HYPERSENSITIVITY

1. Allergic Response2. Allergic Response Type

Type I –III: Immediate Hypersensitivity

Type– IV: Delayed Type Hypersensitivity

Allergic Responses

• Reexposed to antigen that has encountered previously

• Allergic symptoms are caused by immune reponses (Immune product).• Immediate Hypersensivity :

antibody (B) and cytokines (T)

Allergic Response Type

Type (Group) I (Anaphylactic)

B

MastCell

MastCellIgE

degranulasi

histamine release

pollen (first) pollen (second)

Type (Group) II (Cytotoxic)

Allergic Response Type

REDCELLS

C

Direct Cell LYSIS orC5a reqruitment of Neutrophylto phagocytose cell

IgG

Surface Antigen

Allergic Response Type• Type (Group) III (Immunocomplex)

CIgGIgM

Neut Neut

IntegrinICAM-1VCAM-1

CIgGIgM

VASCULITIS

complement

Immunocomplex DiseasesAllergic Diseases

• Arthur Reaction (vaccine,drug,insect bite)• SerumSickness (Protein & nonprotein drugs)

Nonalleric Diseases• Lupus erythematosus

• Vasculitis• Glomerulonephritis

• Rheumatoid arthritis• Acute allograft rejection.

Allergic Response TypeType (Group) IV

(Delayed Type Hipersensitivity or T cell mediated monocyte/ macrophage activation

or Cell Mediated Hypersensitivity)Exp:

Allergic Contact Dermatitis.Hypersensitivity Pneumonitis

Photoallergic Contact Dermatitis.

Allergic Response TypeType IV (Abbas)

Delayed type hypersensitivity

Th1/Tc M

Activated macrophage inflammation

IL-2INFγTNFß

Tissue injury

Tc Tc

Cell killing & tissue injury

Targetcells

T cell mediated cytolysis.

Th0M

IL-12

Th2Th1

IL-2TNFß

INFγIL-10

IL-4 TGFß IL-5

DTH B Cell IH EosinophilIgE

promote

inhibit

antigen

CLASS SPECIFIC IMMUNE MEDIATORS DISEASES REACTANT

I Ig E Mast Cell and Atopy basophil-derived Anaphylaxis Uricaria/angioedema

II IgG,*Ig M Complement Immune hemolytic anemia, Neutropenia

III IgG,IgM Complement Serum Sickness (Immunocomplex)

IV T lymphocyes T cell cytokines Allegic contact dermaitis

DRUG ALLERGY

DRUGANTIGEN

CARRIER PROTEIN(TISSUE)

CONYUGATE SPECIFICANTIBODY

1. Native molecule

2. Hydrolisis/biotransformation products

3. Interaction of the drug/drug metabolite and the protein

4. Conformational change in the tissue protein

DRUG ALLERGY

drug

drug ordrug metabolite

drug ordrug metabolite

drug metabolite

IMMUNOLOGIC IN VIVO IN VITRO REACTION TYPE I Immediate skin prick RAST. ELISA and intradermal

TYPE II None Coombs

TYPE III Intradermal Arthus Test Precipitin Test RAST,ELISA

TYPE IV Patch Test Lymphocyte Proliferation.

DRUG ALLERGY TESTING METHODS