By Novartis Foundation symposium on Anaphylaxis

ISBN-10: 0470861142

ISBN-13: 9780470861141

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The second choice, perhaps a more complex one, is whether the ultimate outcome of allergen-speci¢c Th2 responses will be expression of IgG4 only, or both IgG4 and IgE. In the ¢rst case, the response will be clinically silent; in the second case, disease may ensue. The molecular mechanisms which activate di¡erential isotype switching to IgE and IgG4 in B lymphocytes remain unde¢ned. Our results showing that potentially pathogenic IgE responses are not the inevitable outcome of Th2mediated immunity should provide the impetus to de¢ne these mechanisms and devise approaches to redirect Th2 e¡ector functions toward intermediate responses and expression of the non-pathogenic IgG4 isotype.

Allergen-speci¢c IgG4 were expressed as mg/L. The limit of sensitivity of the assay was 15 mg/L, and undetectable samples were assigned a value of 10 mg/L. Disease was de¢ned as ‘ever hay fever’ and ‘ever asthma’. 3. Values of allergen-speci¢c IgG4 were lognormally distributed and results are reported as geometric means. Due to the large number of undetectable allergen-speci¢c IgE values, detectable IgE values were grouped into half-log intervals and analysed using w-square analysis and contingency tables.

The IgE antibodies produced at a particular site in the tissue would be more likely to occupy IgE receptors on the neighbouring mast cells than IgE di¡using into the tissue from the circulation. It would be very interesting and feasible to biopsy the three tissues mentioned by Hugh Sampson, the skin, GI tract and lung of the milk- and egg-allergic individuals and assay the levels and speci¢cities of the IgE synthesised ex vivo (Smurthwaite et al 2001). This would reveal whether local HISTORY AND CLASSIFICATION 23 IgE production can account for the observed organ speci¢city of the reactions to these allergens.

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Anaphylaxis by Novartis Foundation symposium on Anaphylaxis


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