Type IV hypersensitivity is often called delayed type hypersensitivity as the reaction takes several days to develop.[1] Unlike the other types, it is not antibody-mediated but rather is a type of cell-mediated response. This response involves the interaction of T-cells, monocytes, and macrophages.
This reaction is caused when CD4+ Th1 helper T cells recognize foreign antigen in a complex with the MHC class II on the surface of antigen-presenting cells. These can be macrophages that secrete IL-12, which stimulates the proliferation of further CD4+ Th1 cells. CD4+ T cells secrete IL-2 and interferon gamma, inducing the further release of other Th1 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.
The overreaction of the helper T cells and overproduction of cytokines damage tissues, cause inflammation, and cell death. Type IV hypersensitivity can usually be resolved with topical corticosteroids and trigger avoidance.[1]
Contents
1Examples
2See also
3References
4External links
Examples
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Disease
Target antigen
Effects
Allergic contact dermatitis[2]
Environmental chemicals, like urushiol (from poison ivy and poison oak), metals (e.g. nickel), topical medication
epidermal necrosis, inflammation, skin rash, and blisters
Chronic arthritis, inflammation, destruction of articular cartilage and bone
Tuberculin reaction (Mantoux test)[4]
Tuberculin
Induration and erythema around injection site indicates previous exposure
An example of a tuberculosis (TB) infection that comes under control: M. tuberculosis cells are engulfed by macrophages after being identified as foreign, but due to an immuno-escape mechanism peculiar to mycobacteria,[5] 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. The hyper-activated macrophages secrete TNF-α which recruits multiple monocytes to the site of infection. These cells differentiate into epithelioid cells which wall off the infected cells, but results in significant inflammation and local damage.
Some other clinical examples:
Temporal arteritis
Leprosy
Coeliac disease
Graft-versus-host disease[6]
Chronic transplant rejection
See also
Type I hypersensitivity
Type II hypersensitivity
Type III hypersensitivity
Type V hypersensitivity
References
^ abWarrington, Richard; Watson, Wade; Kim, Harold L.; Antonetti, Francesca Romana (10 November 2011). "An introduction to immunology and immunopathology". Allergy, Asthma & Clinical Immunology. 7 (1): S1. doi:10.1186/1710-1492-7-S1-S1. ISSN 1710-1492. PMC 3245432. PMID 22165815.
^ abcdefgKumar, Vinay; Abbas, Abul K.; Aster, Jon C. (1 May 2012). Robbins Basic Pathology. Elsevier Health Sciences. ISBN 1455737879.
^"Hypersensitivity reactions". www.microbiologybook.org. University of South Carolina School of Medicine - Microbiology and Immunology On-line. Retrieved 29 May 2016.
^"Hypersensitivity reactions". www.microbiologybook.org. Retrieved 29 May 2016.
^McDonough, K.; Kress, Y.; Bloom, B. R. (July 1993). "Pathogenesis of tuberculosis: interaction of Mycobacterium tuberculosis with macrophages". Infect. Immun. 61 (7): 2763–2773. eISSN 1098-5522. ISSN 0019-9567. Retrieved 18 June 2017.
^"eMedicine - Hypersensitivity Reactions, Delayed : Article by Walter Duane Hinshaw".
External links
Classification
D
MeSH: D006968
v
t
e
Hypersensitivity and autoimmune diseases (279.5–6)
Type I/allergy/atopy (IgE)
Foreign
Atopic eczema
Allergic urticaria
Allergic rhinitis (Hay fever)
Allergic asthma
Anaphylaxis
Food allergy
common allergies include: Milk
Egg
Peanut
Tree nut
Seafood
Soy
Wheat
Penicillin allergy
Autoimmune
Eosinophilic esophagitis
Type II/ADCC
IgM
IgG
Foreign
Hemolytic disease of the newborn
Autoimmune
Cytotoxic
Autoimmune hemolytic anemia
Immune thrombocytopenic purpura
Bullous pemphigoid
Pemphigus vulgaris
Rheumatic fever
Goodpasture syndrome
Guillain–Barré syndrome
"Type V"/receptor
Graves' disease
Myasthenia gravis
Pernicious anemia
Type III (Immune complex)
Foreign
Henoch–Schönlein purpura
Hypersensitivity vasculitis
Reactive arthritis
Farmer's lung
Post-streptococcal glomerulonephritis
Serum sickness
Arthus reaction
Autoimmune
Systemic lupus erythematosus
Subacute bacterial endocarditis
Rheumatoid arthritis
Type IV/cell-mediated (T cells)
Foreign
Allergic contact dermatitis
Mantoux test
Autoimmune
Diabetes mellitus type 1
