•Hypersensitivity can be defined as a state of altered immune

response against an antigen characterized by hyper reactivity

leading to immunopathology
•Hypersensitivity reactions require a pre-sensitized (immune)
state of the host.
•There are two categories of adaptive hypersensitivities:
–Immediate hypersensitivities refer to humoral
immunity (antigen/antibody reactions)
–Delayed hypersensitivities refer to cell-
mediated
immunity(cytotoxic T-lymphocytes, macrophages, and cytokines)
Coomb and Gell in 1963 classified hypersensitivity
reactions into the following four types based on the
mechanism involved and time taken for the reaction.
 Type I Hypersensitivity
(IgE mediated anaphylactic hypersensitivity)
 Characteristics of Type-I hypersensitivity
• It is also known as immediate or anaphylactic
hypersensitivity and is mediated by IgE.

• The reaction occurs on exposure to allergen second

time. The first exposure (sensitizing dose) results in
sensitization of host to allergen and subsequent
exposure (s) (shocking dose) will cause reaction

• In type I hypersensitivity reactions, the allergens are

proteins
with a molecular weight ranging from 10 to 40 kDa.
 Mechanism of Type-I hypersensitivity
• The mechanism of reaction involves preferential production of
IgE, in response to certain antigens (allergens).

• Individuals prone to type-I hypersensitivity preferentially

produce IL-4 and IL-13 that favor IgE class switch.

• IgE has very high affinity for its receptor (FcεIII; CD23) expressed
on surface of mast cells and basophils; the Fc portion of IgE
binds to these receptors.
• A subsequent exposure to the same allergen cross links the cell-
bound IgE and triggers the release of various pharmacologically
active substances by a process called as ‘degranulation’;

Cross-linking of IgE Fc-receptor is important in mast cell triggering

Cross linking of IgE by allergen triggers mast cell degranulation
• Degranulation of cells result in the synthesis and secretion of
inflammatory mediators such as platelet-activating factor,
leukotreins, bradykinins, prostaglandins, and cytokines that
contribute to inflammation.

• The reaction is amplified by PAF (platelet activation factor) that

causes platelet aggregation and release of histamine, heparin
and vasoactive amines. Eosinophil chemotactic factor of
anaphylaxis (ECF-A) and neutrophil chemotactic factors attract
eosinophils and neutrophils, respectively, which release various
hydrolytic enzymes that cause necrosis
• These agents cause the early phase of allergic
reactions that appears within minutes after
exposure to the antigen.

• Late phase allergic reactions may begin several hours

after exposure to antigen.

