The relationship between IgE and allergic disease
- Jeff Stokes, MD, FAAAAI, FACAAI
Jeff Stokes, MD, FAAAAI, FACAAI
- Professor of Pediatrics
- Washington University in St. Louis School of Medicine
- Thomas B Casale, MD
Thomas B Casale, MD
- Executive Vice President, American Academy of Allergy Asthma and Immunology
- Professor of Medicine
- University of South Florida
Allergen-specific immunoglobulin E (IgE) is integral to the pathogenesis of allergic disorders. However, the utility of measuring total serum IgE or allergen-specific IgE for purposes of diagnosis and management is variable. It is important to recognize that levels of total IgE rarely provide information about IgE to specific allergens, and the presence of IgE to a specific allergen does not necessarily equate to a clinically meaningful allergic response to that substance. It is also necessary to demonstrate that the individual develops appropriate signs and symptoms upon exposure to the allergen in question.
This topic will review basic concepts concerning the generation of the allergic response and provide an overview of the roles of total and allergen-specific IgE in various allergic diseases. The biology of IgE and the diagnosis of specific allergic diseases are discussed separately. (See "The biology of IgE" and "Diagnosis of asthma in adolescents and adults" and "Allergic rhinitis: Clinical manifestations, epidemiology, and diagnosis" and "Atopic dermatitis (eczema): Pathogenesis, clinical manifestations, and diagnosis".)
The terms "atopy," "sensitization," and "allergy" are often used loosely in the medical literature, although each has a distinct definition.
Atopy — Atopy is the genetic predilection to produce specific IgE following exposure to allergens. At a cellular level, atopy appears to result, in part, from a predisposition toward a certain response on the part of CD4+ T helper cells called a T helper type 2 (Th2) response . The CD4 molecule is a coreceptor in the T cell receptor complex and also binds proteins of the major histocompatibility complex (MHC). Th2 cells secrete large quantities of interleukin-4 (IL-4) and interleukin-13 (IL-13), which promote the production of allergen-specific IgE by plasma cells. (See "T helper subsets: Differentiation and role in disease" and "The biology of IgE", section on 'Regulation of synthesis'.)
Sensitization — Sensitization refers to the production of allergen-specific IgE. Sensitization to an allergen is not synonymous with being allergic to that allergen, because individuals may produce IgE to allergens in a given substance, but not develop symptoms upon exposure to that substance. It is unclear why some individuals demonstrate only sensitization while others have active allergic disease.
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- The atopic march
- RELATIONSHIPS BETWEEN TOTAL IgE LEVELS AND ALLERGIC DISEASE
- Elevated total serum IgE
- Low or normal levels of total serum IgE
- Utility in predicting the development of allergic disease
- - Cord blood
- - Childhood IgE levels
- - Timeline of sensitization
- THE ROLE OF IgE IN SPECIFIC DISORDERS
- - Lung function correlates with IgE
- Allergic bronchopulmonary aspergillosis
- Allergic rhinitis
- Atopic dermatitis
- - Food allergy
- Venom allergy
- Drug allergy
- Chronic urticaria
- RATIO OF ALLERGEN-SPECIFIC IgE TO TOTAL IgE