Delayed-type hypersensitivity reaction
DTH is something that is much more serious than Dr. Offit would lead you to believe.
Date: 3/28/2009 5:13:29 PM ( 14 y ) ... viewed 4694 times
Paul A. Offit, MD says that "Delayed-type
hypersensitivity reaction due to vaccinations" are nothing to be concerned
about.... really???? Just what is meant by delayed hypersensitivity
reaction and is it really nothing to be concerned about?
delayed-type hypersensitivity (DTH) - a delayed hypersensitivity. See
also cell-mediated immune response.
cell-mediated immune response n. - The immune response produced
when sensitized T cells attack foreign antigens and secrete lymphokines
that initiate the body's humoral immune response. Also called
cell-mediated reaction, cellular immune response.
cell-mediated immune response - a delayed reaction of the immune
system, mediated primarily by sensitized T lymphocytes rather than
antibodies. Cell-mediated immune response reactions are responsible for
defense against certain bacterial, fungal, and viral pathogens; malignant
cells; and other foreign proteins and tissues.
is an example of a cell-mediated immune response. Also called cellular
hypersensitivity reaction, delayed hypersensitivity reaction, type IV
hypersensitivity. Compare anaphylactic hypersensitivity.
Mosby's Medical Dictionary, 8th edition. © 2009,
So basically it is
not an IgE response but a T lymphocyte response but it can still be
/al·ler·gy/ (al´er-je) a hypersensitive state acquired through exposure to
a particular allergen, reexposure bringing to light an altered capacity to
react. See hypersensitivity. aller´gic
hypersensitivity /hy·per·sen·si·tiv·i·ty/ (-sen″sĭ-tiv´ĭ-te) a
state of altered reactivity in which the body reacts with an exaggerated
immune response to what is perceived as a foreign substance. The
hypersensitivity states and resulting reactions are usually subclassified
by the Gell and Coombs classification (q.v.).hypersen´sitive
So can a
delayed-type hypersensitivity reaction be serious?
hypersensitivity reaction to anthrax vaccine.
Greidanus TG, Honl BA.
Evans Army Community Hospital, Fort Carson, CO, USA.
RESULTS: Two patients, 39 and 23 years of age, were seen with acute optic
neuritis 1 month and 2 weeks, respectively, after anthrax booster
vaccination and successfully treated with intravenous methylprednisolone.
The first patient had a typical presentation and course of unilateral
retrobulbar optic neuritis with excellent visual recovery. The second
patient had a bilateral anterior optic neuritis and
has required chronic
immunosuppression to maintain his vision. Retinal and optic
nerve autoantibodies were present in the second patient. No cross-reactive
epitopes between anthrax vaccine and retina/optic nerve were identified.
Optic neuritis is a potential adverse reaction of anthrax vaccination.Mil
Med 2002 Jan;167(1):74-5
for Treatment of Patients With Hypersensitivity Reactions After Vaccines
Robert A. Wood, MDa , Melvin Berger, MD, PhDb , Stephen C. Dreskin, MD,
PhDc , Rosanna Setse, MD, MPHd , Renata J.M. Engler, MDe , Cornelia L.
Dekker, MDf , Neal A. Halsey, MDa,d the Hypersensitivity Working Group of
the Clinical Immunization Safety Assessment (CISA) Network
...Although these per-dose estimates suggest that true hypersensitivity
reactions are quite rare, the large number of doses that are
administered, especially for the commonly used vaccines, makes this a
relatively common clinical problem....
[And this is only an immediate
allergic reaction to an ingredient in the vaccine that is being addressed.
Since the food particles vary from shot to shot, food allergies to traces
of food protein from the oils in the adjuvant may or may not occur when a
vaccination is given. - bfg]
Delayed-type reactions occur
hours to days after exposure.27 The longest possible interval
between exposure and the onset of symptoms is not completely clear,
although most immunologists agree that reactions
may occur up to 2 to 3 weeks after exposure. Most delayed
reactions are classified as type 3 hypersensitivity and are attributed to
formation of immune complexes, although other less well-defined
mechanisms, including T cell–mediated processes, may also play a
role. The most common signs of delayed-type reactions are rashes,
which may include urticaria, erythema multiforme, and/or maculopapular
eruptions. Although urticaria and angioedema are generally thought of as
manifestations of immediate-type reactions, they can occur in delayed
reactions as well. In the context of a delayed reaction, this is
likely attributable to non–IgE-mediated processes such as complement
activation by immune complexes,
but late activation of the IgE system cannot be ruled out. Angioedema
may also occur, especially in association with urticaria or erythema
multiforme. Although uncommon, arthralgias, arthritis,[arthritis
is an uncommon reaction? How do you know that? Arthritis is very common.
Few doctors would connect arthritis with a shot given two weeks beforehand
- bfg] joint swelling, serum sickness, and
Henoch-Schönlein purpura may occur, as can a variety of other hematologic,
renal, and gastrointestinal manifestations....
When deciding on administering additional doses of a vaccine that has been
temporally associated with a hypersensitivity reaction, the risks for
immediate and delayed type reactions differ considerably. IgE-mediated
reactions have far more potential to cause life-threatening symptoms, such
as airway obstruction, hypotension, and full-blown anaphylaxis. Although
non–IgE-mediated delayed-type reactions may be very uncomfortable, they
are rarely dangerous....
