INTRODUCTIE
IMMUNE SYSTEM FUNCTION
• Defence
- pathogens, harmful agents, tumours, noxes
• Discrimination
- “SELF – NON-SELF” (TOLERANCE)
- Dangerous (danger signals)
- non-dangerous Innate immune response - adaptive immune response (lymphocytes)
➔ Humoral – cellular component
- Well-controlled (to avoid excessive activation)
HYPERSENSITIVITY = ALLERGY
• Allergy involves activation of adaptive immune system (with activation of specific T and B cells)
• Other mechanisms:
- Effector cell activation via other receptors
- Interference with enzymes: COX, ACEi
! bradikinine veroozaakt vasodilatatie & voor oedeem
1
, ! type IV bestaat uit a,b,c & d !
! type I & II zijn clinical diagnosis!
! rash is not a diagnosis!
2
,TIMING OF DHR
• Immediate DHR < 1h (<6)
- Urticaria / angioedema
- Respiratory
- Gastro-intestinal
- Cardio-vascular
- (anaphylaxis)
• Nonimmediate DHR > 6hrs
- AGEP: 24-72
- MPE: 7-11 days
- SJS/TEN (blistering): 10-25 days
- DRESS: 10-50 days
AGEP: acute generalized exanthematous pustulosis
SJS: Steven Johnson syndrome
TEN: toxic epidermal necrolysis
DRESS: drug reaction with eosinophilia and systemic symptoms
DELAYED SKIN REACTION
3
, DIFFERENT CLINICS & DIAGNOSTICS
• Type I:
- Mast cells / basophils
- might be IgE mediated*
- IgE tests (if available)
- Immediate readings skin tests (SPT and IDT, no patch)
*many alternative mechanisms (that are generally difficult, if at all, demonstrable !!!
• Type IV:
- T cells and others
- IgE- test: useless
- Delayed readings skin test (patch & IDT) (prick test is useless)
! red man syndrome -> type II reaction, not IgE reaction (kan vermeden worden door vancomycine traag toe te
dienen!
4
IMMUNE SYSTEM FUNCTION
• Defence
- pathogens, harmful agents, tumours, noxes
• Discrimination
- “SELF – NON-SELF” (TOLERANCE)
- Dangerous (danger signals)
- non-dangerous Innate immune response - adaptive immune response (lymphocytes)
➔ Humoral – cellular component
- Well-controlled (to avoid excessive activation)
HYPERSENSITIVITY = ALLERGY
• Allergy involves activation of adaptive immune system (with activation of specific T and B cells)
• Other mechanisms:
- Effector cell activation via other receptors
- Interference with enzymes: COX, ACEi
! bradikinine veroozaakt vasodilatatie & voor oedeem
1
, ! type IV bestaat uit a,b,c & d !
! type I & II zijn clinical diagnosis!
! rash is not a diagnosis!
2
,TIMING OF DHR
• Immediate DHR < 1h (<6)
- Urticaria / angioedema
- Respiratory
- Gastro-intestinal
- Cardio-vascular
- (anaphylaxis)
• Nonimmediate DHR > 6hrs
- AGEP: 24-72
- MPE: 7-11 days
- SJS/TEN (blistering): 10-25 days
- DRESS: 10-50 days
AGEP: acute generalized exanthematous pustulosis
SJS: Steven Johnson syndrome
TEN: toxic epidermal necrolysis
DRESS: drug reaction with eosinophilia and systemic symptoms
DELAYED SKIN REACTION
3
, DIFFERENT CLINICS & DIAGNOSTICS
• Type I:
- Mast cells / basophils
- might be IgE mediated*
- IgE tests (if available)
- Immediate readings skin tests (SPT and IDT, no patch)
*many alternative mechanisms (that are generally difficult, if at all, demonstrable !!!
• Type IV:
- T cells and others
- IgE- test: useless
- Delayed readings skin test (patch & IDT) (prick test is useless)
! red man syndrome -> type II reaction, not IgE reaction (kan vermeden worden door vancomycine traag toe te
dienen!
4