• Cell-bound IgE on the surface of basophils of

sensitive individuals binds a substance called
histamine releasing factor (possibly produced by
macrophages and B-lymphocytes) causing further
histamine release
• The inflammatory agents released or produced cause
the following:
– dilation of blood vessels, which causes local redness (erythema)
at the site of allergen delivery. If dilation is widespread, this can
contribute to decreased vascular resistance, a drop in blood
pressure, and shock.
– increased capillary permeability, which causes swelling of local
tissues (edema). If widespread, it can contribute to decreased
blood volume and shock.
– constriction of bronchial airways, which leads to wheezing and
difficulty in breathing.
– stimulation of mucous secretion, which leads to congestion
of airways.
– stimulation of nerve endings, which leads to itching and pain
in the skin.
The IgE mediated diseases include systemic anaphylactic
shock, asthma, Hay fever (allergic rhinitis), tropical
pulmonary eosionophila, allergic conjunctivitis, skin
reactions (urticaria, eczema), food allergies
 Type II Hypersensitivity
(Antibody-mediated cytotoxic hypersensitivity)
• Type II hypersensitivity are antibody mediated cytotoxic reactions
occurring when an antibody binds to antigens located on the
surface of cells (usually RBCs). The reaction time is minutes to
hours.
• It is mediated, primarily, by antibodies of IgM or IgG class.
• The bound antibody can cause cell lysis by activating the classical
complement pathway, promoting phagocytosis (opsonization) or
through ADCC.
• Many different antigens may trigger this cell destruction, but an
infection in a genetically predisposed animal appears to be a major
triggering pathway.
• Antigens are normally endogenous, although exogenous chemicals
(haptens, such as ivy or drugs) that can attach to cell membranes
can also induce type II reactions.
• Autoimmune haemolytic anaemia, transfusion reactions,
Erythroblastosis
Blood fetalis, drug-induced hemolytic anemia,
granulocytopenia and thrombocytopenia are examples.
•IgM or IgG antibodies are made against self antigens either as a
result of failure of immune tolerance or cross-reactive
antibodies can develop during infections, which may bind to
normal tissue antigens and trigger antibody-mediated
cytotoxicity.
•Subsequent binding of these antibodies to the surface of host
cells leads to:
–Opsonization of the host cells whereby phagocytes stick to
host cells by way of IgG, C3b, or C4b and discharge their
lysosomes.
–Activation of the classical complement pathway
causing MAC induced lysis.
–ADCC mediated destruction of the host cells whereby NK
cells attach to the Fc portion of the antibodies.
 Pathology of Type II Hypersensitivity
•Mediated by Abs directed towards antigens present on cell
surfaces or the extracellular matrix (type IIA) or abs with
agonistic/antagonistic properties (type IIB).

•The most common cells involved are blood cells. The outcome
may be:
– hemolytic anemia if RBCs are involved,
– leukopenia involving WBCs, or
– thrombocytopenia involving platelets.

•Under some circumstances, a cytotoxic attack on vascular

epithelial cells will cause a vasculitis with local vascular leakage.

