Immunology and Serology

[LAB]  paroxysmal
sneezing
Hypersensitivity  rhinorrhea, or
- Defined as an exaggerated response to a typically runny nose
harmless antigen that results in injury to the tissue,  nasal congestion
disease, or even death.  itching of the
- Atopy: - inherited tendency to develop classic nose and eyes
allergic response to naturally occurring inhaled or Asthma
ingested allergens. - derived from the
Greek word for
P.G.H Gell and R.R.A Coombs Classification “panting” or
“breathlessness”.
- recurrent airflow
obstruction that leads
to intermittent
sneezing,
breathlessness, and,
occasionally, a cough
with sputum
production.
 bronchial smooth
muscle
 contraction
 mucosal edema
 heavy mucus
secretion
Food Allergy
Type I Hypersensitivity  Abdominal pain
- Aka Anaphylactic hypersensitivity  Vomiting
- Short time lag, usually minutes, between  Urticaria
exposure to allergen and the onset of clinical  Angioedema
symptoms  Anaphylaxis
Immune Mediator IgE Anaphylaxis
Effector Cell - Mast Cell - Paul Portier and
- Basophils Charles Richet in
Chemical Mediator - Histamine 1902
Triggers - Peanuts - Literally means
- Eggs “without protection”.
- Pollen - most severe type of
Immunologic Normal: allergic response
Mechanism Th1 = Th2 because it is an acute
Allergic individual: reaction that
Th1 < Th2 simultaneously
- Th2 response results involves multiple
in production of organs.
several cytokines - fatal if not treated
including IL 4, IL-5 promptly
and IL-13  venom from
→differentiation of B bees, wasps,
cells → : initiates and hornets
coding of ε-heavy  drugs such
chain → more IgE as penicillin
production.  foods such
Three Phases 1. Sensitization as shellfish,
Phase peanuts, and
2. Activation Phase dairy
3. Late Phase products
Clinical Manifestation Rhinitis
- most common form of
atopy.

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Immunology and Serology
Diagnosis IN VIVO - 100 kU/L is
 Skin Test considered the upper
1. Percutaneous limit of normal
- antigen extract is - Largely been
introduce using a replaced by non-
needle of pricking competitive solid-
device into the upper phase immunoassays
layer of the skin, Treatment  Avoidance of
usually of the inner known allergens
forearm or the back. is the first line of
- separate sites 2 to defense
2.5 cm apart.  Antihistamines
- 15 to 20 minutes, and
observe for wheals- decongestants
and flare. A  Bronchodilators
diameter larger than and
3 to 4 mm correlates corticosteroids
best with the  Mast cell
presence of allergy. stabilizers
2. Intradermal  Epinephrine
- uses greater amount  Biological agents
of antigen and are (Omalizumab)
more sensitive than  Allergy
cutaneous tests. Immunotherapy
- Done only if prick - The goal is to induce
tests are negative immune tolerance to
and allergy is still a specific allergen by
suspected because administering
they carry a larger gradually increasing
risk (0.05%). doses of the allergen
- 1-mL tuberculin over time.
syringe is used to
administer 0.01 to Type 2 Hypersensitivity
0.05 mL of test - Aka Antibody-Mediated Cytotoxic
solution between Hypersensitivity
layers of the skin. - IgG and IgM antibodies directed against
IN VITRO (Serologic) - antigens found on cell surface.
 Radioallergosorbent Effects 1. The cell can be
test (RAST) destroyed
- Was introduced in (AIHA, TR)
1972 and detects 2. function of the
allergen-specific IgE. cell can be
- reported in kilo inhibited (MG)
international units 3. function of the
(IU) of allergen cell can be
specific antibody per increased above
liter (kUa/L), where normal (Graves)
one unit is equal to Immune Mechanism 1. Classical
2.42 ng/mL of IgE Complement
- 0.35 kU/L is Pathway
commonly used as 2. Opsonization
the cut-off for a and
positive test Phagocytosis
 Radioimmunosorbent 3. Antibody
test (RIST) Dependent
- used radiolabeled IgE Cellular
to compete with Cytotoxicity
patient IgE for (ADCC) via NK
binding sites on a Cells
solid phase coated
with anti-IgE.

