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Drug Allergy
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Serum sickness–like reactions following exposure to cephalosporins (primarily by cefaclor) usually are caused by antibodies directed to reactive intermediates that are formed by altered metabolism of the drug. In contrast, Arthus reactions are localized type III hypersensitivity reactions that can occur as a result of vaccination and present without systemic manifestations.
Animal Models of Rheumatoid Arthritis
Published in Yuehuei H. An, Richard J. Friedman, Animal Models in Orthopaedic Research, 2020
Erica L. Moran, Earl R. Bogoch
Considerable morbidity in RA is related to the involvement of sheaths, with effects on the tendons. A model of tenosynovitis is described by Cooke.5 In this model, 0.5 ml. of 2% BSA in PBS is injected into the tibialis anterior tendon, an intrasynovial structure which is easily accessible. Within 48 hours, an acute Arthus reaction occurs, with characteristic hemorrhage, hypertrophy of the sheath lining, and influx of polymorphonuclear cells, followed by phagocytic cells and necrosis. The reaction as shown by localization of antigen within the tendon, subsides over two weeks, or six weeks, if challenge is used.
ExperimentaL Oral Medicine
Published in Samuel Dreizen, Barnet M. Levy, Handbook of Experimental Stomatology, 2020
Samuel Dreizen, Barnet M. Levy
Changes in the serum protein fraction were characterized by hypoalbuminuria and hypergammaglobulinemia that peaked between 50 and 100 days after initial sensitization. The hypergammaglobulinemia was coincident with a high titer of specific precipitating antibody. Both precipitin and sensitized red cell agglutination titers increased progressively until the end of the experiments. Arthus reaction and passive cutaneous anaphylaxis reaction were positive. Locally, an allergic demarcating inflammation with a thick granulation tissue layer and vascular lesions including periarteritis and focal histolysis were demonstrated. Slight endocarditis, myocarditis, diffuse interstitial pneumonitis, various forms of hepatitis, diffuse glomerulonephritis, and splenitis were observed. In the submandibular lymph nodes, degenerative changes such as onion skin vascular lesions were seen during the later stages of sensitization. Repeated administration of the antigen through the pulp canals caused both a local and systemic immunologic response. The systemic morphologic changes were allergic in origin. The evidence suggests that an antigenic substance or substances in chronic dental foci might cause a continuous immunologic stimulus that induces systemic disease.
Understanding Retinal Vasculitis Associated with Brolucizumab: Complex Pathophysiology or Occam’s Razor?
Published in Ocular Immunology and Inflammation, 2022
Ashish Sharma, Nilesh Kumar, Nikulaa Parachuri, Sonali Singh, Francesco Bandello, Carl D. Regillo, David Boyer, Quan Dong Nguyen
It is possible that small size may allow higher molar concentration and incite a strong local immune reaction leading to inflammation. We have highlighted the role of type III hypersensitivity reaction (HSR) in the past.15 The majority of vasculitic diseases involve the deposition of antigen-antibody complex, which is Type III HSR. These deposits have been shown in the capillary bed and vessel walls and can lead to occlusive vasculitis. Arthus reaction, a subtype of Type III HSR has been reported in patients on systemic monoclonal antibody (mAb), including systemic anti-VEGF therapies. Such reactions are assumed to be due to high antigen load, which leads to a subsequent increase of antibodies.16,17 Arthus reaction is more frequent in patients with auto-immune conditions. The higher molar concentration of brolucizumab (11 and 22 times greater than aflibercept and ranibizumab, respectively), if antigenic, may produce a higher rate of antibody formation. Type III HSR is due to the formation of biologic/ADA immune complexes in the circulation. When these complexes are in the correct stoichiometric ratio, they are deposited in tissues and cause inflammation and tissue damage. The requirement of the correct ratio to have tissue deposition might explain why vasculitis is seen in some individual rather than in clusters as each individual having differing amounts of ADAs leading to different stoichiometric ratios.18
Diagnosis and management of hypersensitivity reactions to vaccines
Published in Expert Review of Clinical Immunology, 2020
Lucrezia Sarti, Guillaume Lezmi, Francesca Mori, Mattia Giovannini, Jean-Christoph Caubet
Pain, redness, and/or swelling at the injection site are the most common local reactions and are generally mild. They are observed in 23 to 81% and 44 to 84% of infants and toddlers following vaccinations with 7 or 13 valent-pneumococcal conjugate vaccines, respectively [30], and in more than 75% of children between 4four and 6 years of age following a booster vaccination for diphtheria-tetanus-pertussis-poliomyelitis [34]. These reactions could result from nonspecific inflammation induced by microbial or other components used as adjuvants [14]. Large injection site reactions typically occur within 24 to 72 hours following immunization and disappear in two to 3 days [11,14]. Reactions extending beyond the nearest joint or lasting more than 3 days are sometimes defined as severe local reactions [13]. Large injection site reactions most frequently occur after injections of toxoid-containing vaccines but may be observed after the injection of any vaccine [11,13]. They may result from toxoid or aluminum hydroxide-induced inflammation and may occur after any injections of a vaccine [11,35]. Large injection site reactions may also result from an Arthus reaction in previously immunized patients who have developed high titers of specific IgG against the microbial components of the vaccine [11]. In this case, IgG antibodies may bind to vaccine antigens at the injection site and form antigen/antibody complexes, which are thought to activate complement, leading to nonspecific mast-cell degranulation and neutrophil recruitment. Arthus reactions develop only in previously immunized patients and typically occur after the fourth or fifth injection [11].
Keratoconjunctivitis as a Single Entity in X-linked Agammaglobulinemia?
Published in Ocular Immunology and Inflammation, 2023
Stefan Mielke, Bastian Grundel, Sebastian M. Schmidt, Frank Tost
In the current case, a type III allergic reaction (Arthus reaction) was also possible. In this situation, after activating the complement system, the local inflammation reaction is initiated by immune complexes after contact with microbial complements. Both medications could improve the inflammation as seen during the clinical course: the anti-inflammatory medication directly and the antibiotics indirectly by reducing the local microbial flora, given that our repeated conjunctival swabs failed to detect still existing, possibly physiological skin flora.