Reviews and Feature Articles: Current PerspectivesAllergic and nonallergic forms of atopic diseases☆,☆☆
Section snippets
The role of IgE
Since Prausnitz and Kustner described the existence of a human serum factor that reacts with allergens in 1921, much effort has been made to characterize the effector molecule of immunologic hypersensitivity responses in depth.6 Today, we know that the antibody called IgE, which was discovered in 1967 by Ishizaka et al7 is composed of 2 identical heavy and 2 identical light chains. These chains form the variable antigen binding and the constant Fc domain, through which the IgE molecule binds to
Allergic or nonallergic disease?
The term “allergy” was introduced in 1906 by Clemens P. Pirquet, who used it to describe the reactions of protective immunity and hypersensitivity.8 Later there was a tendency to use the word “allergy” to describe all kinds of unpredictable reactions in the skin and the mucosa.9 Today, the term “allergy” is frequently used synonymously with IgE-mediated allergic diseases and will be used in this sense here. However, it has also been observed that serum IgE levels might lie within the normal
Clinical parameters
With regard to the diagnosis of atopic dermatitis (AD), numerous scoring strategies and diagnostic criteria have been developed. The criteria of Diepgen et al,12 Hanifin,13 the United Kingdom Working Party's Diagnostic Criteria for Atopic Dermatitis,14 and the Millennium Criteria for the Diagnosis of Atopic Dermatitis15 are most often used. In the definition of Hanifin, an elevated serum IgE level is not essential for diagnosis, and it can be defined by a syndrome of skin lesions, which are not
Clinical parameters
In general, asthma can be subdivided into 3 forms: the extrinsic/allergic asthma, which is clearly caused by an allergen, the intrinsic/nonallergic asthma, which is not linked to such an allergen, and the mixed form. It is well accepted that in all 3 variants local phenomena occurring in the mucosal tissue, such as bronchoconstriction of the smooth muscles as a consequence of local or systemic inflammation of the airways, are the central pathophysiologic mechanisms of asthma.
The sensitivity of
Clinical parameters
Seasonal or perennial allergic rhinitis, which has an overall prevalence of 9% to 42%,78 arises in atopic individuals with an increased tendency to generate IgE antibodies against common environmental allergens, such as ragweed, pollen, or house dust mite. This form is characterized by mucosal infiltration and activity of plasma cells, mast cells, and eosinophils.78, 79 Typically, positive skin prick test reactions toward aeroallergens can be observed in these patients (Table III).
Conclusion
The genetic, humoral, and cellular differences between patients with allergic and nonallergic forms of atopic diseases mirror a complex network of distinct properties, which together determine the outcome of the allergic or nonallergic variants of atopic diseases. As a common feature, local IgE production in the affected tissue and the relevance of allergic and nonallergic (infectious) inflammatory processes seem to play a major role in all subtypes of atopic diseases.
Perhaps the most
Acknowledgements
We thank Dr Thomas A. E. Platts-Mills for the critical revision and helpful discussion of the manuscript, Elisabeth Geiger for critically reviewing this manuscript, and Natalie McGauran for editorial support.
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This work has been supported by a grant from the Deutsche Forschungsgemeinschaft DFG FOR 423 and NO454 1-1.
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Reprint requests: Natalija Novak, MD, Department of Dermatology, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.