Hashimoto's thyroiditis
Multiple sclerosis
Coeliac disease
Giant-cell arteritis
Postorgasmic illness syndrome
Reactive arthritis
GVHD
Transfusion-associated graft versus host disease
Unknown/ multiple
Foreign
Hypersensitivity pneumonitis
Allergic bronchopulmonary aspergillosis
Transplant rejection
Latex allergy (I+IV)
Autoimmune
Sjögren syndrome
Autoimmune hepatitis
Autoimmune polyendocrine syndrome
APS1
APS2
Autoimmune adrenalitis
Systemic autoimmune disease
UpToDate Contents
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…requires time (normally many hours or days after antigen exposure), hence the name delayed-type hypersensitivity (DTH). In some cases, other cell types (eg, macrophages, eosinophils, or neutrophils) are…
…are believed to be important in the pathogenesis of multiple types of drug-induced, delayed-type hypersensitivity (DTH) reactions, such as contact dermatitis, maculopapular and bullous drug eruptions, and…
…several skin reactions including delayed-type hypersensitivity reactions and, rarely, immediate hypersensitivity reactions or skin necrosis . Delayed-type hypersensitivity reactions may occur with both unfractionated…
…higher cytokine and antibody responses to unrelated vaccines given concomitantly . Delayed-type hypersensitivity (DTH) skin test responses to antigens such as Candida and tetanus toxoid are absent or decreased …
…soluble immunoglobulin A (IgA) in saliva and tears; Lymphoid organ atrophy; Reduced delayed-type hypersensitivity (DTH) responses; Fewer circulating cells ; A shift from T helper type 1 (Th1)-associated …
English Journal
Histamine releasing factor and elongation factor 1 alpha secreted via malaria parasites extracellular vesicles promote immune evasion by inhibiting specific T cell responses.
Demarta-Gatsi C, Rivkin A, Di Bartolo V, Peronet R, Ding S, Commere PH, Guillonneau F, Bellalou J, Brûlé S, Abou Karam P, Cohen SR, Lagache T, Janse CJ, Regev-Rudzki N, Mécheri S.
Cellular microbiology. 2019 Jul;21(7)e13021.
Protozoan pathogens secrete nanosized particles called extracellular vesicles (EVs) to facilitate their survival and chronic infection. Here, we show the inhibition by Plasmodium berghei NK65 blood stage-derived EVs of the proliferative response of CD4 T cells in response to antigen presentation. Im
Remote induction of cellular immune response in mice by anti-meningococcal nanocochleates - nanoproteoliposomes.
Tamargo Santos B, Fleitas Pérez C, Infante Bourzac JF, Márquez Nápoles Y, Ramírez González W, Bourg V, Torralba D, Pérez V, Mouriño A, Ayala J, Labrada Rosado A, Aleya L, Bungau S, Sierra González VG.
The Science of the total environment. 2019 Jun;668()1055-1063.
New adjuvant formulations, based on proteoliposomes <40 nm and cochleates <100 nm, without Al(OH) adjuvant, were evaluated regarding their ability to generate Th1 immune response through a Delayed -Type Hypersensitivity Test, at the mouse model, by using a Neisseria meningitidis B protein comple
Rapid subcutaneous desensitization for the management of delayed hypersensitivity reactions to omalizumab：A case report.
Gan H, Wang L, Fu W, Zhang J, Yu M, Liu G.
Journal of clinical pharmacy and therapeutics. 2019 Jun;44(3)486-488.
Omalizumab is effective as an add-on drug to treat severe persistent allergic asthma. However, delayed hypersensitivity reactions to omalizumab may deprive patients of its use. Rapid subcutaneous desensitization could be a solution. A 61-year-old man developed a delayed allergy to omalizumab after t
Type 1 hypersensitivity Hypersensitivity type 1 is also known as immediate or anaphylactic hypersensitivity. Therefore, it can include skin (urticaria and eczema), eyes (conjunctivitis), nasopharynx (rhinorrhea, rhinitis ...
delayed hypersensitivity (DH) (delayed type hypersensitivity (DTH)) the type of hypersensitivity exemplified by the tuberculin reaction, which (as opposed to immediate hypersensitivity) takes 12 to 48 hours to develop and which can be ...
What is type IV hypersensitivity? Type IV hypersensitivity is a T-cell-mediated hypersensitivity, meaning the inflammation and potential tissue damage is caused by either T helper cells (CD4+) or cytotoxic ...
体内に侵入した抗原は樹状細胞やマクロファージなどの抗原提示細胞に貪食され分解されて、MHC class IIに抗原をのせてT細胞に提示する。T細胞は感作され、再び抗原刺激を受けるとINF-γやTNF-αなどのサイトカインを産生し炎症を惹起する。この反応は抗原進入後48時間程度でピークとなる。(SPE.291)