Hypersensitivity

Hypersensitivity (also called hypersensitivity reaction or intolerance) refers to undesirable reactions produced by the normal immune system, including allergies and autoimmunity. They are usually referred to as an over-reaction of the immune system and these reactions may be damaging, uncomfortable, or occasionally fatal. Hypersensitivity reactions require a pre-sensitized (immune) state of the host. The Gell and Coombs classification of hypersensitivity is the most widely used, and distinguishes four types of immune response which result in bystander tissue damage.

Gell and Coombs classification

Immunologic aspects of hypersensitivity reactions
Type Alternative names Antibodies or Cell Mediators Immunologic Reaction Often mentioned disorders
I
  • Allergy
  • Immediate
  • Anaphylactic
  • Antibody IgE
Fast response which occurs in minutes, rather than multiple hours or days. Free antigens cross link the IgE on mast cells and basophils which causes a release of vasoactive biomolecules. Testing can be done via skin test for specific IgE.
  • Atopy
  • Anaphylaxis
  • Asthma
  • Churg-Strauss Syndrome
II
  • Cytotoxic,
  • Antibody-dependent
  • Antibody IgM
  • Antibody IgG
  • Complement
  • MAC
Antibody (IgM or IgG) binds to antigen on a target cell, which is actually a host cell that is perceived by the immune system as foreign, leading to cellular destruction via the MAC. Testing includes both the direct and indirect Coombs test.
  • Autoimmune hemolytic anemia
  • Rheumatic heart disease
  • Thrombocytopenia
  • Erythroblastosis fetalis
  • Goodpasture's syndrome
  • Graves' disease
  • Myasthenia gravis
III
  • Immune complex
  • Antibody IgG
  • Complement
  • Neutrophils
Antibody (IgG) binds to soluble antigen, forming a circulating immune complex. This is often deposited in the vessel walls of the joints and kidney, initiating a local inflammatory reaction.
  • Serum sickness
  • Rheumatoid arthritis
  • Arthus reaction
  • Post streptococcal glomerulonephritis
  • Membranous nephropathy
  • Reactive arthritis
  • Lupus nephritis
  • Systemic lupus erythematosus
  • Extrinsic allergic alveolitis (hypersensitivity pneumonitis)
IV
  • Delayed,
  • cell-mediated immune memory response,
  • Antibody-independent
Cells
  • T-cells
T helper cells (specifically Th1 cells) are activated by an antigen presenting cell. When the antigen is presented again in the future, the memory Th1 cells will activate macrophages and cause an inflammatory response. This ultimately can lead to tissue damage.
  • Contact dermatitis, including Urushiol-induced contact dermatitis (poison ivy rash).
  • Mantoux test
  • Chronic transplant rejection
  • Multiple sclerosis
  • Coeliac disease
  • Hashimoto's thyroiditis
  • Granuloma annulare
V
  • Autoimmune
  • IgM or IgG
  • Complement

This is an additional type that is sometimes (especially in the UK) used as a distinction from Type 2.

Instead of binding to cell surfaces, the antibodies recognise and bind to the cell surface receptors, which either prevents the intended ligand binding with the receptor or mimics the effects of the ligand, thus impairing cell signaling.

  • Graves' disease
  • Myasthenia gravis


Notes

  1. ^ a b See type V explanation in table.