Local IgE and the Future of Allergy Care

Abstract

Previously, it was believed that immunoglobulin E (IgE) class switching, in response to exposure to airborne and food allergens, took place only in the spleen and large lymphoid structures of the body, before being transported to various mucosal and epithelial surfaces. However, recent studies have demonstrated that this process can take place directly in locally symptomatic regions of both the upper and lower aerodigestive tracts, without evidence of sensitization in the serum. This raises questions concerning the most appropriate location to test for IgEmediated allergic disease, and whether the ability to produce antigen-specific IgE is more widespread in the population than that previously estimated. Several methods are currently available to test for local IgE, but the clinical implications of locally present IgE are not completely understood, particularly when considering testing and treatment options for symptomatic individuals.