関: type IV hypersensitivity

WordNet

act later than planned, scheduled, or required; "Dont delay your application to graduate school or else it wont be considered"
time during which some action is awaited; "instant replay caused too long a delay"; "he ordered a hold in the action" (同)hold, time_lag, postponement, wait
the act of delaying; inactivity resulting in something being put off until a later time (同)holdup
cause to be slowed down or delayed; "Traffic was delayed by the bad weather"; "she delayed the work that she didnt want to perform" (同)detain, hold_up
not as far along as normal in development
pathological sensitivity
extreme sensitivity

PrepTutorEJDIC

…'を'『延期する』,延ばす / 〈事故などが〉…'を'『遅らせる』 / 『ぐずぐずする』,『手間取る』 / 『遅れ』,遅延 / 『延期』,猶予
過敏,過敏症

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/05/01 23:53:54」(JST)

wiki en

Type 4 hypersensitivity is often called delayed type hypersensitivity as the reaction takes two to three days to develop. Unlike the other types, it is not antibody mediated but rather is a type of cell-mediated response.

CD4+ helper T cells recognize antigen in a complex with Class II major histocompatibility complex. The antigen-presenting cells in this case are macrophages that secrete IL-12, which stimulates the proliferation of further CD4+ T_h1 cells. CD4+ T cells secrete IL-2 and interferon gamma, further inducing the release of other T_h1 cytokines, thus mediating the immune response. Activated CD8+ T cells destroy target cells on contact, whereas activated macrophages produce hydrolytic enzymes and, on presentation with certain intracellular pathogens, transform into multinucleated giant cells.

Examples

Disease	Target antigen	Effects
Diabetes mellitus type 1	Pancreatic beta cell proteins (possibly insulin, Glutamate decarboxylase)	Insulitis Beta cell destruction
Multiple sclerosis	Oligodendrocyte proteins (myelin basic protein, proteolipid protein)	Demyelinating disease Perivascular inflammation Paralysis Ocular lesions
Some peripheral neuropathies	Schwann cell antigen	Neuritis Paralysis
Hashimoto's Thyroiditis	Thyroglobulin antigen	Hypothyroidism Hard goiter Follicular thymitis
Crohn's disease	Unknown	Chronic inflammation of ileum and colon
Allergic contact dermatitis	Environmental chemicals, e.g. poison ivy, nickel	Dermatitis with usually short-lived itching
Mantoux test* (diagnostic)	Tuberculin	Skin induration indicates TB exposure
Unless else specified in boxes, then ref is:^[1] * - Mantoux test not taken from ^[1]

An example of a TB infection that came under control: M. tuberculosis are engulfed by macrophages after being identified as foreign, but due to an immuno-escape mechanism peculiar to mycobacteria, TB bacteria are able to block the fusion of their enclosing phagosome with lysosomes which would destroy the bacteria. Thereby TB can continue to replicate within macrophages. After several weeks, the immune system somehow [mechanism as yet unexplained] ramps up and, on stimulation with IFN-gamma, the macrophages become capable of killing M. tuberculosis by forming phagolysosomes and nitric oxide radicals. However the hyper-activated macrophages secrete TNF which recruits multiple monocytes into the battle. These cells differentiate into epithelioid histiocytes which wall off the infected cells, but at the cost of significant inflammation and local damage.

Some other clinical examples:

Temporal arteritis
Hashimoto's thyroiditis
Symptoms of leprosy
Symptoms of tuberculosis
Coeliac disease
Graft-versus-host disease^[2]
Chronic transplant rejection

References

^ ^a ^b Table 5-5 in: Mitchell, Richard Sheppard; Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson. Robbins Basic Pathology. Philadelphia: Saunders. ISBN 1-4160-2973-7. 8th edition.
^ "eMedicine - Hypersensitivity Reactions, Delayed : Article by Walter Duane Hinshaw".

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 薬物アレルギー：分類および臨床的特徴 drug allergy classification and clinical features
2. 薬疹 drug eruptions
3. アレルギー性接触皮膚炎の基本的機序および病態生理 basic mechanisms and pathophysiology of allergic contact dermatitis
4. 薬物アレルギー：病因 drug allergy pathogenesis
5. 免疫系の臨床検査評価 laboratory evaluation of the immune system

English Journal

Coronary drug-eluting stents: From design optimization to newer strategies.

