Hypersensitivity and allergy 12&17

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2. Disease mechanisms and host responses AD1 (Immunology MD) Flashcards on Hypersensitivity and allergy 12&17, created by Rachael Jones on 16/11/2016.
Rachael Jones
Flashcards by Rachael Jones, updated more than 1 year ago
Rachael Jones
Created by Rachael Jones over 7 years ago
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Question Answer
What is hypersensitvity? An individual who has been sensitised to a particular antigen by repeated exposure over time is susceptible to developing an excessive immune response (hypersensitivity reaction) on subsequent exposure to the antigen
What causes hypersensitivity? Antigens (allergens) involved are generally ubiquitous environmental substances to which only genetically susceptible individuals react inappropriately
Is there only one cause for allergy? No - multifactorial
What does the hypersensitivity response result in? Cellular and tissue changes and clinical signs of allergic disease
Is the same hypersensitivity mechanism used for useful purpose and for foreign antigen? Yes
What is another name for 'hypersensitivity mechanisms'? Immunopathological mechanisms
What are the 4 classifications of hypersensitivity? 1. Type I - immediate 2. Type II (antibody dependent: - cytotoxic type, - anti-receptor type) 3. Type III- immune complex 4. Type IV - cell mediated/ delayed type hypersensitivity (DTH)
What are the 2 stages of a hypersensitivity reaction? 1. Sensitisation 2. Hypersensitivity
What is the process of sensitisation in type 1 hypersensitivity? 1. Allergen is recognised by dendritic cell 2. Allergen grabbed and internalised by DC which then migrates to lymph tissue 3. Th2 produce specific cytokines 4. Cytokines act on allergen specific B cells 5. B cell produce allergen specific IgE
What is the hypersensitivity stage of type I? 1. The allergen is recognised by the IgE which coats mast cells 2. Cross-linking of allergen by IgE causes degranulation of mast cell 3. Cuasing bronchoconstriction, vasodilation, pruritus within 5-60 mins (usually 15)
What is related to mast cell degranulation between 4-24 hours after? Late phase recruitment of eosinophils and macrophages - inflammatory cells
What does the allergen cross link? IgE bound to FCER
What leads to the degranulation of the mast cells? Intracellular signalling pathway
What may also coat mast cells (reagenic antibody)? IgG (of a particular subclass)
Give 3 other substances that can degranulate mast cells. 1. C3a 2. C5a 3. Neuropeptide
Give 3 localised type 1 hypersensitivity disease. 1. Cutaneous (eg flea allergy) 2. Respiratory (eg asthma) 3. Intestinal (eg food allergy)
Give 3 systemic type 1 hypersensitivity disease. 1. Anaphylaxis (eg bee sting, penicillin reaction) 2. Severe and life threatening 3. Bronchoconstriction, laryngeal oedema, vasodilation
How is type 1 hypersensitivity regulated? The lack of Tregulatory activity causes there to be an increase in Th2
What does an increase in Th2 cause? - IgE production - Eosinophil attraction (IL-5, eotaxin) - Mast cell attraction (IL-4)
What 2 cell types will be found in a histological section of a canine asthma-like disease? 1. Bronchial mast cells 2. Bronchial CD4+ T cells
Give 7 factors that cause allergy. 1. Age 2. Parasitism? 3. Microbial infection 4. Stress 5. Immune dysregulation 6. Allergen exposure 7. Genetic
What are the 2 things that have influenced the cause of the hygiene hypothesis? The way we live How we bring up kids
Give 7 factors that influence the hygiene hypothesis. 1. Isolation 2. Cleanliness 3. Processes foods 4. Vaccination 5. Antibiotic usage 6. Allergy 7. Autoimmunity
Is the allergic incidence increasing or decreasing? Increasing
What does repeated infection cause with relation to the hygiene hypothesis? - Induces Tregulatory cells - Causing 'bystander suppression' and non microbe-specific - No Th1 or Th2 induced - Controls autoimmunity/ allergy
What does lack of microbial exposure cause with relation to the hygiene hypothesis? - Reduces expansion - Increases autoimmunity and allergy - Th1 and Th2 produced
What are the 3 ways an antibody can kill a target cell? 1. Opsonisation 2. Complement mediated lysis 3. ADCC through the binding of FcR of a natural killer cell to target cell
Give 3 examples of when there is type II hypersensitivity. 1. Blood transfusion reactions 2. Antibody-mediated autoimmune diseases 3. Graft rejection
