Arthus reactions

Di-tert-butyl-4-hydroxyphenyl)-7//-triazolo [3,2-b][l, 2,4]triazin-7-one (HWA-131)is anon-immunosuppressive drug that effectively inhibited carrageenan-induced paw edema, attenuated the active Arthus reaction, and demonstrated antierythema as well as antipyretic activity. Part of the antiinflammatory effect of this new compound is most probably related to its antioxidative activity as well as inhibition of lipoxygenase... 

Hazenbos WL, Gessner JE, Hofhuis FM, Kuipers H, Meyer D, Heijnen lA, Schmidt RE, Sandor M, Capel PJ, Daeron M, van de Winkel JG, Verbeek JS Impaired IgG-dependent anaphylaxis and Arthus reaction in FcyRIII (CD16)-deficient mice. Immunity 1996 5 181-188. 

The Arthus reaction. The phenomenon is a local one and occurs if a soluble antigen is introduced into the body when there is a great excess of antibody. The union between the two results in an acute inflammatory reachon which may involve complement, polymorphs, lymphokines or platelet aggregation, all of which enhance the inflammatoiy response. 

Pain at the injection site is one of the most commonly reported adverse effects of vaccination. The reaction is usually mild with complaints of pain and tenderness at the injection site that may or may not be accompanied by erythema. Local reactions tend to be more frequent with repeated doses or booster doses of vaccine. The frequency and degree of the reactions appear to be related to the amount of preformed antibodies and rapid immunologic responses reflective of priming from previous doses. More serious Arthus reactions are infrequently reported. Arthus reactions are classified as type III hypersensitivity reactions, and are characterized by a massive local response involving the entire thigh or deltoid. Arthus reactions are also related to preformed antibody complexes that induce an inflammatory lesion.14... 

Arthus reaction Local inflammatory response due to deposition of immune complexes in tissues. 

Docebenone has shown anti-inflammatory effects in several animal models following local dosing phorbol ester-induced oedema and neutrophil influx in mouse skin [208,209], arachidonate-induced plasma extravasation in rabbit skin [210], the pleural reversed passive Arthus reaction in rats [211], and GPB [212], An oral dose of 80 mg/kg reduced infarct size, LTB4 levels and neutrophil infiltration in a rat myocardial infarction model [213,214], and in a rat brain ischaemia-reperfusion model oedema and LTC4 levels were reduced at 200 mg/kg [107]. Significant, but not dramatic, improvement in nasal symptoms was seen in humans following 150 mg of docebenone twice daily for 8 weeks [215], but there was no effect on bronchial hyperresponsiveness to acetylcholine in asthmatics [216]. 

Type 3, immune complex vasculitis (serum sickness, Arthus reaction). Drug-antibody complexes precipitate on vascular walls, complement is activated, and an inflammatory reaction is triggered. Attracted neutrophils, in a futile attempt to phagocytose the complexes, liberate lysosomal enzymes that damage the vascular walls (inflammation, vasculitis). Symptoms may include fever, exanthema swelling of lymph nodes, arthritis, nephritis, and neuropathy. 

Arthus (reaction) Type III immediate hypersensitivity reaction. 

Type III Reactions These reactions involve the presence of antigen-antibody complexes, particularly those formed as a result of the production of autoantibodies. These complexes deposit in various tissues and involve inflammatory cells as well as complement, resulting in tissue damage due to the production of proteolytic enzymes by polymorphonuclear leukocytes and macrophages. A number of autoimmune diseases result from these reactions. Some clinical examples include systemic lupus erythematosus, rheumatoid arthritis, immune complex glomerulonephritis, Arthus reaction and serum sickness. 

A 45-year-old woman who had used insulin for 4 years had a biphasic hypersensitivity reaction to human insulin (or another component of the injection fluid) (135). Within 20 minutes after the injection a swelling developed and in a later phase papular lesions with lichenoid features and post-inflammatory hyperpigmentation emerged. Histologically, there was neutrophilic infiltration with erythrocyte extravasation and eosinophilic amorphous material, surrounded by neutrophilic infiltrate. Saline injection did not elicit an effect. IgE anti-insulin antibodies were not found. There was no Arthus reaction (type IV allergy). 

Systemic lupus erythematosus (SLE or lupus), serum sickness, arthus reaction. Mediated by IgG and complement. 

Arthus reactions and systemic reactions have commonly been reported after booster doses of polysaccharide vaccine and are thought to result from antigen-antibody reactions involving antibodies induced by the previous immunization (16). Data on revaccination of children are not yet sufficient to provide a basis for recommendation. 

Ohnishi, M, Koike, H, Kawamura, N, Tojo, S J, Hayashi, M, Morooka, S, Role of P-selectin in the early stage of the arthus reaction, Immunopharmacology, 34, 161-170, 1996. 

P-ARK An enzyme that phosphoylates the occupied form of a G-protein coupled receptor, e.g. the 6-adrenoceptor, leading to uncoupling of that receptor and desensitization. ARMI age-related memory impairment, arrhythmia (dysrhythmia) An abnormality of heart rhythm or rate of heartbeat, usually caused by disturbance of the electrical impulses and their conduction within the heart. They include ectopic beats (isolated irregular beats), tachycardias (too fast a heartbeat), bradycardias (too slow a heartbeat) and atrial flutter and ventricular fibrillation. Arthus reaction A severe local inflammatory response, a skin reaction characterized by erythema, oedema, necrosis, local haemorrhage. A type III hypersensitivity reaction. Arunlakshana and Schild plot See Schild plot, ascites fluid The fluid that accumulates in the peritoneal cavity during certain pathological conditions, aspiration The withdrawal of fluid or tissue from the body by suction. 

In a model of acute inflammatory disease, the reverse passive Arthus reaction, protease Inhibitors such as trasylol and SBTI have been shown to diminish the inflammatory response, particularly accumulation of leukocytes and vascular permeability.95 This provides support for the rational to search for specific neutral proteinase inhibitors as new modalities of therapy in R.A. See also chapter 23. 

The formation of antigen-antibody complexes can lead to clinical syndromes such as the Arthus reaction. In this model, a high level of preformed specific IgG antibody combines with antigen to produce a localized edematous, erythematous reaction within 5 to 8 hours. The reaction involves local formation of insoluble antigen-antibody complexes, complement activation with release of C3a and C5a collectively referred to as anaphylatoxins, mast cell degranulation, and influx of polymorphonuclear cells. 

C5a Mobilizes reverse passive Arthus reactions in lung. Partially suppresses neutrophil infiltration, edema formation, TNF, and IL-6 production in reverse passive Arthus reactions of peritoneal cavity and skin... 

Type III (Arthus) reactions are those involving both free antigen and free antibody (mainly IgG) which... 

Immediate hypersensitivity Hay fever, urticaria, atopic asthma Antibody-dependent cytotoxic hypersensitivity Immune complex mediated hypersensitivity (Arthus reaction)... 

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