Sun D1, Zheng Y, Yin T, Tang C, Yu Q, Wang G.Author information 1Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, Chongqing Engineering Laboratory in Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400044, People's Republic of China.AbstractCompared with early bare-metal stents, drug-eluting stents (DESs) are more effective in treating coronary artery diseases, especially in inhibiting restenosis. However, in-stent restenosis still clinically occurs at a non-negligible rate. More importantly, delayed endothelialization, inflammation, and hypersensitivity trigger subacute or late adverse events, particularly stent thrombosis, and thereby raise more concerns over the long-term safety of DESs. These problems are mostly associated with the permanent polymeric materials, non-optimal therapeutic drugs, and/or metallic stent platforms used in current DES design. It is critically important to further improve and optimize DES design and apply newer strategies for developing next generation DES. These new generation DESs should maintain their clinical efficacy and meanwhile eliminate the long-term safety concerns. In this review article, the current information on the optimization of DES design was critically reviewed based on DES's basic components, namely, stent platform, restenotic drug, and polymer coating. The available strategies for designing next-generation DESs were also summarized, ranging from degradable polymer DESs, to polymer-free DESs, to fully biodegradable DESs. © 2013 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 102A: 1625-1640, 2014.
Journal of biomedical materials research. Part A.J Biomed Mater Res A.2014 May;102(5):1625-40. doi: 10.1002/jbm.a.34806. Epub 2013 Jul 1.
Compared with early bare-metal stents, drug-eluting stents (DESs) are more effective in treating coronary artery diseases, especially in inhibiting restenosis. However, in-stent restenosis still clinically occurs at a non-negligible rate. More importantly, delayed endothelialization, inflammation, a
PMID 23703913

Evaluation of the relation between patient characteristics and the state of chemotherapy-induced nausea and vomiting in patients with gynecologic cancer receiving paclitaxel and carboplatin.

Furukawa N1, Akasaka J, Shigemitsu A, Sasaki Y, Nagai A, Kawaguchi R, Kobayashi H.Author information 1Department of Obstetrics and Gynecology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan, furunao0813@gmail.com.AbstractPURPOSE: An antiemetic regimen for patients taking paclitaxel and carboplatin (TC) includes dexamethasone (20 mg) to protect against hypersensitivity. Chemotherapy-induced nausea and vomiting (CINV), however, is difficult to adequately control in patients receiving TC. In the present study, we retrospectively investigated risk factors for CINV in patients receiving TC with this antiemetic regimen based on a questionnaire.
Archives of gynecology and obstetrics.Arch Gynecol Obstet.2014 Apr;289(4):859-64. doi: 10.1007/s00404-013-3058-7. Epub 2013 Nov 2.
PURPOSE: An antiemetic regimen for patients taking paclitaxel and carboplatin (TC) includes dexamethasone (20 mg) to protect against hypersensitivity. Chemotherapy-induced nausea and vomiting (CINV), however, is difficult to adequately control in patients receiving TC. In the present study, we retr
PMID 24185939

Reactive metabolites as a cause of late diabetic complications.

Fleming T, Nawroth PP.Author information *Department of Medicine I and Clinical Chemistry, University Hospital of Heidelberg, INF 410, 69120 Heidelberg, Germany.AbstractPatients suffering from DN (diabetic neuropathy) suffer from the coexistence of positive (i.e. pain, hypersensitivity, tingling, cramps, cold feet, etc.) and negative (i.e. loss of sensory perception, delayed wound healing, etc.) symptoms. Elevated blood glucose alone cannot explain the development and progression of DN. Recently it has been shown that the endogenous reactive metabolite MG (methylglyoxal), elevated as a consequence of reduced Glo1 (glyoxalase I), can contribute to the gain of function via post-translational modification of neuronal ion channels involved in chemosensing and action potential generation in nociceptive nerve endings. The effects of dicarbonyls on the neuronal compartment provides a unifying mechanism for the development of DN. Targeting the accumulation and effects of MG may therefore provide new, more effective, therapeutic approaches for the treatment of DN.
Biochemical Society transactions.Biochem Soc Trans.2014 Apr 1;42(2):439-42. doi: 10.1042/BST20130265.
Patients suffering from DN (diabetic neuropathy) suffer from the coexistence of positive (i.e. pain, hypersensitivity, tingling, cramps, cold feet, etc.) and negative (i.e. loss of sensory perception, delayed wound healing, etc.) symptoms. Elevated blood glucose alone cannot explain the development
PMID 24646257