Allergy: When the immune system backfires

Coombs and Gell classification

Type I Type II Type III Type IV

Synonyms Immediate or Cytotoxic type Immune complex type Cellular or delayed

anaphylactic type type

Allergens Pollen, food allergens, Drugs, infectious Inhaled molds (lung), Contact allergens:
more rarely drugs agents or in infused foreign nickel in jewelry, black
autoimmune reactions proteins (serum hair dyes, fragrances,
sickness), tetanus preservatives, drugs
vaccine (Arthus
reaction)

Latencies Seconds to minutes Several minutes to Approx. 3 to 12 hours Approx. 12 hours to 2

hours days

Immune IgE IgG/IgM IgG/IgM T cells

reactant

Effector Once sensitized, free Antibody binds to Antibody binds to T effector cells are
mechanisms antigens cross-link the antigen on a target soluble antigen, activated by an
antibodies expressed cell, which is actually forming a antigen presenting
on mast cells or a host cell that the circulating immune cell. When the antigen
basophils, which immune system complex. Elimination is presented again in
causes the release of considers as foreign, of circulating the future, the
immune mediators. leading to cellular infectious agents by memory T cells will
destruction via immune complexing activate macrophages
complement. and elimination by and cause an
phagocytosis. inflammatory
response.

Clinical Urticaria, Secondary symptoms Cutaneous vasculitis, Allergic contact

signs angioedema, corresponding to the allergic alveolitis in the eczema, photocontact
conjunctivitis, rhinitis, affected cell types, lungs (farmer’s lung), allergy, drug
bronchial asthma, e.g. purpura in serum sickness, exanthems
colic, vomiting, thrombocytopenia, or Arthus reaction
diarrhea, anaphylaxis severe bacterial
infections in
granulocytopenia.

Table 1: Coombs and Gell classification.

Table showing the classification of allergic reactions according to Coombs and Gell.