[But since they have not even considered the food allergies as being
caused by the vaccines, and the other health problems that they are
probably discounting as being due to the vaccine, "rarely dangerous" means
what? The risk of getting sick from a disease that the vaccine supposedly
prevents is less than getting a serious side effect from the vaccine. But
they haven't added in all of the serious side effects! - bfg]
Published online September 1, 2008
PEDIATRICS Vol. 122 No. 3 September 2008, pp. e771-e777
First, what is
the difference between an allergy and a side effect? As with any
medication, vaccines can have side effects such as fever, rash or local
redness or swelling. This is not an allergy. An allergy is when the body
reacts to a specific substance. An allergic reaction can be a rash,
shortness of breath or swelling of the face, and these, almost
immediately, or within an hour after the injection. As an example, the MMR
(Measles, Mumps, Rubella) vaccine can cause a rash that occurs 7-10 days
after the infection. This is not an allergic reaction. This is a side
effect of the MMR vaccine itself.
allergy that the MMR may cause to one of the ingredients in the vaccine,
if it doesn't react immediately, is a side effect and not an allergy
because IgE may or may not be involved? But what about all the other Ig-
responses - IgM... etc? How many ways can we split a hair? - bfg]
She says she’s
allergic to penicillin, but her doctor calls it a “drug hypersensitivity.”
What’s the difference?
Q. My wife can’t take penicillin or any drug in the penicillin family. She
says she’s allergic to penicillin, but her doctor calls it a “drug
hypersensitivity.” What’s the difference? [Splitting hairs....
terminology.... medical BS..... - bfg]
A. An allergic reaction to a drug is one form of drug hypersensitivity.
Both fall under the larger category of adverse drug reactions—unwanted
effects of a particular medication. Most adverse drug reactions don’t
involve the immune system, but both allergy and hypersensitivity do. They
occur when a person’s immune system reacts to the medication or to
substances produced when the body processes the medication.
An allergic reaction most
frequently occurs when the drug is given either intravenously (into a
vein) or by injection. It is less likely when a drug is taken by mouth.
again. An allergic reaction is more likely to occur from an injection than
eating something... - bfg] The
allergic reaction occurs only when a person has had a previous exposure to
[Babies are not BORN ALLERGIC!!
It comes from the vaccination they are given often before they leave the
hospital to go home!!! - bfg]
Symptoms of drug hypersensitivity include hives or a skin rash, wheezing,
and swelling. The most serious reaction is anaphylaxis, which is
potentially life-threatening and thus a medical emergency. Although these
symptoms generally occur within minutes to hours after taking the drug,
they can also appear a week after the medication has been discontinued.
[And is there any reason to
think that this cannot occur from a vaccination? -bfg]
The first DTH reaction described used only the tuberculin antigen
(tuberculin reaction), but the definition was later expanded to include
cell mediated reactions to other bacterial and viral antigens,
responses to pure protein with
adjuvant or haptens, and host responses to allograft.
The classic form of DTH is induced by injecting an antigen preparation
of Mycobacterium tuberculosis intradermally....
Jones-Mote Hypersensitivity: Protein-Adjuvant Reactions
related to the tuberculin reaction, is the
host response to pure protein
mixed with an adjuvant. This form of DTH was discovered in 1929
by Louis Dienes. He demonstrated that when ovalbumin, an egg white protein
that is normally not immunogenic, is injected into a tuberculosis
tubercule, the patient would become sensitized to the protein. Later
with the introduction of Freund's adjuvant, the reaction could be mimicked
by mixing the protein with killed mycobacterium in oil.
When it was discovered that any
pure protein mixed with adjuvant could induce an immune response,
the DTH reaction was termed the Jones-Mote reaction since it was
fundamentally different from the tuberculin reaction in one remarkable
Finally, it is necessary to view DTH not as an individual phenomenon but
rather a group of related responses to antigen. These include the
tuberculin reaction, Jones-Mote reaction, contact hypersensitivity and
graft vs. host disease.... It is clear that cell mediated immunity must be
highly adaptable and therefore variable. The phagocyte (monocyte/macrophage)
is involved in all of these responses, sometimes as a host for the
pathogen, but more often as an effector cell. The exact mechanism by which
the macrophage is activated is still being debated but it is clear that a
T cell is required to initiate the response. When T cell or macrophage
function is compromised the entire complement of cell mediated immunity is
affected. This leads to a
profoundly immunocompromised state in the host. Of course,
in infection this can be lethal, but in allograft rejection it can be life
saving. Finally, DTH must be viewed not as a host response in and of
itself but rather one component of an interrelated coordinated host
response to disease.
No one knows exactly what causes JRA [Juvenile Rheumatoid
Arthritis]. Scientists do know it is an
which means your immune system,
which normally helps your body fight infection, attacks your body's own
tissues. Medicines and physical therapy can help maintain
movement and reduce swelling and pain.
Juvenile rheumatoid arthritis is most probably caused by vaccinations!!! -
National Institute of Arthritis and Musculoskeletal and Skin Diseases
Basically, I would
say that all food allergy reactions fall under the
delayed-hypersensitivity reaction immune responses. And a food allergy
that leads to anaphylaxis is definitely serious. Having a "profoundly
immunocompromised state sounds serious to me. So does arthritis, juvenile
rheumatoid arthritis, and optic
neuritis. I submit that the medical community has basically ignored
delayed-hypersensitivity reactions and when they have occurred have
attributed them to something other than the vaccination.
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