Arthus reaction
Classification and external resources
ICD-10	T78.4
ICD-9	995.21
DiseasesDB	33220
MeSH	D001183

In immunology, the Arthus reaction is a type of local type III hypersensitivity reaction. Type III hypersensitivity reactions are immune complex-mediated, and involve the deposition of antigen/antibody complexes mainly in the vascular walls, serosa (pleura, pericardium, synovium), and glomeruli.

Contents 1 History 2 Process 3 References 4 See also

[edit] History

The Arthus reaction was discovered by Nicolas Maurice Arthus in 1903.^[1] Arthus repeatedly injected horse serum subcutaneously into rabbits. After four injections, he found that there was edema and that the serum was absorbed slowly. Further injections eventually led to gangrene.

[edit] Process

The Arthus reaction involves the in situ formation of antigen/antibody complexes after the intradermal injection of an antigen. If the animal/patient was previously sensitized (has circulating antibody), an Arthus reaction occurs. This manifests as local vasculitis due to deposition of immune complexes in dermal blood vessels. Activation of complement and recruitment of PMNs ensue, resulting in an inflammatory response.

Arthus reactions have been infrequently reported after vaccination against diphtheria and tetanus. To quote from the CDC:^[2]

Arthus reactions (type III hypersensitivity reactions) are rarely reported after vaccination and can occur after tetanus toxoid–containing or diphtheria toxoid–containing vaccines. An Arthus reaction is a local vasculitis associated with deposition of immune complexes and activation of complement. Immune complexes form in the setting of high local concentration of vaccine antigens and high circulating antibody concentration. Arthus reactions are characterized by severe pain, swelling, induration, edema, hemorrhage, and occasionally by necrosis. These symptoms and signs usually occur 4–12 hours after vaccination.....ACIP has recommended that persons who experienced an Arthus reaction after a dose of tetanus toxoid–containing vaccine should not receive Td more frequently than every 10 years, even for tetanus prophylaxis as part of wound management.

[edit] References

1. ^ Injections répétées de serum du cheval chez le lapin, Comptes rendus des séances de la Société de biologie et de ses filiales, Paris, 55 (1903), 817–820.
2. ^ Preventing Tetanus, Diphtheria, and Pertussis Among Adolescents: Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccines, K. R. Broder et al., MMWR Recommendations and Reports, March 24, 2006 / 55(RR03), 1–34, page 18.

[edit] See also

• Serum sickness

v • d • e Consequences of external causes (T66-T88, 990-999) Temperature/radiation elevated: Hyperthermia · Heat syncope · Radiation poisoning reduced: Hypothermia · Immersion foot · Chilblain Air Hypoxia/Asphyxia · Barotrauma (Aerosinusitis, Decompression sickness) · Altitude sickness/Chronic mountain sickness Food Starvation Maltreatment Physical abuse · Sexual abuse · Psychological abuse Emesis Motion sickness · Seasickness · Airsickness · Space adaptation syndrome Other Electric shock · Anaphylaxis · Angioedema Hypersensitivity (Allergy, Arthus reaction) Subcutaneous emphysema Certain early complications of trauma embolism (Air, Fat) Crush syndrome/Rhabdomyolysis Contracture/Volkmann's contracture/Compartment syndrome Complications of surgical and medical care transfusion reactions: Transfusion hemosiderosis · TRALI · TACO · TA-GvHD · FNHTR · Acute/Delayed hemolytic transfusion reaction other: Serum sickness · Malignant hyperthermia · Herxheimer reaction · Graft-versus-host disease · Tumor lysis syndrome

v • d • e Immune disorders: hypersensitivity and autoimmune diseases Type I/allergy/atopy (IgE) Foreign Atopic dermatitis · Allergic urticaria · Hay fever · Allergic asthma · Anaphylaxis · Food allergy (Milk, Egg, Peanut, Tree nut, Seafood, Soy, Wheat), Penicillin allergy Autoimmune none Type II/ADCC (IgM, IgG) Foreign Pernicious anemia · Hemolytic disease of the newborn Autoimmune Cytotoxic Autoimmune hemolytic anemia · Idiopathic thrombocytopenic purpura  · Bullous pemphigoid  · Pemphigus vulgaris · Rheumatic fever · Goodpasture's syndrome "Type 5"/receptor Graves' disease · Myasthenia gravis Type III (Immune complex) Foreign Henoch-Schönlein purpura · Hypersensitivity vasculitis · Reactive arthritis · Rheumatoid arthritis · Farmer's lung · Post-streptococcal glomerulonephritis · Serum sickness · Arthus reaction Autoimmune Systemic lupus erythematosus · Subacute bacterial endocarditis Type IV/cell-mediated (T-cells) Foreign Contact dermatitis · Mantoux test Autoimmune Diabetes mellitus type 1 · Hashimoto's thyroiditis · Guillain–Barré syndrome  · Multiple sclerosis  · Coeliac disease · Giant cell arteritis GVHD Transfusion-associated graft versus host disease Unknown/ multiple Foreign Hypersensitivity pneumonitis (Allergic bronchopulmonary aspergillosis) · Transplant rejection · Latex allergy (I+IV) Autoimmune Sjögren's syndrome · Autoimmune hepatitis · Autoimmune polyendocrine syndrome (APS1, APS2) · Autoimmune adrenalitis lymphocyte navs: cells/physio, immunodeficiency/immunoproliferative immunoglobulin/neoplasia, proc

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