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	\| Fast response which occurs in minutes rather than multiple hours or days. Free antigens cross link the IgE on mast cells and basophils which causes a release of vasoactive biomolecules.		\| Fast response which occurs in minutes rather than multiple hours or days. Free antigens cross link the IgE on mast cells and basophils which causes a release of vasoactive biomolecules.

	Testing can be done via skin test for specific IgE.<ref name=":1" />		Testing can be done via skin test for specific IgE.<ref name=":3" />
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	\| Antibody (IgM or IgG) binds to antigen on foreign cell leading to cellular destruction via the ].		\| Antibody (IgM or IgG) binds to antigen on foreign cell leading to cellular destruction via the ].

	Testing includes both the direct and indirect Coombs test.<ref name=":2" />		Testing includes both the direct and indirect Coombs test.<ref name=":3" />
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	\| Antibody (IgG) binds to antigen on foreign cell leading to cellular destruction via neutrophils and the subsequent release of lysosomal enzymes.<ref>Le, Tau. First Aid for the USMLE Step 1 2013, p. 203-204</ref>		\| Antibody (IgG) binds to antigen on foreign cell leading to cellular destruction via neutrophils and the subsequent release of lysosomal enzymes.<ref name=":3">Le, Tau. First Aid for the USMLE Step 1 2013, p. 203-204</ref>
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	\| T cells find antigen and activate macrophages.<ref~~>Le,~~ ~~Tau.~~ ~~First Aid for the USMLE Step 1 2013, p. 203-204<~~/~~ref~~>		\| T cells find antigen and activate macrophages.<ref name=":3" />
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Revision as of 11:52, 30 September 2013

Not to be confused with Sensory processing disorder § Hyposensitivities and hypersensitivities. This page is about the medical condition. For the music album, see Hypersensitive. For the cause of dental pain, see Dentine hypersensitivity. Medical condition

Elitre (WMF)/Sandbox

Hypersensitivity (also called hypersensitivity reaction or intolerance) refers to undesirable reactions produced by the normal immune system, including allergies and autoimmunity. These reactions may be damaging, uncomfortable, or occasionally fatal. Hypersensitivity reactions require a pre-sensitized (immune) state of the host. The four-group classification was expounded by P. H. G. Gell and Robin Coombs in 1963.

Coombs and Gell classification

**Comparison of hypersensitivity types**
Type	Alternative names	Often mentioned disorders	Mediators	Description
I	Allergy (immediate)	Atopy Anaphylaxis Asthma	IgE and IgG4	Fast response which occurs in minutes rather than multiple hours or days. Free antigens cross link the IgE on mast cells and basophils which causes a release of vasoactive biomolecules. Testing can be done via skin test for specific IgE.
II	Cytotoxic, antibody-dependent	Autoimmune hemolytic anemia Thrombocytopenia Erythroblastosis fetalis Goodpasture's syndrome Membranous nephropathy Graves' disease see type V explanation below Myasthenia Gravis see type V explanation below	IgM or IgG (Complement) MAC	Antibody (IgM or IgG) binds to antigen on foreign cell leading to cellular destruction via the MAC. Testing includes both the direct and indirect Coombs test.
III	Immune complex disease	Serum sickness Arthus reaction Rheumatoid arthritis Post streptococcal glomerulonephritis Lupus Nephritis Systemic lupus erythematosus (SLE) Extrinsic allergic alveolitis (Hypersensitivity pneumonitis)	IgG (Complement) Neutrophils	Antibody (IgG) binds to antigen on foreign cell leading to cellular destruction via neutrophils and the subsequent release of lysosomal enzymes.
IV	Delayed-type hypersensitivity(DTH), cell-mediated immune memory response, antibody-independent	Contact dermatitis Mantoux test Metal joint replacement Chronic transplant rejection Multiple sclerosis	T-cells	T cells find antigen and activate macrophages.
V	Autoimmune disease, receptor mediated (see below)	Graves' disease Myasthenia Gravis	IgM or IgG (Complement)

Type V

This is an additional type that is sometimes (often in the UK) used as a distinction from Type 2.

Instead of binding to cell surface components, the antibodies recognise and bind to the cell surface receptors, which either prevents the intended ligand binding with the receptor or mimics the effects of the ligand, thus impairing cell signaling.

Some clinical examples:

The use of Type 5 is rare. These conditions are more frequently classified as Type 2, though sometimes they are specifically segregated into their own subcategory of Type 2.