•The lesion contains antibody, complement and neutrophils

 Examples of Type II Hypersensitivity
 AB and Rh blood group reactions (blood transfusion reactions,
erythroblastosis foetalis)
 Autoimmune diseases:
 Rheumatic fever where antibodies result in joint and heart valve
damage;
 Idiopathic thrombocytopenia purpura where antibodies result in
the destruction of platelets;
 myasthenia gravis where antibodies bind to the
acetylcholine
receptors on muscle cells causing faulty enervation of muscles;
 Goodpasture's syndrome where antibodies lead to destruction of
cells in the kidney;
 Examples of Type II Hypersensitivity
 Autoimmune diseases:
 Graves' disease where antibodies are made against thyroid-
stimulating hormone receptors of thyroid cells leading to faulty
thyroid function;
 Multiple sclerosis where antibodies are made against the
oligodendroglial cells that make myelin, the protein that forms
the myelin sheath that insulates the nerve fiber of neurons in
the brain and spinal cord;
 Some drug reactions, e.g. penicillin
 Bovine Neonatal Pancytopenia
Erythroblastosis Foetalis
 TYPE – III HYPERSENSITIVITY
(Immune complex mediated hypersensitivity)
 Characteristics of Type III Hypersensitivity
• In type III hypersensitivity, soluble immune complexes are
formed in blood and are deposited in various tissues (typically
the skin, kidney and joints), activate classical complement
pathway and cause inflammatory damage.
• It is mediated by soluble immune complexes. They are mostly
of IgG class, although IgM may also be involved.
• The reaction takes hours to days (3-10 hours) to develop.
• The antigen may be exogenous (chronic bacterial, viral or
parasitic infections), or endogenous (non-organ specific
autoimmunity: e.g., Systemic Lupus Erythematosus-SLE).
• The antigen is soluble and not attached to the organ involved.
• The prerequisite for the development of immune-complex
disease is the persistent presence of soluble antigen and
antibody.
 Mechanism of Type III Hypersensitivity
 Soluble antigen-antibody (IgG or IgM) complexes are
normally removed by macrophages in the spleen and liver.
 On of excessive amount or large immune
formation
complexes these gets lodged in capillaries, pass between
endothelial cells of blood vessels – specially those in the skin,
joints, and kidneys - and become trapped on the surrounding
basement membrane beneath these cells.
 The Ag-Ab complexes then activate the classical complement
pathway; the damage being caused by platelets and neutrophils :
 massive inflammation, due to complement protein C5a;
 influx of neutrophils, due to complement protein C5a , resulting in
neutrophils discharging their lysosomes and causing tissue destruction and
further inflammation;
 MAC induced lysis of surrounding tissue cells; and
 aggregation of platelets, resulting in more inflammation and the formation
of microthrombi that block capillaries.
TYPE – III HYPERSENSITIVITY
 Pathology of Type III Hypersensitivity
• The affinity of antibody and size of immune complexes are
important in production of disease and determining the tissue
involved.
• The lesion contains primarily neutrophils and deposits of
immune complexes and complement.
• Macrophages infiltrating in later stages may be involved in the
healing process.
• The location of the immune complexes is largely determined by
the route by which antigen enters the body:
– Inhaled antigens give rise to a pneumonitis,
– antigens that enter through the skin cause local skin lesions, and
– antigens that access the bloodstream form immune complexes that are
deposited in renal glomeruli or joints.
• Clinical are therefore variable but may include fever,
cutaneous signs, polyarthritis, ataxia, behavior change,
signs
or nonspecific signs such as vomiting, diarrhea, or abdominal
 Examples of Type II Hypersensitivity
• Examples in human beings are: serum sickness, Arthus reaction,
polyarteritis, rheumatoid arthritis, Glomerulonephritis, SLE,
allergies to penicillin and sulfonamides, poststreptococcal
glomerulonephritis, meningitis, hepatitis, mononucleosis.
• Examples in animals include:
– Membranoproliferative Glomerulonephritis in dogs
– Hypersensitivity Pneumonitis in large animals (Extrinsic allergic
alveolitis, Farmer’s lung disease)
– Vasculitis
– Periarteritis Nodosa Nodosa, Necrotizing
(Polyarteritis
Polyarteritis)
– Canine Rheumatoid Arthritis
– Plasmacytic-Lymphocytic Synovitis
 Examples of Type II Hypersensitivity
• Examples in animals include:
– Purpura hemorrhagica of horses is a severe
thrombocytopenic purpura occurring non-
as immune
a Streptococcus equi infection; it occurs when a sequelae
complexes
of antibody and streptococcal antigen are to deposited in vascular
basement membranes.
– Blue-eye disease in dogs is an immune complex–mediated
reaction that frequently occurs in the recovery stage of infectious
canine hepatitis. It is haracterized by anterior uveitis and results
from the reaction of serum antibodies with uveal endothelial cells
infected with canine adenovirus 1.
– Equine recurrent uveitis is associated with immunologic reactions
to Leptospira or Onchocerca spp.
 Arthus Reaction
 An Arthus reaction is a localized type III hypersensitivity
reaction characterized by immune complex–mediated small-
vessel vasculitis associated with deposition of immune
complexes and activation of complement, and consequent
organ damage
 Immune complexes form following high local concentration of
vaccine antigens and high circulating antibody concentration.
 It was first observed by Arthus in 1903 following repeated
injections of horse serum into rabbits.
 The formation of immune complexes initiates complement
activation and an influx of inflammatory cells, followed
by thrombus formation and hemorrhagic infarction in the
areas of most intense inflammation; the types of mediators
involved in Arthus reaction determines the pathological
outcome of disease.
 Arthus Reaction
 Arthus reaction is characterized by pain, swelling, induration, and
edema beginning several hours after immunization and usually
reaching a peak 12 to 36 hours after immunization.

 It is self-limiting, resolving over the course of a few days.

