1] Allergy and Clinical Immunology Research Centre, Liaoning Medical University, Jinzhou 121001, China [2] Clinical Research Centre, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
Acta Pharmacol Sin. 2013 Oct;34(10):1270-83. doi: 10.1038/aps.2013.88. Epub 2013 Aug 26.
The current definition of allergy is a group of IgE-mediated diseases. However, a large portion of patients with clinical manifestations of allergies do not exhibit elevated serum levels of IgE (sIgEs). In this article, three key factors, ie soluble allergens, sIgEs and mast cells or basophils, representing the causative factors, messengers and primary effector cells in allergic inflammation, respectively, were discussed. Based on current knowledge on allergic diseases, we propose that allergic diseases are a group of diseases mediated through activated mast cells and/or basophils in sensitive individuals, and allergic diseases include four subgroups: (1) IgE dependent; (2) other immunoglobulin dependent; (3) non-immunoglobulin mediated; (4) mixture of the first three subgroups. According to our proposed definition, pseudo-allergic-reactions, in which mast cell or basophil activation is not mediated via IgE, or to a lesser extent via IgG or IgM, should be non-IgE-mediated allergic diseases. Specific allergen challenge tests (SACTs) are gold standard tests for diagnosing allergies in vivo, but risky. The identification of surface membrane activation markers of mast cells and basophils (CD203c, CCR3, CD63, etc) has led to development of the basophil activation test (BAT), an in vitro specific allergen challenge test (SACT). Based on currently available laboratory allergy tests, we here propose a laboratory examination procedure for allergy.
目前的过敏定义是一组 IgE 介导的疾病。然而，很大一部分具有过敏临床表现的患者并未表现出血清 IgE（sIgE）水平升高。在本文中，分别讨论了三个关键因素，即可溶性过敏原、sIgE 和肥大细胞或嗜碱性粒细胞，它们分别代表过敏炎症中的致病因素、信使和主要效应细胞。基于目前对过敏疾病的认识，我们提出过敏疾病是一组由敏感个体中激活的肥大细胞和/或嗜碱性粒细胞介导的疾病，包括四个亚组：（1）IgE 依赖性；（2）其他免疫球蛋白依赖性；（3）非免疫球蛋白介导；（4）前三个亚组的混合。根据我们提出的定义，假性过敏反应，其中肥大细胞或嗜碱性粒细胞的激活不是通过 IgE 介导，或者在较小程度上通过 IgG 或 IgM 介导，应是非 IgE 介导的过敏疾病。特定过敏原挑战测试（SACT）是体内诊断过敏的金标准测试，但具有风险。肥大细胞和嗜碱性粒细胞表面膜激活标志物（CD203c、CCR3、CD63 等）的鉴定导致了嗜碱性粒细胞激活测试（BAT）的发展，这是一种体外特定过敏原挑战测试（SACT）。基于目前可用的实验室过敏测试，我们在此提出了一种过敏的实验室检查程序。