References

Gell PGH, Coombs RRA, eds. Clinical Aspects of Immunology. 1st ed. Oxford, England: Blackwell; 1963.
^ Le, Tau. First Aid for the USMLE Step 1 2013, p. 203-204
Black, CA. Delayed Type Hypersensitivity: Current Theories with an Historic Perspective Dermatol. Online J. (May 1999) 5(1):7 at http://dermatology.cdlib.org/DOJvol5num1/reviews/black.html
http://emedicine.medscape.com/article/136118-overview
Table 5-1 in:Mitchell, Richard Sheppard; Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson (2007). Robbins Basic Pathology. Philadelphia: Saunders. ISBN 1-4160-2973-7.{{cite book}}: CS1 maint: multiple names: authors list (link) 8th edition.
Rajan TV (2003). "The Gell-Coombs classification of hypersensitivity reactions: a re-interpretation". Trends Immunol. 24 (7): 376–9. doi:10.1016/S1471-4906(03)00142-X. PMID 12860528. {{cite journal}}: Unknown parameter |month= ignored (help)

External links

"Hypersensitivity reactions". GPnotebook.

Template:Medical conditions

Consequences of external causes

Temperature

Elevated	Burn Hyperthermia Heat syncope
Reduced	Hypothermia Immersion foot syndromes Trench foot Tropical immersion foot Warm water immersion foot Non-freezing cold injury Chilblains Frostbite Aerosol burn Cold intolerance Acrocyanosis Erythrocyanosis crurum

Radiation

Oxygen

Pressure

Food

Starvation

Maltreatment

Travel

Adverse effect

Hypersensitivity

Adverse drug reaction

Other

Ungrouped
skin conditions
resulting from
physical factors

Dermatosis neglecta
Pinch mark
Pseudoverrucous papules and nodules
Sclerosing lymphangitis
Tropical anhidrotic asthenia
UV-sensitive syndrome
environmental skin conditions
- Electrical burn
frictional/traumatic/sports
Uranium dermatosis
iv use

Category
Commons
Glossary
Outline
Portal

Lymphoid and complement disorders causing immunodeficiency

Primary

Antibody/humoral
(B)

Hypogammaglobulinemia	X-linked agammaglobulinemia Transient hypogammaglobulinemia of infancy
Dysgammaglobulinemia	IgA deficiency IgG deficiency IgM deficiency Hyper IgM syndrome (1 2 3 4 5) Wiskott–Aldrich syndrome Hyper-IgE syndrome
Other	Common variable immunodeficiency ICF syndrome

T cell deficiency
(T)

thymic hypoplasia: hypoparathyroid (Di George's syndrome)
euparathyroid (Nezelof syndrome
Ataxia–telangiectasia)

peripheral: Purine nucleoside phosphorylase deficiency

Hyper IgM syndrome (1)

Severe combined
(B+T)

x-linked: X-SCID
autosomal: Adenosine deaminase deficiency
Omenn syndrome
ZAP70 deficiency
Bare lymphocyte syndrome

Acquired

HIV/AIDS

Leukopenia:
Lymphocytopenia

Idiopathic CD4+ lymphocytopenia

Complement
deficiency

Hypersensitivity and autoimmune diseases

Type I/allergy/atopy
(IgE)

Foreign	Allergic asthma Allergic urticaria Allergic rhinitis (Hay fever) Anaphylaxis Atopic dermatitis Food allergy common allergies include: Egg Milk Peanut Seafood Soy Tree nut Wheat Penicillin allergy
Autoimmune	Autoimmune urticaria Eosinophilic esophagitis

Type II/ADCC

- IgG
- IgM

Foreign

Hemolytic disease of the newborn

Autoimmune

Cytotoxic	Autoimmune hemolytic anemia Bullous pemphigoid Goodpasture syndrome Guillain–Barré syndrome Immune thrombocytopenic purpura Pemphigus vulgaris Rheumatic fever
"Type V"/receptor	Graves' disease Myasthenia gravis Pernicious anemia

Type III
(Immune complex)

Foreign	Arthus reaction Farmer's lung Henoch–Schönlein purpura Hypersensitivity vasculitis Post-streptococcal glomerulonephritis Reactive arthritis Serum sickness
Autoimmune	Lupus Rheumatoid arthritis Subacute bacterial endocarditis

Type IV/cell-mediated
(T cells)

Foreign	Allergic contact dermatitis Mantoux test
Autoimmune	Coeliac disease Giant cell arteritis Hashimoto's thyroiditis Multiple sclerosis Postorgasmic illness syndrome Reactive arthritis Type 1 diabetes
GVHD	Transfusion-associated graft-versus-host disease

Unknown/
multiple

Foreign	Hypersensitivity pneumonitis Allergic bronchopulmonary aspergillosis Latex allergy (I+IV) Transplant rejection
Autoimmune	Autoimmune adrenalitis Autoimmune hepatitis Autoimmune polyendocrine syndrome APS1 APS2 Sjögren syndrome Systemic autoimmune disease