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hypersensitivity reaction type IV disease

ICD-10 Codes

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Description

Type IV Hypersensitivity Reaction: A Cell-Mediated Immune Response

A Type IV hypersensitivity reaction, also known as delayed-type hypersensitivity (DTH), is a cell-mediated immune response that occurs when the body's immune system reacts to an antigen. This type of reaction is characterized by a delay in the onset of symptoms, typically occurring 24-48 hours after exposure to the antigen.

Key Features:

  • Cell-mediated response: Type IV hypersensitivity reactions are mediated by T cells and macrophages, rather than antibodies.
  • Delayed onset: Symptoms occur at least 1-3 days after initial exposure to the antigen.
  • Inflammatory reaction: The immune system responds with an inflammatory reaction against exogenous or endogenous antigens.

Examples of Type IV Hypersensitivity Reactions:

  • Tuberculin reaction (Mantoux test): A diagnostic skin test for tuberculosis that involves a recall response to purified mycobacterial antigens.
  • Granuloma formation: The inability to kill intracellular pathogens in macrophages often results in a chronic stimulation of the pathogen, leading to granuloma formation.

Normal Physiological Events:

Type IV hypersensitivity reactions are normal physiological events that help fight infections. However, dysfunction in this system can predispose individuals to multiple opportunistic infections.

References:

  • [1] Type IV hypersensitivity is a type of delayed-type immune response, in which the immune system responds to an antigen several hours or days after exposure. (Source: #5)
  • [2] Type IV hypersensitivity reactions are mediated by T cells that provoke an inflammatory reaction against exogenous or endogenous antigens. (Source: #4)
  • [3] Type IV hypersensitivity is a cell-mediated immune reaction, in which the immune system responds to an antigen without the participation of antibodies. (Source: #7)

Additional Characteristics

  • A cell-mediated immune response
  • Delayed onset symptoms
  • Inflammatory reaction against exogenous or endogenous antigens
  • Tuberculin reaction (Mantoux test)
  • Granuloma formation

Signs and Symptoms

Delayed-Type Hypersensitivity Reactions: Signs and Symptoms

Type IV hypersensitivity reactions, also known as delayed-type hypersensitivity (DTH) reactions, are characterized by a cell-mediated immune response that occurs hours to days after exposure to specific antigens. The signs and symptoms of Type IV hypersensitivity reactions can vary depending on the location and severity of the reaction.

Common Signs and Symptoms:

  • Skin manifestations: Redness, swelling, itching, and blistering at the site of contact with the allergen (e.g., poison ivy, nickel in jewelry)
  • Inflammation: Swelling, redness, and warmth around the affected area
  • Pain: Pain or tenderness at the site of the reaction
  • Fever: Elevated body temperature (usually mild to moderate)
  • Generalized symptoms: Fatigue, headache, and muscle aches in some cases

Specific Signs and Symptoms:

  • Urticaria (hives): Itchy, raised patches on the skin, often accompanied by redness and swelling
  • Eczema: Inflammation of the skin, characterized by dryness, itching, and redness
  • Granulomatous reactions: Formation of granulomas (aggregates of immune cells) in response to certain antigens, leading to symptoms such as pain, swelling, and inflammation

Timing of Symptoms:

  • Early phase: Within 24-48 hours after exposure to the allergen
  • Late phase: 2-3 days or longer after exposure, characterized by more severe symptoms and tissue damage

These signs and symptoms can be caused by various Type IV hypersensitivity reactions, including allergic contact dermatitis, transplant rejection, graft-versus-host disease, and others. It's essential to note that the severity and duration of symptoms can vary widely depending on individual factors.

References:

  • [3] Type IV hypersensitivity is a type of delayed-type immune response, in which the immune system responds to an antigen several hours or days after exposure.
  • [8] Skin manifestations include urticaria (hives) and eczema, while inflammation, pain, fever, and generalized symptoms can also occur.
  • [10] Type IV allergic reactions are characterized by a delayed-type response, with symptoms appearing 48-72 hours or longer after contact with the allergen.
  • [11] Type IV hypersensitivity is often called delayed type hypersensitivity as the reaction takes two to three days to develop.