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Immunology and Serology
Transfusion Reaction - cell destruction that Drug-induced - Drugs like penicillins
results from autoimmune hemolytic and cephalosporins
antibodies anemia act as hapten after
combining with binding to a protein
heteroantigens. in RBC membrane.
- Major groups Antibody Mediators 1. Warm-reactive
involved in antibodies –
transfusion reactions reacts at 37°C
include the ABO, 2. Cold-reactive
Rh, Kell, Duffy, and antibodies –
Kidd systems. reacts at temp
Factors Affecting the <30°C
Extent of Reaction: Paroxysmal Cold - Rare form of AIHA.
1. Temperature Hemoglobinuria - Often occurs after
2. Plasma infection with certain
concentration of viral illnesses,
the antibody including measles,
3. Immunoglobulin mumps, chickenpox,
class and infectious
4. Extent of mononucleosis.
complement - BIPHASIC
activation AUTOANTIBODIES
5. Density of the o Binds to RBC at
antigen on the cold
RBC temperature
6. Number of and activates
RBCs the complement
transfused system at 37°C
Acute Transfusion to produce
Reaction intermittent
- Within minutes to hemolysis
hours from - Often resolves
transfusion. spontaneously as a
- Immediate reaction transient disorder
is usually associated Type 2 Reactions Goodpasture’s
with ABO Involving Tissue Syndrome
incompatibility Antigens - Antibodies produced
mediated by react with basement
preformed IgM. membrane proteins.
- Intravascular - Affects mainly the
hemolysis kidneys and the
Delayed Transfusion lungs.
Reaction - Treated with
- Within the first 2 Corticosteroids and
weeks following other
transfusion. immunosuppresants.
- Mediated by IgG. Hashimoto’s Disease,
- Predominantly Myasthenia Gravis,
extravascular Insulin Dependent
hemolysis Diabetes Mellitus
Autoimmune Hemolytic Anemia Diagnosis and Testing Antiglobulin Test
- Type of Hypersensitivity Type II against - - discovered by
autoantigen. Coombs in 1945
Associated diseases - IM, Direct Antiglobulin
Cytomegalovirus, Test (DAT)
chronic hepatitis, - Detection of
immunoproliferative antibody or
diseases complement on
Idiopathic autoimmune - If the cause of RBC.
hemolytic anemia antibody production - performed to detect
is unknown transfusion

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Immunology and Serology
reactions, HDN, and
autoimmune
hemolytic anemia
o Polyspecific–
detects IgG,
C3b and C3d
o Monospecific
Indirect Coomb’s Test
- used in cross
matching to prevent
transfusion reaction.
Type 3 Hypersensitivity
- aka Complex-mediated Hypersensitivity
- antigen is SOLUBLE.
- Antigen-antibody complex deposit in tissues.
 glomerular basement membrane
 vascular endothelium
 joint linings
 pulmonary alveolar membranes
Arthus Reaction - First demonstrated
by Maurice Arthus in
1903.
- Characterized by
erythema and
edema, peaks within
3 to 8 hours and is
followed by a
hemorrhagic
necrotic lesion that
may ulcerate
- Arthus reaction can
sometimes be seen
in humans following
booster injections
with tetanus,
diphtheria, or
measles vaccines
Serum Sickness - results from passive
immunization of - Skin testing for exposure to tuberculosis
humans with animal - 0.1 mL of 5 tuberculin units (TU) of PPD is
serum.
- Generalized
symptoms of serum - examined between 48 and 72 hours for the
sickness appear 7 to
21 days after
injection of the
animal serum and
include headache,
fever, nausea,
vomiting, joint pain,
rashes, and
lymphadenopathy.
- Self-limiting
Type 4 Hypersensitivity
- First described by Robert Koch in 1890.
- sensitized T cells, rather than antibodies, play
the major role in its manifestations.
- symptoms peak between 48 to 72 hours
- after exposure to antigen.
MA. PATRICIA VILLANUEVA
- Delayed / Cell Mediated Hypersensitivity
Triggers from  Mycobacterium
intercellular pathogens tuberculosis
and contact antigens  Mycobacterium
leprae
 Pneumocystis
carinii
 Leishmania
species,
 Herpes simplex
virus
 poison ivy
 poison oak
 nickel salts
 hair dyes and
cosmetic
Contact Dermatitis - produces a skin
eruption
characterized by
erythema, swelling,
and the formation of
papules that
appears from 6
hours to several
days after the
exposure.
- papules may
become vesicular
with blistering,
peeling, and
weeping.
- last for 3 to 4 weeks
after the antigen has
been removed.
- PATCH TEST is
considered the gold
standard for testing
Mantoux / PPD Test
injected intradermal into the inner surface of the
forearm using a fine needle and syringe.
presence of a hardened, raised area called
induration
o 15 mm or more is considered a positive
test in individuals with no risk factors.
o 10 mm or greater is considered positive in
recent immigrants of high prevalence
countries, intravenous drug users,
employees of health-care and other high
risk facilities, persons with certain clinical
conditions, and children younger than 5
years of age
o 5 mm or more is considered positive in
persons who have HIV infection or other
forms of immunosuppression, features on
a chest x-ray consistent with tuberculosis,
or recent contact with tuberculosis patients
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