CHUA, PRINCE ROBERT C.

2021-A

CASE A

1. Discuss the pathophysiologic mechanism of this type of hypersensitivity reaction.

The hypersensitivity presented in the case was a Type I hypersensitivity reaction.
In this type of hypersensitivity reaction, the body needs to have an initial exposure to the
antigen. In the case, the first contact with the antigen of Benzathine Penicillin was from
the skin test. The required dose given was the one that caused the Type I hypersensitivity
reaction. Type I hypersensitivity has a short time lag usually 2-30mins. The other name
for this type is immediate hypersensitivity reaction. The main reactant present here is the
immunoglobulin IgE. Antigens that are able to trigger the formation of IgE are called atopic
antigens or allergens. When a person with this condition was exposed to an allergen, IgE
levels are increased and causes mast cells to degranulate. This releases histamine into
the blood. Histamine would act upon H1 receptors which results in the contraction of
smooth muscle in the bronchioles, blood vessels, and the intestines. It generally produces
proinflammatory activity. Vascular permeability and increased mucous gland secretion
also occur due to the action of histamine. Histamine causes local erythema in the skin as
well as wheal and flare formation. Type I hypersensitivity can also lead to anaphylactic
shock. Other examples that exhibit this type of hypersensitivity is allergic rhinitis or hay
fever, bee stings, asthma, eczema, and other allergies to food and drugs.
2. What are the other types of hypersensitivity reactions and how will you compare
these to the one above?
The other types of hypersensitivity are Type II, III, IV hypersensitivity reaction.
Type II is also called as Antibody-mediated cytotoxic hypersensitivity. This reaction
occurs when an antibody is directed against an antigen present on a cell surface. This
binding would cause cell destruction via the antibody dependent cell-mediated cytotoxicity
or through the use of the complement pathway. An example of this type of hypersensitivity
is during hemolytic transfusion reactions. An anti-B antibody from a donor’s blood was
transfused to a patient who is blood type B. The patient’s red cells contain the B antigen
which will agglutinate with the donor’s antibodies causing hemolysis. Type III
hypersensitivity is also called Immune complex mediated hypersensitivity. This reaction
also involves the formation of a complex from the binding of an antigen with its
corresponding antibody. The complex formed is small enough to avoid detection from
phagocytes such as a macrophage. The complex could then bind to the basement
membrane of the endothelium. This would then signal the complement pathway to
activate. The complement pathway initiates and in the end tries to destroy the immune
complex with the use of the membrane attack complex. The products from the
complement pathway also has a function of chemotaxis calling in neutrophils to
phagocytose the immune complex. The neutrophils are unable to phagocytose the
complex so they release their granules to destroy the complex instead. The granules also
damage the endothelium where the immune complex was bound. This could cause
vasculitis as seen in patients with systemic lupus erythematosus. Type IV hypersensitivity
is also called cell-mediated or delayed hypersensitivity. It is the only hypersensitivity
reaction that is cell-mediated. The first three types are all humoral mediated. Type IV
hypersensitivity is called the delayed type since the reaction occurs around 24-72 hours.
Antigen interacts with specifically sensitized T-cell causing a release of cytokines that
recruit and activate macrophages. Examples of this type of hypersensitivity are contact
hypersensitivity and tuberculin-type hypersensitivity.
3. Discuss the host immune response of rheumatic fever.
The immune response of the host during rheumatic fever is a type II
hypersensitivity reaction. Streptococcus pyogenes contains M protein. M protein is highly
immunogenic causing the body to produce antibodies against it. Some of the cells of the
body such as myocytes have a protein similar to that of the M protein. The antibody
directed against M protein mistakes the protein found in myocytes as foreign. This causes
destruction of the cells of the body. This phenomenon is called molecular mimicry. This
would cause rheumatic fever and could lead to other conditions such as rheumatic
arthritis if proteins present in the joints are targeted.
4. Discuss desensitization.
Desensitization is an immunotherapy with the aim to induce or restore tolerance to
the allergen by reducing the tendency to produce IgE. Patients are given increasing doses
of the drug which contains the allergen. This would then decrease the response of IgE to
the allergen. This method shifts the response away from humoral immunity towards cell-
mediated immunity. It stimulates T-regulatory cells to secrete IL-10 which reduces the
response of IgE. In the end desensitization will decrease the action of IgE upon exposure
to an allergen.