Additional Symptoms

Diagnostic Tests

Diagnostic Tests for Type IV Hypersensitivity Reactions

Type IV hypersensitivity reactions, also known as delayed hypersensitivity reactions, are a type of immune response that occurs when the body's immune system overreacts to a specific antigen. This type of reaction is mediated by T-cells and can involve tissue damage mediated by activated macrophages and cytotoxic T cells.

Diagnostic Tests

Several diagnostic tests can be used to establish the diagnosis of Type IV hypersensitivity reactions, including:

  • Patch testing: Also known as contact delayed hypersensitivity allergy test, patch testing involves applying small amounts of potential allergens to the skin and observing for a reaction. This test is often helpful in determining the responsible antigen.
  • Delayed intradermal testing (IDT): IDT involves injecting a small amount of antigen into the skin and observing for a reaction. This test is more sensitive than patch testing but less specific.
  • Drug challenges: In some cases, a drug challenge may be performed to confirm the diagnosis of a hypersensitivity reaction.

Other Tests

In addition to these diagnostic tests, other tests such as:

  • Serum tryptase level: Elevated serum tryptase levels can indicate an allergic reaction and should be periodically checked.
  • Bone marrow examination: If the baseline level exceeds 20µg/L, bone marrow examination may be necessary.

Prognosis

The prognosis of Type IV hypersensitivity reactions depends on various factors, including the severity of the reaction and the underlying cause. Basic routine investigations such as looking at blood function, liver function, thyroid function, and kidney function may also be helpful in determining the prognosis.

References

  • [1] Diagnostic “in clinic” approaches to delayed hypersensitivity reactions have included patch testing (PT), delayed intradermal testing (IDT) and drug challenges. [7]
  • [2] Patch testing is often helpful in determining the responsible antigen. [4]
  • [3] IDT involves injecting a small amount of antigen into the skin and observing for a reaction. [9]
  • [4] Serum tryptase level should be periodically checked if elevated. [5]
  • [5] Bone marrow examination may be necessary if the baseline level exceeds 20µg/L. [6]

Note: The numbers in square brackets refer to the context search results provided, which were used to generate this answer.

Additional Diagnostic Tests

  • Patch testing
  • Bone marrow examination
  • Serum tryptase level
  • Delayed intradermal testing (IDT)
  • Drug challenges

Treatment

Treatment Options for Type IV Hypersensitivity Reactions

Type IV hypersensitivity reactions, also known as delayed-type hypersensitivity (DTH) reactions, are mediated by T cells and macrophages. While there is no specific medication to treat this condition, the following treatments can help manage symptoms and reduce inflammation:

  • Topical corticosteroids: These medications can be applied directly to the affected area to reduce inflammation and itching [7].
  • Systemic corticosteroids: In severe cases, systemic corticosteroids may be prescribed to suppress the immune system and reduce inflammation [1].
  • Antihistamines: These medications can help relieve symptoms such as itching, redness, and swelling [8].
  • Desensitization therapy: This treatment involves gradually exposing the individual to small amounts of the allergen to build up tolerance [8].

Medications for Specific Conditions

In some cases, specific medications may be used to treat underlying conditions that contribute to Type IV hypersensitivity reactions. For example:

  • Aspirin or ibuprofen: These antipyretic medications can help reduce fever and alleviate symptoms in self-limited reactions [5].
  • Antibiotics: If a bacterial infection is present, antibiotics may be prescribed to treat the underlying condition [1].

Avoidance of Triggers

The mainstay of treatment for Type IV hypersensitivity reactions is avoidance of contact with the causative agent. This can include:

  • Avoiding exposure to allergens: Identifying and avoiding triggers such as nickel, latex, or other substances that may cause a reaction [6].
  • Wearing protective gear: Using gloves, masks, or other protective equipment when working with potential allergens [6].

It's essential to note that treatment for Type IV hypersensitivity reactions is often focused on managing symptoms and preventing further exposure to the causative agent. In some cases, underlying conditions may require specific medical attention.

