Hypersensitivity (also called hypersensitivity reaction or intolerance) refers to undesirable

reactions produced by the normal immune system, including allergies and autoimmunity. They
are usually referred to as an over-reaction of the immune system and these reactions may be
damaging and uncomfortable. This is an immunologic term and is not to be confused with the
psychiatric term of being hypersensitive which implies to an individual who may be overly
sensitive to physical (ie sound, touch, light, etc.) and/or emotional stimuli. Although there is a
relation between the two – studies have shown that those individuals that have ADHD (a
psychiatric disorder) are more likely to have hypersensitivity reactions such as allergies, asthma,
eczema than those who do not have ADHD.[1]

Types of hypersensitivity reactions

Hypersensitivity reactions can be classified into four types.

Type I: IgE mediated immediate reaction

Type II: Antibody-mediated reaction (IgG or IgM antibodies)

Type III: Immune complex-mediated reaction

Type IV: Cytotoxic, cell-mediated, delayed hypersensitivity reaction[2]

The first three types are considered immediate hypersensitivity reactions because they occur
within 24 hours. The fourth type is considered a delayed hypersensitivity reaction because it
usually occurs more than 12 hours after exposure to the allergen, with a maximal reaction time
between 48 and 72 hours.[3]
Gell and Coombs classification

The Gell and Coombs classification of hypersensitivity is the most widely used, and distinguishes four
types of immune response which result in bystander tissue damage. [4]

Immunologic aspects of hypersensitivity reactions

Antibodies or Cell Immunologic

Type Alternative names Examples
Mediators Reaction

Fast response
which occurs
in minutes,
rather than
multiple
hours or days.
Free antigens  Atopy
cross link the
 Allergy  Anaphylaxis
IgE on mast
I  Immediate  Antibody IgE cells and  Asthma
basophils
 Anaphylactic  Churg–Strauss
which causes
a release of Syndrome
vasoactive
biomolecules.
Testing can
be done via
skin test for
specific IgE.[5]

Antibody  Autoimmune
(IgM or IgG) hemolytic anemia
binds to
 Rheumatic heart
antigen on a
disease
 Antibody IgM target cell,
which is  Thrombocytopenia
 Antibody IgG actually a
II  Antibody-dependent host cell that  Erythroblastosis
 Complement fetalis
is perceived
 MAC by the  Goodpasture's
immune syndrome
system as
foreign,  Graves' disease
leading to  Myasthenia gravis
cellular
Immunologic aspects of hypersensitivity reactions

Antibodies or Cell Immunologic

Type Alternative names Examples
Mediators Reaction

destruction
via the MAC.
Testing
includes both
 Pemphigus vulgaris
the direct and
indirect
Coombs test.
[6]

 Serum sickness
Antibody  Rheumatoid
(IgG) binds to arthritis
soluble
antigen,  Arthus reaction
forming a
 Post streptococcal
circulating
glomerulonephritis
immune
 Antibody IgG complex. This  Membranous
is often nephropathy
III  Immune complex  Complement
deposited in
 Reactive arthritis
 Neutrophils the vessel
walls of the  Lupus nephritis
joints and
kidney,  Systemic lupus
initiating a erythematosus
local  Extrinsic allergic
inflammatory alveolitis
reaction.[7] (hypersensitivity
pneumonitis)

CTL's and T  Contact dermatitis,

 Delayed,[5][6] helper cells including Urushiol-
(specifically induced contact
 cell-mediated immune Th1 and Th17 dermatitis (poison
Cells
IV memory response, cells)[8] are ivy rash).
 T-cells activated by
 Antibody-independent  Mantoux test
an antigen
 Cytotoxic presenting  Chronic transplant
cell. When rejection
the antigen is
Immunologic aspects of hypersensitivity reactions

Antibodies or Cell Immunologic

Type Alternative names Examples
Mediators Reaction

presented
again in the
future, the
memory Th1  Multiple
cells will sclerosis[10]
activate  Coeliac disease
macrophages
and cause an  Hashimoto's
inflammatory thyroiditis
response.  Granuloma
This annulare
ultimately can
lead to tissue
damage.[9]