IgE in the diagnosis and treatment of allergic disease

Thomas A.E. Platts-Mills, MD, PhD

,

 Alexander J. Schuyler, BS, BA

,

 Elizabeth A. Erwin, MD

,

 Scott P. Commins, MD, PhD

,

 Judith A. Woodfolk, MBChB, PhD

DOI: http://dx.doi.org/10.1016/j.jaci.2016.04.010Article Info

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Article Outline

1. Chronic asthma in patients with sensitization to 1 or more perennial allergens
2. Diagnostic relevance of IgE antibodies to asthma
3. Understanding the role of allergens in asthmatic patients and the relevance of IgE antibodies
4. Sensitization to fungi colonizing the skin, nails, or lungs as a risk factor for allergic disease
5. Role of IgE assays in the diagnosis of different forms of food allergy: peanut anaphylaxis, eosinophilic esophagitis (EoE), and delayed anaphylaxis to red meat (the alpha-gal syndrome)
6. Relevance of the route of sensitization to the specificity and titer of IgE antibody responses
7. Conclusions
8. References

Traditionally, the concept of allergy implied an abnormal response to an otherwise benign agent (eg, pollen or food), with an easily identifiable relationship between exposure and disease. However, there are syndromes in which the relationship between exposure to the relevant allergen and the “allergic” disease is not clear.

In these cases the presence of specific IgE antibodies can play an important role in identifying the relevant allergen and provide a guide to therapy. Good examples include chronic asthma and exposure to perennial indoor allergens and asthma related to fungal infection. Finally, we are increasingly aware of forms of food allergy in which the relationship between exposure and the disease is delayed by 3 to 6 hours or longer. Three forms of food allergy with distinct clinical features are now well recognized. These are (1) anaphylactic sensitivity to peanut, (2) eosinophilic esophagitis related to cow's milk, and (3) delayed anaphylaxis to red meat. In these syndromes the immunology of the response is dramatically different. Peanut and galactose α-1,3-galactose (alpha-gal) are characterized by high- or very high-titer IgE antibodies for Ara h 2 and alpha-gal, respectively. By contrast, eosinophilic esophagitis is characterized by low levels of IgE specific for milk proteins with high- or very high-titer IgG4 to the same proteins. The recent finding is that patients with alpha-gal syndrome do not have detectable IgG4 to the oligosaccharide. Thus the serum results not only identify relevant antigens but also provide a guide to the nature of the immune response.

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