Iv-1B

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* Anaphylaxis
* Allergic asthma
* Atopic allergies- hay fever, allergic rhinitis,
and allergies to specific allergens such as latex, peanuts, iodine ect.

Type I (cont)
* Allergens can be encountered in the following ways

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* Inhaled- ragweed, house dust
* Ingested- peanuts
* Injected- bee venom, drugs
* Contact- pollens, environmental
* Some reactions are confined to areas exposed to the antigen, others may be systemic- anaphylaxis

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Type II - Cytotoxic

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* The body makes special autoantibodies directed against self-cells or tissues that have some form of foreign protein attached to them
* The autoantibody then binds to the self-cell and forms an antigen-antibody complex (immune complex)
* The self-cell is then destroyed by phagocytosis or complement-mediated lysis

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* Clinical examples type 2

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- hemolytic anemia's, hemolytic transfusion reaction

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Type II (cont)
* Treatment of type II begins with

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discontinuing the offending drug or blood product
* Plasmapheresis
* Symptomatic treatment
* Complications may be life threatening

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Type III Immune Complex

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* Soluble immune complexes are formed, usually with antigen excess . P. 401
* The circulating immune complexes are then deposited in the walls of small blood vessels (kidneys, skin, joints)
* The deposited immune complex activates complement, resulting in tissue or vessel damage

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Type III (cont)
* Many immune complex disorders (mostly connective tissue disorders) this is the major mechanism of the disease
* Examples include

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RA, and SLE
* Serum sickness is a complex of symptoms that occurs after the administration of a foreign serum or certain drugs

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Type III (cont) Serum sickness

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* Caused by the collection of immune complexes deposited in the walls of blood vessels in the skin, joints, and kidney.
* Most common causes are pcn, related drugs, and animal serums antitoxins.
* Symptoms include- fever, arthralgia, rash, and lymphadenopathy, and malaise, and usually appear 7-10 days after receiving the agent.
* Self limiting- treatment is symptomatic, prednisone for severe cases

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Type IV Delayed hypersensitivity

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* Reactive cell is the sensitized T- lymphocyte. Respond to an antigen by producing and releasing certain lymphokines (chemical mediators), and they recruit, retain, and activate macrophages to destroy the antigen.
* Typically occurs hours to days after an exposure
* Characterized by an accumulation of lymphocytes and macrophages, causing edema, ischemia, and tissue destruction at the site

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Type IV (cont)
* Examples include

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positive ppd, contact dermatitis, poison ivy, local response to insect stings
* Interventions include removal of the offending antigen, usually self-limiting and treatment symptomatically.
* Patch testing to identify the allergen

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Type V Stimulatory reactions

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* Relatively new
* Inappropriate stimulation of a normal cell surface receptor by an autoantibody, resulting in a continuous “turned on state” for the cell
* Graves disease, a form of hypothyroidism
* An autoantibody binds to thyroid-stimulating hormone receptor sites on the thyroid gland, causing the tissue that responds to the autoantibody is “out of control”
* Thyroid will be normal

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Type V (cont)

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* Treatment includes removing enough of the responding (stimulated) tissue either surgically or by radiation

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Hypersensitivity or Allergy

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* A state of increased or excessive response to the presence of an antigen (foreign protein or allergen) to which the patient has been previously exposed.
* Symptoms range from uncomfortable feelings (sneezing) to life threatening reactions (anaphylaxis)

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Five Types of Allergy

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* Type I – immediate
* Type II – cytotoxic
* Type III – immune complex-mediated
* Type IV – delayed
* Type V - stimulated

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Type I Immediate

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* Atopic, the most common type of hypersensitivity
* Results from increased production of the immunoglobulin E (IgE)
* An acute inflammatory reaction occurs when IgE responds to an otherwise harmless antigen and causes the release of histamine and other vasoactive amines from basophils, eosinophils and mast cells
Type I examples