References:

[1] Marwa K (2023) - Type IV hypersensitivity treatment includes aggressive life-saving therapy...

[7] Treatment involves topical corticosteroids and avoidance of triggers to reduce inflammation and cell death.

[8] Treatment is medication discontinuation, supportive treatment (eg, with antihistamines), and sometimes desensitization.

Recommended Medications

  • Desensitization therapy
  • Topical corticosteroids
  • Systemic corticosteroids
  • Antihistamines
  • Antibiotics
  • Aspirin or ibuprofen

💊 Drug information is sourced from ChEBI (Chemical Entities of Biological Interest) database. Always consult with a healthcare professional before starting any medication. Click on any medication name for detailed information.

Differential Diagnosis

Differential Diagnosis of Type IV Hypersensitivity Reaction

Type IV hypersensitivity reactions, also known as delayed hypersensitivity reactions, are a type of immune response that occurs 48-72 hours after exposure to an allergen. This type of reaction is mediated by T cells and can cause a range of symptoms, including skin lesions, inflammation, and tissue damage.

Differential Diagnoses

When diagnosing Type IV hypersensitivity reactions, it's essential to consider the following differential diagnoses:

  • Acute Sinusitis: A bacterial or viral infection that causes inflammation in the sinuses.
  • Acute Urticaria: A sudden onset of hives and itching due to an allergic reaction.
  • Allergic and Environmental Asthma: A type of asthma triggered by allergies or environmental factors.
  • Anaphylaxis: A severe, life-threatening allergic reaction that requires immediate medical attention.
  • Angioedema: A condition characterized by swelling of the skin and mucous membranes.
  • Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN): Rare but serious skin conditions caused by an adverse reaction to medication or infection.
  • Drug Rash with Eosinophilia and Systemic Symptoms (DRESS): A rare but potentially life-threatening condition characterized by a rash, fever, and internal organ involvement.

Other Conditions

In addition to the above differential diagnoses, other conditions that may be considered in the diagnosis of Type IV hypersensitivity reactions include:

  • Erythema Exsudativum Multiforme: A skin condition caused by an infection or autoimmune response.
  • Skin Lymphoma-Malignancies: Cancers of the lymphatic system that can cause skin lesions and other symptoms.
  • Inflammatory Dermatoses: Conditions such as psoriasis, eczema, and dermatitis that cause inflammation and skin lesions.
  • Nutritional Deficiencies: Deficiencies in vitamins or minerals that can cause skin problems and other symptoms.

Key Points

When diagnosing Type IV hypersensitivity reactions, it's essential to consider the patient's medical history, physical examination findings, and laboratory results. A thorough evaluation of these factors will help healthcare providers to accurately diagnose and manage this condition.

References:

  • [2] Type four hypersensitivity reaction is a cell-mediated reaction that can occur in response to contact with certain allergens resulting in what is called contact ...
  • [4] Type IV hypersensitivity reactions in the skin are referred to as allergic contact dermatitis in which erythema, edema, pruritus, vesicles or bullae may occur.
  • [7] Disorders involving type IV reactions include Stevens-Johnson syndrome, toxic epidermal necrolysis (SJS/TEN), drug rash with eosinophilia and systemic symptoms (DRESS).
  • [13] The differential diagnosis includes erythema exsudativum multiforme, which must be ruled out; this entity is not a hypersensitivity reaction and generally arises after an infection.
  • [14] Allergic contact dermatitis (ACD) is a type IV (delayed) hypersensitivity reaction that has a wide spectrum of presentations that often imitate or overlap with other cutaneous eruptions.

Additional Differential Diagnoses

  • Anaphylaxis
  • Acute Urticaria
  • Allergic and Environmental Asthma
  • Skin Lymphoma-Malignancies
  • Inflammatory Dermatoses
  • Nutritional Deficiencies
  • Acute Sinusitis
  • Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)
  • Drug Rash with Eosinophilia and Systemic Symptoms (DRESS)
  • erythema multiforme
  • angioedema

Additional Information

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