SUBMITTED BY:VEENA ADMISSION NO:L-2011-BS-77-IM

TYPE IV HYPERSENSITIVITY IS ALSO KNOWN AS CELL-MEDIATED OR DELAYED TYPE HYPERSENSITIVITY. THE CLASSICAL EXAMPLE OF THIS HYPERSENSITIVITY IS TUBERCULIN (MONTOUX) REACTION. MONTOUX REACTION PEAKS AFTER 48 HOURS AFTER INJECTION OF ANTIGEN (PPD OR TUBERCULIN). THE LESION IS CHARACTERISED BY INDURATION OR ERYTHEMA.

TYPE IV HYPERSENSITIVITY IS CHARACTERISED BY CELLMEDIATED RESPONSE RATHER THAN ANTIBODIES AS IN OTHER TYPES OF HYPERSENSITIVITY REACTIONS. SPECIFICALLY,THE T-LYMPHOCYTES ARE INVOLVED IN THE DEVELOPMENT OF THE SENSITIVITY,HENCE CALLED CELL MEDIATED HYPERSENSIVITY.T-LYMPHOCYTES ARE WHITE BLOOD CELLS IN THE BODY. AFTER EXPOSURE TO ANTIGENS,THROUGH A SERIES OF BIOCHEMICAL EVENTS,T-CELLS WILL BE ACTIVATED. BY RELEASING SOME CHEMICALS,THE CELLS ACTIVATE OTHER WHITE BLOOD CELLS TO ACTIVATE THE IMMUNE RESPONSE. THE ENTIRE CASCADE OF REACTIONS TAKE 2-3 DAYS TO DEVELOP AND IS DIFFERENT FROM OTHER TYPES OF REACTIONS.

TYPE

REACTION TIME
48-72 HOURS

CLINICAL APPEARANC E
ECZYMA

HISTOLOGY

ANTIGEN AND LIFE

CONTACT

LYMPHOCYTES, FOLLOWED BY MACROPHAGES, EDEMA OF EPIDERMIS. LYMPHOCYTES, MONOCYTES, MACROPHAGES

EPIDERMAL (ORGANIC CHEMICALS,HEAVY METALS etc.) INTRADERMA (TUBERCULIN, LAPROMIN)

TUBERCULIN 48-72 HOURS

LOCAL INDURATION

GRANULOMA

21-28 DAYS HARDENING

MACROPHAGES, EPITHELOID AND GIANT CELLS,FIBROSIS

PERSISTENT ANTIGEN OR FOREIGN BODY PRESENCE (TUBERCULOSIS,LEPROS Y etc.)

IN THIS HYPERSENSITIVITY ACTIVATED Th-1 CELLS SECRETE LARGE AMOUNTS OF INTERFERON-GAMMA A CYTOKINE THOUGHT TO BE POTENT STIMULATOR OF MACROPHAGES.THUS,IT IS THE MACROPHAGES THAT CAUSE MOST OF THE DAMAGE IN DELAYED TYPE HYPERSENEITIVITY . IN ADDITION TO PRODUCING PRO-INFLAMMATORY MEDIATORS THESE MACROPHAGES INCRESE THEIR PRODUCTION OF GROWTH FACTORS THAT STIMULATE THE PROLIFERATION AND DIFFERENTIATION OF FIBROBLASTS. IF THE INFLAMMATORY REACTION IS SUSTAINED FIBROSIS ENSUES.THUS,DELAYED TYPE HYPERSENSITIVITY REACTIONS OFTEN RESULTS IN FIBROSIS AND GRANULOMATORS INFLAMMATION. THUS, DELAYED TYPE HYPERSENSITIVITY REACTION IS THE BASIS OF CONTACT DERMATITIS AND A HOST OF DEBITILATING AUTO IMMUNE DISEASES.