoid Arthritis Common Type Ill hypersensitivity reactions :-
- 29. SLIDESMANIA.COM SLIDESMANIA.COM Fever, fatigue, weight loss . Skin : rash , urticaria Kidney : proteinuria Joints : arthralgias Mucosa : ulcers Serosa : pleuritis, pericarditis Signs & symptoms
- 30. Treatment Medications Systemic lupus erythematosus (SLE) :- Administration of anti- inflammatory, corticosteroids, cytotoxic medications to decrease inflammatory activity.
- 31. Type IV hypersensitivity reaction Type IV hypersensitivity typically occurs at least 48 hours after exposure to an antigen. It involves activated T cells, which release cytokines and chemokines, and macrophages and cytotoxic CD8+ T cells that are attracted by these moieties. Type IV reactions are further subdivided into type IVa, IVb, IVc, and IVd based on the type of T cell (CD4 T-helper type 1 and type 2 cells) involved and the cytokines/chemokines produced. Delayed hypersensitivity plays a crucial role in our body's ability to fight various intracellular pathogens such as mycobacteria and fungi. They also play a principal role in tumor immunity and transplant rejection.
- 33. SLIDESMANIA.COM SLIDESMANIA.COM Etiology & Pathology Signs & symptoms Examples of reaction type II Treatment Type IV Hypersensitivity Reaction
- 34. Etiology & Pathology Type IV hypersensitivity reaction are, to some extent, normal physiological events that aid in the fight against infections, and disruption in this system can predispose to a variety of opportunistic illnesses. Exposure to poison ivy resulting in contact dermatitis is a classic example. Several drugs (antibiotics, anticonvulsants) can trigger type IV hypersensitivity reactions .Certain viral infections, when exposed to certain drugs, can trigger a reaction, such as cytomegalovirus with antibiotics, Epstein Barr virus with amoxicillin.
- 36. There are three subtypes of Type IV hypersensitivity: Contact Dermatitis Tuberculin-type Hypersensitivity Granulomatous-type Hypersensitivity
- 37. SLIDESMANIA.COM SLIDESMANIA.COM Contact hypersensitivity dermatitis occurs when haptens, which are considered as exogenous antigens, penetrate the skin with proximity to epidermal and dermal cells resulting in an inflammatory reaction. Additionally, keratinocytes help in recruiting immune cells by secreting other groups of cytokines . This results in inflammation of the skin with swelling, itchiness, and pain.
- 38. Tuberculin-type hypersensitivity can be seen after intradermal injection of purified protein derivative (PPD) called tuberculin (product of tuberculosis bacillus), that produces measurable local induration and swelling, typically measured in millimeters between 48 to 72 hours after the injection. This local reaction indicates the presence of type four hypersensitivity. The tuberculin test is a validated method to diagnose tuberculosis infection, even if latent.
- 39. SLIDESMANIA.COM SLIDESMANIA.COM Can occur in response to a variety of antigens. Macrophages that engulfed antigens are unable to destroy them and recruit several more macrophages to the site of these antigens. A collection of macrophages filled with intracellular antigens is termed granuloma. One instance is sarcoidosis disease, which is a systemic granulomatous disease of unknown cause, with a wide variety of clinical presentations. Granulomatous-type Hypersensitivity
- 40. Signs & symptoms Local inflammatory reaction :- erythema warmth edema fever Sequelae of organ-specific cell destruction Islet cell destruction in pancreas insulin-deficient (e.g. lethargy, seizure, coma) . Chronic inflammation granuloma formation organ failure (e.g. lethargy, seizure, coma) Chronic inflammation granuloma formation organ failure
- 41. Graft-versus-host disease (GVHD). Mantoux test Allergic contact dermatitis Multiple sclerosis Coeliac disease. Giant-cell arteritis Postorgasmic illness syndrome Diabetes mellitus type 1 Hashimoto's thyroiditis Common Type IV hypersensitivity reactions :-
- 42. Medications Corticosteroids for inflammatory control Systemic for severe, generalized reactions. site-specific (e.g. topical for contact dermatitis; inhaled for hypersensitivity pneumonitis). Treatment
- 43. Summary in video
- 44. References Justiz VaillaAA, Vashisht R, Zito PM. Immediate Hypersensitivity Reactions. [Updated 2021 Nov 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513315/ https://www.osmosis.org/ Marwa K, Kondamudi NP. Type IV Hypersensitivity Reaction. [Updated 2021 Nov 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562228/
- 45. References Bajwa SF, Mohammed RHA. Type II Hypersensitivity Reaction. [Updated 2021 Sep 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563264 Usman N, Annamaraju P. Type III Hypersensitivity Reaction. [Updated 2021 Aug 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559122/ Essential Pathology For Dental Students ; Authors, Harsh Mohan, Sugandha Mohan ; Edition, illustrated ; Publisher, JP Medical Ltd, 2011.