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|  |

| 
A hypersensitivity resulting from large quantities
of soluble antigen-antibody complexes passing between endothelial cells of the blood
vessels and becoming trapped on the surrounding basement membrane.
 Also known as i   i i
i 
 |he reaction may be-
 i  r  r

 r  i
°  
       
° 
nephritis.
-
   
°
   
°      
 |he reaction    after exposure to the antigen (as in Arthus
reaction).
 èediated by   i  
 èostly of      may also be involved.
 |he antigen may be
exogenous (chronic bacterial, viral or parasitic infections),
endogenous (non-organ specific autoimmunity:  à ).

|he antigen is soluble and        i



 
|ype III-èechanism of reaction
à   
 i i    i
 i    i     |  i i   i
   
    ii    i
        
   
|ype III-èechanism of reaction

à   
|  i i   i
  |     i  i
 i      i  i       

 i i  
| i   i 

 
|    i 
iii  
  i

i  i | i 
   i   
  
Arthus Reaction: acute antibody-mediated
hypersensitivity to soluble antigens

   i 

xperimental
model for
Immune Complex
disease    
 i
 i 
 i 
 A   i   i , can result from the injection of
large quantities of a poorly catabolized foreign antigen.
 frequently followed the administration of therapeutic
horse antiserum.
 àtreptokinase (bacterial enzyme) .
 Antibiotics (penicillin or cephalosporin).

    after the injection of horse serum.


 |he clinical features
-chills,
-fever,
-rash,
-arthritis,
-glomerulonephritis.
 Urticaria is a prominent feature of the rash.
 i i i i
   i   àecond dose of antigen follows the
kinetics of a secondary antibody
response .
   i i  
 i i   ii 
as in
-subacute bacterial endocarditis
-chronic viral hepatitis.
 |he replicating pathogen is
continuously generating new antigen in
the presence of a persistent antibody
response, with the consequent
formation of abundant immune
complexes.
 |hese are deposited within small blood
vessels, with consequent injury in many
tissues and organs, including the skin,
kidneys, and nerves.
|ype III :- Rheumatoid arthritis
 èost often affecting women from
40 to 60 years .
 èany individuals with rheumatoid
arthritis produce a group of auto-
antibodies called    i 
    i
i 
  i in the Fc region of
IgG.
 Auto-antibodies bind to normal
circulating IgG, forming Igè-IgG
complexes that are deposited in the
joints.
 |hese immune complexes can
activate the complement cascade,
resulting in to chronic inflammation
of the joints.
 Also causes by type II mechanism.
|ype III -àystemic upus rythematosus
 |ypically in women between 20 and 40 yrs.
 Female to male patients is 10:1.
 à  is characterized by
-fever,
-weakness,
-arthritis,
-skin rashes,
-pleurisy,
-kidney dysfunction
 èay produce autoantibodies to ʹ
-DNA,
-histones,
-RBCs,
- platelets,
- leukocytes,
- clotting factors
 complement-mediated lysis of cells.
 Ghen immune complexes of auto-antibodies with various nuclear
antigens are deposited along the walls of small blood vessels 
 i i
 i  
 
 |he complexes activate the complement system and generate
membrane-attack complexes and complement split products that
damage the wall of the blood vessel, resulting in vasculitis and
glomerulonephritis.
 As neutrophils attach to small blood vessels, the number of
circulating neutrophils declines (neutropenia) and various
occlusions of the small blood vessels develop (vasculitis).
 aboratory diagnosis :-  i  i i,directed against
doublestranded or single-stranded DNA, nucleoprotein, histones,
and nucleolar RNA.
 i    i i
   i    

 
    
  à 
 

   

Ú   
  
  

è  
     

    
    

   
     

  
   

    


      
|  r!i i
i 
A hypersensitivity resulting from cell-mediated immunity
(cytotoxic |-lymphocytes and cytokines) causing harm to the body

 Used to describe the signs and symptoms associated


with a cell mediated immune response.
 Results from reactions involving | lymphocytes.
 Koch reaction caused by injection of
tuberculoprotein (PPD test) intradermally resulting in
an area of induration of 5 mm or more in diameter
and surrounded by erythema within 48 hours is a
positive.
|  r!i i
i 
 Characteristics of this phenomenon are:
 Delayed, taking 12 hours to develop.
 Causes accumulation of lymphs and macrophages.
 Reaction is not mediated by histamine.
 Antibodies are not involved in the reaction.
 Cell mediated reactions in certain circumstances are wholly
damaging and may be seen in the following conditions:
 Drug allergy and allergic response to insect bites and stings.
 Contact dermatitis.
 Rejection of grafts.
 Autoimmune disease.
   i i
i  is mediated by | cells
(|ype IV hypersensitivity)

·  
   i i
i |!
    ii  !

|1 from a previous


immunization
(memory)
Chemical èediators of D|

A positive tuberculin skin test is a


D| reaction

Before the distinction


between |1 and |2
(circa 1990), there was
| cell and |D|.
| is now |2 and |D| is
now |1
|     i ii 

     i i Can be caused by poison ivy and mango sap

åa contact-sensitizing agent is usually a small molecule


that penetrates the skin then binds to self-proteins,
making the protein ͞look͟ foreign
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