Cell-mediated reactions are initiated by T-lymphocytes and mediated by effector T-cells and macrophages. This response involves the interaction of antigens with the surface of lymphocytes. Sensitized lymphocytes can produce cytokines, which are biologically active substances that affect the functions of other cells. This type of reaction takes 48-72 hours, or longer, after contact with the antigen to fully develop. Many chronic infectious diseases, including tuberculosis and fungal infections, exhibit delayed hypersensitivity.
Evidence suggests that hypersensitivity reactions, particularly Type III and IV, may be involved in the pathogenesis of periodontal disease.