Hypersensitivity Disorders

CAUSES OF HYPERSENSITIVITY DISEASES, 407

MECHANISMS AND CLASSIFICATIONS OF HYPERSENSITIVITY REACTIONS, 408

DISEASES CAUSED BY ANTIBODIES, 409

Diseases Caused by Antibodies Against Fixed Cell and Tissue Antigens, 410

Immune Complex-Mediated Diseases, 411

DISEASES CAUSED BY T LYMPHOCYTES, 414

Diseases Caused by Cytokine-Mediated Inflammation, 414 Diseases Caused by Cytotoxic T Lymphocytes, 416

THERAPEUTIC APPROACHES FOR IMMUNOLOGIC DISEASES, 417

SELECTED IMMUNOLOGIC DISEASES: PATHOGENESIS AND THERAPEUTIC STRATEGIES, 419

Systemic Lupus Erythematosus: The Prototypic Immune Complex-Mediated Disease, 419 Rheumatoid Arthritis, 419 Multiple Sclerosis and Experimental Autoimmune Encephalomyelitis, 421 Type 1 Diabetes Mellitus, 422 Inflammatory Bowel Disease, 423

SUMMARY, 423

Adaptive immunity serves the important function of host defense against microbial infections, but immune responses are also capable of causing tissue injury and disease. Disorders caused by immune responses are called hypersensitivity diseases. This term arose from the clinical definition of immunity as "sensitivity," which is based on the observation that an individual who has been exposed to an antigen exhibits a detectable reaction or is "sensitive" to subsequent encounters with that antigen. Normally, immune responses eradicate infecting organisms without serious injury to host tissues. However, these responses are sometimes inadequately controlled, inappropriately targeted to host tissues, or triggered by commensal microorganisms or environmental antigens that are usually harmless. In these situations, the normally beneficial immune response is the cause of disease.

In this chapter, we describe the pathogenesis of different types of hypersensitivity diseases, with an emphasis on the effector mechanisms that cause tissue injury. We conclude with a brief consideration of the treatment of immunologic diseases and examples of diseases that illustrate important principles.

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