The first distinction that recurs in the allergy literature is between
immediate and delayed patterns of allergic reactivity which loosely correspond
to IgE-mediated allergy and non-IgE mediated responses. Many authors refer to
the original four categories of immune-mediated injury defined by Gell and
Coombs. The concept of four mechanisms is just a starting point for
understanding immune-mediated disease. These very complicated defense-injury
sequences cause a variety of disease states.
The immediate or type 1 allergy pattern is easily recognized because it
involves quick and dramatic symptoms. Hay fever is the most common type 1
allergy that can be diagnosed by allergy skin tests and by IgE antibody tests.
Hay fever is a reaction to airborne plant pollens in the nose. Allergy tests are
positive, antihistamines help and allergy shots can sometimes reduce the
reactivity over time.
Bias toward Simple Ideas American and Canadian allergists tend to focus on
type 1 hypersensitivity mediated by IgE-armed basophils and mast cells. Some of
these physicians view allergy practice as exclusively concerned with type 1
reactions and ignore or diminish any effort to describe, investigate and
understand other forms of immune reactivity. Thus two camps have arisen:
1. An exclusively IgE group and 2. An IgE plus other mechanisms group.
The type 1 model is easier to study and easier to deal with in practice, so
the exclusively IgE-group tends to dominate the literature and demands
compliance with the IgE-model. The IgE model is simple and linear: the same
responses are expected from a sensitized individual with repeated
challenges; skin tests, serum IgE measurement, and double-blind oral challenges
are correlated Even when applied to patients with clearly defined
IgE-mediated allergy, the model is unrealistic since no human body is a linear
machine. While single, discrete allergic responses do occur, they are not the
only reactions and are not fully characteristic of immune networks. Patients
tend to have evolving and multiple reaction patterns over time, and show marked
variability in their reactivity with repeated antigen challenges.
Delayed patterns of allergy
Many diseases are created by delayed hypersensitivity. These are not so obvious and generally
go unrecognized. Allergy skin tests do not show this problem. Symptom
onset is delayed hours to days after exposure to a variety of antigens,
especially trigger foods. Allergic
reactions to drugs such as penicillin and to foods are usually delayed
Many chronic diseases are either degenerative and/or inflammatory and many
are recognized to be immune-mediated or hypersensitivity diseases. The delayed
patterns of allergy can be the cause of chronic and disabling hypersensitivity
disease. The stakes are high both for individual patients and for the society as
a whole. None of the common hypersensitivity diseases have been solved and most
appear to rage on, afflicting increasing numbers of patients with disabling
diseases. Asthma, allergy, rheumatic diseases, autoimmune diseases, multiple
sclerosis, diabetes, thyroiditis, psoriasis are examples of hypersensitivity
diseases which involve humoral and cell-mediated immunity. We use celiac disease
- wheat allergy- as a prototype which demonstrates the prolific ability of food
allergy to produce a wide range of diseases.
Prominent allergist-immunologists such as Brennerman, Gerrard, Knicker, Hill,
Brostoff and numerous others for many years made conspicuous efforts to
elucidate the delayed forms of food allergy which involve the most profound
immune mechanisms. Unfortunately, all the good science that has been done is now
mostly ignored. Allergists for the most part act as if delayed patterns of
allergy do not exist and physicians in other specialties have no idea about
food-related immune mediated disease. The only hope for patients is to resolve
these problems is to take charge of their own management.
Different Patterns of Hypersensitivity Disease
The Allergy Center is devoted to explaining a complicated subject. We
offer resources online and encourage our readers to further pursue their
interest by reading other books such as Air and Breathing, Managing Food Allergy
and Immunology Notes written by Stephen Gislason MD.
The book, Gluten Problems and Solutions, describes the patterns of food
allergy triggered by the proteins in cereal grains. The book, Air and
Breathing, discusses airborne and food allergy as causes of respiratory
disease. Immunology Notes explains in more detail how the immune system
works and how immune mediated diseases develop.
For a detailed discussion of all the problems related to food allergy
go to Food Allergy
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