PATHOPHYSIOLOGY OF ASTHMA

Lamina Propria

In the lamina propria, theres dendritic cells (DC) and Mast Cells sitting in it.

T-helper 2 cells
When an allergen is inhaled, the allergen will trigger some reactions.
1. The allergen will be engulfed by the dendritic cells (DC) and activate the
dendritic cells.
2. The columnar pseudostratified epithelium will recognise the allergen and
secrete Thymic Stromal Lymphocytes. Thymic Stromal Lymphocytes will
conditions activated dendritic cells to produce chemokines
(chemoattractant) to attract specifically Th2 cells.
The activated dendritic cells itself will activate the T-helper cells to differentiate
into Th2 cells as well as attracting other Th2 cells sources to the
bronchioles/lungs.
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Activated Th2 cells do several stuff.

1. It promotes the humoral immunity, so it will stimulate plasma cells
through interleukin-13 (IL-13) and interleukin-4 (IL-4). This will then
promotes IgE antibody production by the plasma cells. IgE will then bind to
the mast cells to create IgE-Mast cells complex.
2. It will also promotes mast cells activities directly via mediator Interleukin-9
(IL-9).
3. It will stimulate the production of eosinophil from the bone marrow
through interleukin-5 (IL-5). Therefore, there will be an increased in
number of eosinophil in the lamina propria. With more eosinophil, a
chemotactic process will occur, which attracts the eosinophil to the
lungs/airway.
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When inhaled allergens bind/cross-link with the IgE-Mast cells complexes, it will
causes the mast cell to de-granulate, hence producing histamine, prostaglandins
and leukotrienes. Histamine specifically, will stimulate smooth muscles in the
airways to cause constriction bronchoconstriction.
During this whole process, the endothelial cells will release stem cell factors, that
maintain the mast cells to the area.
Memory IgE will be produced too. So whenever the same types of allergen is
inhaled, it will trigger this whole process of histamine release.