Delayed Hypersensitivity Reactions Clinical Presentation
- Author: Stuart L Abramson, MD, PhD; Chief Editor: Michael A Kaliner, MD more...
The clinical history of delayed hypersensitivity reactions differs depending on the etiology. Some of the more common examples are as follows:
Contact hypersensitivity (ie, allergic contact dermatitis)
Patients often report being in wooded areas or having made contact with poison ivy or poison oak, which caused a rash, itching, or both.
The exposure occurs 48-72 hours before the development of symptoms.
Tuberculin hypersensitivity reactions
Many times during a routine health screening, patients have a positive Mantoux test result and are asymptomatic. In these cases, patients may recall being exposed to someone with TB or with a chronic cough. In many cases, patients do not recall a possible exposure.
The Mantoux test itself is a delayed hypersensitivity reaction.[2, 3] Thus, 48-72 hours following the intradermal administration of purified M tuberculosis protein derivative, patients who have been exposed to the bacteria develop a delayed hypersensitivity reaction manifested by inflammation and edema in the dermis.
Granulomatous hypersensitivity reactions
Diseases in which delayed hypersensitivity is the major pathophysiological response include tuberculous leprosy, TB, sarcoidosis, and schistosomiasis.
The physical examination findings can be normal, or they can reveal the signs and symptoms of the specific disease.
Contact hypersensitivity: Examination usually reveals edematous and erythematous epidermal tissue with microvesicles. If the offending antigen is from the Rhus genus of plants, the involved area usually appears in a linear fashion. If the offending antigen is nickel (eg, jewelry), then the involved area is oriented in a fashion consistent with the area of contact. Long-term nickel exposure results in an eczematous dermatitis with lichenification of the skin.
Tuberculin hypersensitivity reactions: Approximately 48-72 hours following the intradermal administration of purified M tuberculosis protein, patients who have been exposed to M tuberculosis develop an area of erythema and induration.
Granulomatous hypersensitivity reactions: The physical examination findings differ depending on the underlying disease. For example, if the patient has active TB, then a chronic cough, malaise, night sweats, weight loss, and pyrexia are present.
Delayed hypersensitivity reactions are normal physiological events. Anything that alters these normal events can lead to multiple opportunistic infections. Immune deficiencies (congenital or acquired) and immunosuppressive agents can alter this normal response.
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