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Y2 MCD Immunology > hypersensitivity, allergy and inflammation > Flashcards

hypersensitivity, allergy and inflammation Flashcards

immunological mechanisms: summarise the mechanisms by which IgE, antibodies, immune complexes and T cells can cause tissue damage and inflammation (the four types of hypersensitivity); clinical disease: list examples of the clinical syndromes associated with each type of hypersensitivity reaction

1
Q

what do appropriate immune responses occur in response to

A

harmful agents e.g. viruses, bacteria, fungi, parasites

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2
Q

function and side effect of appropriate immune response

A

eliminate pathogens, and whilst there may be concomitant tissue damage as a side effect, as long as pathogen is eliminated quickly this will be minimal and repaired easily

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3
Q

what 2 thnigs does appropriate immune response involve

A

recognition by cells of immune system and antibody production

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4
Q

what does appropriate immune tolerance occur in response to

A

self and to foreign harmless proteins e.g. food, pollens, other plant proteins, animal proteins, commensal bacteria

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5
Q

what does appropriate immune tolerance involve

A

antigen recognition and generation of Treg cells and regulatory (blocking) antibody (IgG4) production (antigen recognition in context of danger signals (microbial signatures) leads to immune reactivity, but in absence of danger leads to tolerance)

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6
Q

what 3 things do immune responses mount against to cause hypersensitivity reactions

A

harmless foreign antigens (allergy, contact hypersensitivty), autoantigens (autoimmune diseases), alloantigens (serum sickness, transfusion reactions, graft rejection)

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7
Q

4 classes of hypersensitivity reactions (many diseases involve mixture of types)

A

type I: immediate hypersensitivity (IgE), type II: antibody-dependent cytotoxicity hypersensitivity (antibody), type III: immune complex mediated hypersensitivity (complex), type IV: delayed cell mediated hypersensitivity (T cell)

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8
Q

type I: what is immediate hypersensitivity present in

A

anaphylaxis, asthma, rhinitis (seasonal and perennial), food allergy

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9
Q

type I: immediate hypersensitivity: 3 features and purposes of primary antigen exposure

A

sensitisation not tolerance, IgE antibody production, IgE binding to mast cells and basophils

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10
Q

type I: immediate hypersensitivity: 3 features of secondary antigen exposure

A

more IgE antibodies produced, antigen exposure causes cross-linking IgE on mast cells and basophils, IC signalling leading to degranulation and release of inflammatory mediators

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11
Q

type II: antibody-dependent hypersensitivity: what does clinical presentation depend on

A

target tissue (i.e. organ-specific)

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12
Q

type II: antibody-dependent hypersensitivity: 4 organ-specific autoimmune diseases and what antibodies do to cause them

A

myasthenia gravis (anti-acetylcholine receptor antibodies), glomerulonephritis (anti-glomerular basement membrane antibodies), pemphigus vulgaris (anti-epithelial cell cement protein antibodies), pernicious anaemia (intrinsic factor blocking antibodies)

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13
Q

type II: antibody-dependent hypersensitivity: what happens in autoimmune cytopenias

A

antibody mediated blood cell destruction

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14
Q

type II: antibody-dependent hypersensitivity: 3 autoimmune cytopenias

A

haemolytic anaemia, thrombocytopenia, neutropenia

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15
Q

type II: antibody-dependent hypersensitivity: 2 tests for specific antibodies

A

immunofluorescence, ELISA (e.g. anti-CCP for rheumatoid arthritis)

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16
Q

type III: immune complex mediated hypersensitivity: 5 stages

A

formation of antigen-antibody complex in blood -> complex deposition in blood vessels/tissue -> complement and cell activation (e.g. monocytes and neutrophils to cause inflammation) -> activation of other cascades e.g. clotting -> tissue damage (vasculitis)

17
Q

type III: immune complex mediated hypersensitivity: 2 examples of autoimmune diseases which cause tissue damage (vasculitis) due to immune complex formation

A

systemic lupus erythematosus, vasculitides (poly arteritis nodosum, many different types)

18
Q

type III: immune complex mediated hypersensitivity: 4 most common areas affected by tissue damage

A

glomerulus, skin, joints, lung

19
Q

type IV: delayed cell mediated hypersensitivity responses: 5 examples of disorders caused by Th1 responses

A

chronic graft rejection, GVHD, coeliac disease, contact hypersensitivity, most autoimmune diseases

20
Q

type IV: delayed cell mediated hypersensitivity responses: 3 examples of disorders caused by Th2 responses

A

asthma, eczema, rhinitis

21
Q

type IV: delayed cell mediated hypersensitivity responses: 3 main varieties of T cells involved

A

Th1, cytotoxic, Th2

22
Q

type IV: delayed cell mediated hypersensitivity responses: 2 mechanisms leading to tissue damage

A

transient/persistent antigen leading to T cell activation of macrophages, CTLs, fibroblasts and perforin (much of tissue damage dependent upon TNF - released from macrophages - and CTLs)

23
Q

type IV: delayed cell mediated hypersensitivity responses: common cause of contact hypersensitivity

A

nickel exposure

24
Q

hypersensitivity reactions

A

S19 (image)

25
Q

common feature of hypersensitivity

A

inflammation

26
Q

2 promoters of inflammation in hypersensitivity

A

immune cells (recruitment and activation), inflammatory mediators (e.g. complement, cytokines)

27
Q

4 features of inflammation (blood vessels, cells, mediators and outcome)

A

vasodilation, increased vascular permeability, inflammatory mediators and cytokines, inflammatory cells and tissue damage

28
Q

4 signs of inflammation

A

redness, heat, swelling, pain

29
Q

what 4 things cause increased vascular permeability in inflammation

A

C3a (complement), C5a (complement), histamine, leukotrienes

30
Q

5 pro-inflammatory cytokines

A

IL-1, IL-6, IL-2 (released from Th1 to activate CTLs), TNF, IFN-y

31
Q

2 pro-inflammatory chemokines

A

IL-8/CXCL8, IP-10/CXCL10

32
Q

process by which inflammatory cells infiltrate tissue (cell trafficking)

A

chemotaxis by cytokines

33
Q

4 inflammatory cells which infiltrate tissue then activate

A

neutrophils, macrophages, lymphocytes, mast cells

Y2 MCD Immunology (14 decks)

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