 The and severity can be lessened by

frequency
immunizations spacing recommended
tetanus-diphtheria
moretoxoid
widely,
booster
asinjections.
has been for
 Serum Sickness
 Serum sickness is a systemic type III hypersensitivity reaction that
results from the injection of heterologous or foreign protein or
serum.
 Von Pirquet and Schick first described the syndrome in 1905, in
regions draining the site of injection after patients were given
antitoxin in the form of horse serum, hence the name
 Certain medications (eg, penicillin, nonsteroidal anti-
inflammatory drugs [NSAIDs]) have also been associated with
serum sickness–like reactions.
 These reactions typically occur 1 to 3 weeks after exposure to the
drug, but may occur as early as 1 to 24 hours afterward.
 Clinical manifestations include general malaise, fever, urticaria,
artheralgia, eosinophilia, splenomegaly and lymphadenopathy.
 Serum Sickness
 On exposure to a foreign serum protein, 6-10 days later
antibodies and form antigen-antibody complexes.
 If the macrophage activating system is not functioning properly,
these complexes will become saturated in the circulation, leading
to immune complex deposition, most commonly in parenchymal
tissues and synovial joint fluid.
 The deposition of immune complexes may activate the classical
complement pathway, which will trigger histamine release and
increase vascular permeability, which leads to an inflammatory
response in the tissues and joints.
 The mediation of injury in serum sickness appears to involve
several mechanisms, such as vasoactive amines, infiltration
of neutrophils, and cytokines, in particular TNFα) and IL-1
Pathogenesis of Serum Sickness
Arthus reaction versus Serum Sickness
TYPE – IV HYPERSENSITIVITY
(Cell mediated hypersensitivity)
(Delayed type hypersensitivity)
 Characteristics of Type IV Hypersensitivity
• Type IV hypersensitivity is often called delayed type
hypersensitivity as the reaction takes more than 12 hours to
develop. Typically the maximal reaction time occurs between
48 to 72 hours
• It is mediated by cells that cause an inflammatory reaction to
either exogenous or autoantigens
• The major cells involved are T lymphocytes and
monocytes/macrophages.
• This reaction to exogenous antigens involves T cells and also
antigen-presenting cells (APC), all produce cytokines that
stimulate a local inflammatory response in a sensitized
individual.
• DHR cannot be transferred from an animal to another by
means of antibodies or serum. However, it can be transferred
by T cells, particularly CD4 Th1 cells.
 Mechanism of Type IV Hypersensitivity
• CD8 cytotoxic T cells and CD4 helper T cells recognize antigen
in a complex with either type I or II MHC antigens
• The antigen-presenting cells in this case are macrophages and
they release interleukin 1, which further stimulates the
proliferation of CD4 cells.
• These cells release IL-2 and IFN-λ, which together regulate the
immune reaction; other lymphokines involved in
hypersensitivity reaction include delayed
monocyte factor, TNF α etc. chemotactic
• Cytokines produced by keratinocytes, APC, and T cells recruit
antigen-nonspecific T cells and macrophages to participate in
a local inflammatory reaction.
• Activated CD8 cells destroy target cells on contact, while
activated macrophages produce hydrolytic enzymes and,
transform into multinucleated giant cells.
Mechanism of Type IV Hypersensitivity
 Pathology of Type IV Hypersensitivity
• Type IV hypersensitivity is involved in the pathogenesis of many
autoimmune and infectious diseases (tuberculosis, leprosy,
blastomycosis, histoplasmosis, toxoplasmosis, leishmaniasis,
etc.) and granulomas due to infections and foreign antigens.
• There are three variants of delayed hypersensitivity as listed
below and their maximal reaction time appears in brackets:
– Contact (48 to 72 hours)
– Tuberculin (48 to 72 hours)
– Granulomatous (21 to 28 days)
• The delayed hypersensitivity lesions mainly contain monocytes
and a few T cells.
– Contact: mononuclear cells infiltrates present in both
dermis and
epidermis.
– Tuberculin: dermal infiltrate of leukocytes
– Granulomatous: typical epithelioid-cell granuloma and giant cells in the
Delayed Hypersensitivity Reactions
Contact Dermatitis Tuberculin type

Granuloma (T.B)
Comparison of Types of Hypersensitivity