hypersensitivity is an inappropriate immune response to harmless foreign
antigen to which the individual is previously sensitized. This allergic
reaction is usually IgE-mediated, which induces mast cells and basophils activation
1. It occurs within minutes of exposure to the antigen (also termed
immediate hypersensitivity), may be local as well as systemic. Severity ranges
from irritating (hay fever) to fatal (systemic anaphylaxis).
allergic reaction occurs in 2 sequences:
exposure of sensitization
Primary exposure of sensitization
is inhaled and acquired by an antigen-presenting cell (APC), such as dendritic
cell or B cells. Dendritic cell migrates to the lymph nodes and present it to a
CD4 T cell. Naïve T cell gets activated and differentiates into TH2 cell 2.
other hand, B cell was bound to an allergen. It processes the antigen and
displays class II MHC-peptide complexes on the surface. B cell binds to the TH2
cell through TCR-MHC interaction and by CD40-CD40L interaction 2, 3.
cell releases cytokines such as IL-4, IL-5 and IL-13 upon subsequent exposure with
the antigen. IL-4 stimulates the differentiation of TH2 cells and class
switching of B cell to IgE-producing plasma cell. IL-5 develops and activates
eosinophils, which release toxic substances that can damage host cells. IL-13
enhances IgE production and stimulates epithelial cells to secrete mucus.
Secreted IgE binds
to the high affinity receptor (Fc?RI) of mast cells and basophils. This end the
Figure 1 showed the key steps in T- and B-cell collaboration to
produce antibodies during sensitization.
re-exposure to the same allergen triggers the cross linking of IgE antibodies,
which result in mast cells degranulation and release of pro-inflammatory
mediators that give the clinical effect seen in an allergic reaction 4,5.
Type I hypersensitivity
reactions can be classified into early and late phase reactions.
Early phase reactions occur within
minutes of the second exposure and may subside within 60 minutes. Some of the
preformed mediators contained in the mast cells granules are histamine, enzymes
like chymase, tryptase and eosinophilic chemotactic factors.
causes smooth muscle contraction of the airways making it more difficult to
breath. It also causes vasodilation and increased vascular permeability. Thus,
local blood flow increased and leakage of fluid through vessels causing edema
and swelling 4, 5.
cause tissue damage and lead to generation of kinins and complements leading to
further inflammation 4.
chemotactic factors recruits eosinophils to the affected site and are
implicated in later phase reactions.
Late phase reactions occur 2-24
hours later without additional allergen exposure. They may last for several
days and are due to infiltration of eosinophils, neutrophils, monocytes, CD4 T
cells as well as sustained epithelial tissue inflammation. Newly synthesized
mediators include arachidonic acid derivatives (leukotrienes, prostaglandins)
and cytokines will be released.
C4 and D4 are several thousand times more potent than histamine in causing
smooth muscle constriction and vascular permeability. Leukotriene B4 is a
neutrophil chemotaxis 4, 5.
D2 produced mainly in mast cells cause bronchoconstrictive and vasodilating
effect. It also increased mucus secretion 5.
include IL-1 and TNF-? are pro-inflammatory cytokines that promotes leukocytes
influx 4, 5.
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