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A 21-year-old student develops recurrent episodes of sneezing, watery rhinorrhoea and itchy eyes every spring. Which immunological mechanism best explains these symptoms?

A Delayed T-cell mediated hypersensitivity causing local tissue damage
B Neutrophil-driven inflammation secondary to bacterial infection
C Immune complex deposition activating complement
D IgE-mediated mast cell degranulation causing histamine release ✓
E Direct viral cytopathic effect on nasal epithelium

The answer is D: IgE-mediated mast cell degranulation causing histamine release

Explanation

Why D is correct

See Conditions Affecting the Nose and Sinuses. Option D is correct. Seasonal allergic rhinitis, known as hay fever, is an IgE-mediated inflammatory disorder of the nose that causes sneezing, nasal itching, a runny nose (rhinorrhoea) and congestion, and it is usually due to grass or tree pollen. It is a type I hypersensitivity reaction (an immediate allergic reaction). On first contact the immune system makes IgE antibodies (the allergy antibody) against the pollen, and these coat mast cells (immune cells in the lining of the nose and eyes that store histamine). On the next exposure the pollen links neighbouring IgE molecules, the mast cells degranulate (burst open and release their granules) and the histamine inside makes the nose itch, run and swell and sets off sneezing. Because the allergy antibody is already in place, symptoms begin within minutes. A plain memory aid: type I is immediate, pollen to sneeze in a flash.

Condition: Seasonal allergic rhinitis (hay fever) is a type I hypersensitivity reaction, usually to grass or tree pollen.
Antibody: IgE made on first contact coats mast cells in the lining of the nose and eyes.
Trigger: On the next exposure pollen links neighbouring IgE molecules, so mast cells degranulate and release histamine.
Timing: Symptoms begin within minutes.

Why the other options are incorrect

A. Delayed T-cell mediated hypersensitivity causing local tissue damage: Delayed T-cell mediated hypersensitivity is type IV, as in contact dermatitis, and takes one to three days to develop. Hay fever symptoms begin within minutes of exposure, so a delayed mechanism does not fit.
B. Neutrophil-driven inflammation secondary to bacterial infection: Neutrophil-driven inflammation from bacterial infection would typically cause thick, purulent (pus-containing) discharge, facial pain and fever. This student has watery discharge and itchy eyes only in spring.
C. Immune complex deposition activating complement: Immune complex deposition (antigen bound to antibody) with complement activation is type III hypersensitivity, as in serum sickness. It develops over hours to days and does not give seasonal sneezing with itchy eyes within minutes of pollen exposure.
E. Direct viral cytopathic effect on nasal epithelium: A direct viral effect on the nasal lining causes the common cold, with fever, malaise and symptoms that do not recur every spring. The recurrent, seasonal pattern and itchy eyes point to allergy.

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More questions from this set. Start the quiz to answer them and see each explanation.

1
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2
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