Why might a type II hypersensitivity reaction occur in dogs with transfusion reactions? DEA1- dog given DEA1+ blood on two occasions (induced alloantibody) - make antibody on the first occasion and then will hypersensitivity on second time due to antibody attacking 'foreign' antigen
Why might a type II hypersensitivity reaction occur in cats with transfusion reactions? Transfuse type B cat with type A or AB blood (naturally occurring alloantibody against type A)
Give 2 outcomes of blood transfusion reactions. 1. Acute angioedema 2. Chronic haemolytic
Give an autoimmune disease which is a type II hypersensitivity reaction to the antibody. Autoimmune haemolytic anaemia (AIHA)
What happens in AIHA? Attack own red blood cells due to marcophages with FcR and C3bR
What is the anti-receptor antibodies (subtype of type II hypersensitivity) also referred to as? Type V hypersensitivity
Give an example of a receptor stimulating antibody disease in type II hypersensitivity. Grave's disease
How does Grave's disease work? Anti-TSHR (thyroid stimulating hormone receptor) antibody binds to TSHR to cause prolonged stimulation of the pituitary and therefore excess hormone is produced
Give a disease that involves receptor blocking antibodies in type II hypersensitivity. Myasthenia Gravis
What happens in Myasthenia Gravis? The antibody blocks the Ach receptor and therefore Ach can't bind resulting in the muscle motor end plate not working due to no stimulation (neuromuscular junction)
What are the clinical signs of Myasthenia Gravis? Episodic walking and collapsing due to the AchR being blocked/destroyed
What are the 2 sub types of type III hypersensitivity? 1. Antibody 2. Antigen
What happens in type III when there is antibody in excess? - Sensitisation leads to IgG response - Local exposure to antigen - Local immune complex formation - Local inflammation - The 'Arthus Reaction'
What can the antigen entering where the antibody is in excess cause? 1. Complement activation ( causes neutrophil degranulation, mast cell degranulation, platelet aggregation microthrombi- inflammation) 2. Macrophage activation ( IL-1, TNF - Inflammation)
Give 3 human arthus reactions (occupational diseases). 1. Farmer's lung (fungal spores) 2. Pigeon Fancier's lung 3. Cheesemaker's lung
What happens in type III when there is antigen in excess? - Sensitisation leads to circulating antibody - Exposure to high concentration antigen - Small soluble immune complexes in antigen excess - Circulating immune complexes - Systemic disease
What is the effect of antibody-antigen complex sitting in the wall of a blood vessel when there is excess antigen? - Complement activation - Neutrophil degranulation - Basophils - Platelet aggregation microthrombi - Vasodilation - Vasculitis - Inflammation
Why do immune complexes fall out of blood vessels? Turbulent blood flow
Give 4 places where it is common to get localisation of circulating immune complexes. 1. Renal glomerulus 2. Eye 3. Skin between epidermis and dermis 4. Synovium of joints
Give 6 factors that determine the immune complex deposition. 1. Size of complex 2. Overwhelmed IC clearance mechanisms 3. Nature of antigen 4. Nature of antibody 5. High blood pressure and turbulent flow 6. Endothelial lesions
What is another term used to describe type IV hypersensitivity? Delayed type hypersensitivity (DTH)
What is involved in type IV hypersensitivity? Mononuclear cells and cytokines due to contacting the allergen
How long does it take for the DTH to occur? 24-72 hours
What is stimulated in a DTH? Sensitised memory Th1 which release IFN-gamma which recruits other cells to the tissue and producing a localised immune tissue response
What cells are recruited by the IFN-gamma? Macrophae (IL-1, TNF, IL-6) Th1 CD8 NK
What is an example of a DTH in human medicine? Heaves test for the BCG injection against TB - larger response means the body is more sensitised and therefore higher level exposure has been had
What everyday compounds can cause a DHT? Sensitization by metal
How has veterinary medicine been seen to cause a DTH? Reaction to neomycin containing topical - use of an ear infection cream as topical to an infection on the snout
What was the initial purpose of hypersensitivity reactions? Defend the body from infection
What does a type 1 hypersensitivity reaction help to protect against? Anti-parasitic
What does a type IV hypersensitivity reaction help to protect against? Tuberculosis
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