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Activation of cell surface receptors by antibodies
3%
8/258
Cross-linking of IgE antibodies
15%
38/258
Cytotoxicity due to antibodies
2%
5/258
Cytotoxicity due to T-cells
69%
178/258
Immune complex deposition
9/258
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This patient with pruritic papules and vesicles most likely has poison ivy-triggered contact dermatitis, which is a type IV hypersensitivty reaction involving T-cell activation. Contact dermatitis is an erythematous and pruritic rash caused by cutaneous exposure to allergens or irritants. For example, poison ivy releases urushiol, which can penetrate the skin and modify endogenous proteins in the body. These modified proteins then become allergenic and activate a T-cell mediated response. This is a delayed reaction so symptoms will not present until 12-48 hours after exposure to the allergen. Notably, since this reaction is mediated by activation of T-cells, contact dermatitis is classified as a type IV hypersensitivity reaction. Incorrect Answers: Answer 1: Activation of cell surface receptors by antibodies is consistent with type II hypersensitivity; however, contact dermatitis is a type IV hypersensitivity reaction. Answer 2: Cross-linking of IgE antibodies is consistent with type I hypersensitivity; however, contact dermatitis is a type IV hypersensitivity reaction. Answer 3: Cytotoxicity due to antibodies is consistent with type II hypersensitivity; however, contact dermatitis is a type IV hypersensitivity reaction. Answer 5: Immune complex deposition is consistent with type III hypersensitivity; however, contact dermatitis is a type IV hypersensitivity reaction. Bullet Summary: Contact dermatitis is a type IV hypersensitivity reaction mediated by T-cell activation.
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