Allergy- A form of immediate or type 1 hypersensitivity
reaction (IgE-production and mast cell activation)
Atropy- propensity of an individual to produce IgE Abs in
response to environmental stimuli and develop strong immediate
hypersensitivity reactions (strong genetic component)
Hayfever-most common, caused by inhalation
of allergens. Disease of the upper respiratory
tract. Clinical features include leukocyte
infiltration, coughing and difficulty in breathing
Allergic conjunctivitis- often associated
with hay fever, itchy, irritated eyes
Asthma- immediate hypersensitivity reaction
in the lung-reversible airway obstruction,
bronchial inflammation. Difficulty in breathing
Eczema, Urticaria- allergic reaction in
skin occurs when allergens come into
direct contact with skin or after an
allergen enters the system circ
Anaphylaxis- systemic immediate
hypersensitivity reaction characterised
by edema, bronchoconstriction and/or
hypotension (fall in blood pressure)
Allergens
House dust mites (their excreta), tree and
grass pollen, food proteins especially egg and
peanut, cat & dog dander-shed skin and
hair-the allergen is a saliva protein, drugs
Dust mites
thrive in warm
humid
conditions-
bedding etc
feed on dead
kin and body
fluids you
excrete while
you sleep
Wild grasses
Mechanisms
1. Exposure to allergen 2. Activation of Th2 cells 3. IgE class switching in B-cells
4.Secretion of IgE 5. Binding of IgE to Fc on mast cells 6.Following re-exposure to
Ag=cross linking of IgE 7.Activation of mast cells= degranulation and release of mediators
Mediators
Histamine, platelet-activating factor,
leukotrienes, prostaglandin D
Early response= vasodilation, edema, bronchospasm/
late response=cellular recruitment, inflammation
Mast cell cytokines: IL-3 promotes mast cell
proliferation, TNFa promotes inflammation, IL4 & IL13
promote TH2 differentiation, IL5 promotes eosinophil
recruitment further eosinophil production and activation
time course graph
Production of IgE
IgE Ab is produced by B-cells stimulated with a Ag, IgE
binds to mast cells, IgE binds to Fc receptor on mast cells,
forming a multi-valent binding site for the Ag. The same Ag
that stimulated B cells and IgE production subsequently
binds to IgE on mast cells=degranulation. Atopic individual
produce high levels of IgE following exposure to Ag. Normal
individuals produce lower levels and or other isotopes
Activation of Th2 cells
IgE synthesis is dependent on
activation of CD4+ T cells that
secrete IL-4 & IL-13. Cytokines
from type 2 T cells promote Ab
class switchibg in B cells. T cells
also secrete IL-5 and eotaxin which
are involved in the recruitment and
activation of eosinophils which are
involved in the late phase of
immediate hypersensitivity
Mast cells
Mature mast cells are found throughout
the body. Contains many pre-formed
granules that contain histamine and other
mediators. Following Ag cross-linking of
Fc receptor bound IgE, there is three
types of biological response -secretion of
pre-formed mediators from granules
-synthesis of further mediators -cytokine
synthesis
Eosinophils
Migrate to sites of inflammation (move
towards IL5). They secrete proteins (eg
major basic protein) from granules- these
proteins can directly damage host cells
Genetic susceptibility
IgE synthesis and atopy generally runs in families.
The propensity to produce IgE is influenced by the
inheritance of several genes (multi-genetic)
Candidate genes: IL4 & 13-promote IgE class
switching/ IL5 promotes eosinophil growth or
activation/ MHC class II-certain alleles regulate T cell
response to different Ags/ TNFa-mast cell mediator
(inflammatory)/Fc receptor-mast cell receptor
Treatment
Anaphylaxis-Adrenaline which can be life-saving reverses
bronchoconstriction, vasodilation & improve cardiac
output/Antihistamines-antagonism of histamine receptors
Asthma- corticosteroids-block the production of
inflammatory cytokines/ sodium
cromolyn-inhibits release of mast cell mediators