Type IV hypersensitivity
|Type IV hypersensitivity|
|Classification and external resources|
Type 4 hypersensitivity is often called delayed type hypersensitivity as the reaction takes two to three days to develop. Unlike the other types, it is not antibody mediated but rather is a type of cell-mediated response.
CD4+ helper T cells recognize antigen in a complex with Class II major histocompatibility complex. The antigen-presenting cells in this case are macrophages that secrete IL-12, which stimulates the proliferation of further CD4+ Th1 cells. CD4+ T cells secrete IL-2 and interferon gamma, further inducing the release of other Th1 cytokines, thus mediating the immune response. Activated CD8+ T cells destroy target cells on contact, whereas activated macrophages produce hydrolytic enzymes and, on presentation with certain intracellular pathogens, transform into multinucleated giant cells.
|Diabetes mellitus type 1||Pancreatic beta cell proteins
(possibly insulin, Glutamate decarboxylase)
|Multiple sclerosis||Oligodendrocyte proteins
(myelin basic protein, proteolipid protein)
|Rheumatoid arthritis||Antigen in synovial membrane
(possibly type II collagen)
|Some peripheral neuropathies||Schwann cell antigen||
|Hashimoto's Thyroiditis||Thyroglobulin antigen|
|Allergic contact dermatitis||Environmental chemicals, e.g. poison ivy, nickel||
|Mantoux test* (diagnostic)||Tuberculin|
|Unless else specified in boxes, then ref is:
* - Mantoux test not taken from 
An example of a TB infection that came under control: M. tuberculosis are engulfed by macrophages after being identified as foreign, but due to an immuno-escape mechanism peculiar to mycobacteria, TB bacteria are able to block the fusion of their enclosing phagosome with lysosomes which would destroy the bacteria. Thereby TB can continue to replicate within macrophages. After several weeks, the immune system somehow [mechanism as yet unexplained] ramps up and, on stimulation with IFN-gamma, the macrophages become capable of killing M. tuberculosis by forming phagolysosomes and nitric oxide radicals. However unfortunately the hyper-activated macrophages secrete TNF which recruits multiple monocytes into the battle. These cells differentiate into epithelioid histiocytes which wall off the infected cells, but at the cost of significant inflammation and local damage.
Some other clinical examples:
- Temporal arteritis
- Hashimoto's thyroiditis
- Symptoms of leprosy
- Symptoms of tuberculosis
- Coeliac disease
- Graft-versus-host disease
- Chronic transplant rejection
- Table 5-5 in: Mitchell, Richard Sheppard; Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson. Robbins Basic Pathology. Philadelphia: Saunders. ISBN 1-4160-2973-7. 8th edition.
- "eMedicine - Hypersensitivity Reactions, Delayed : Article by Walter Duane Hinshaw".