Immunoglobulin E plays a central role in the pathogenesis of allergic diseases. Therefore an understending of mechanisms which regulate production of IgE is very important. Recent studies have demonstrated that the induction of IgE synthesis in B cells requires two signals. The first one, IgE isotype-specific, is delivered by interleukins 4 or 13 and results in e germ line transcription. The second B-cell-activating factor is responsible for switch recombination and expression of mature eRNA transcripts. This signal is delivered by lymphocytes T, but these cells can be replaced by Epstein-Barr virus infection, protein gp39 (CD40L), monoclonal antibodies to CD40 and CD58, membrane-TNF-a, as well as corticosteroids. Besides this a variety of factors can modulate the IgE synthesis. Interleukin-2, -5, -6, -9, -10, MIPI-a, RANTES and sCD23 enhance the prodution of IgE whereas PAF, PGE2, IL-8, -12 and 18, IFN-a and g, TGF-b, sIL-4R, IL-1Ra, and probably sIL-1R inhibit it. In this article, we review current knowledge about the mechanisms underlying the synthesis of IgE in humans, including molecular events and clinical attempts at redution of the total IgE level in patients with allergic diseases.
Human immediate hypersensitivity diseases are strongly associated with an excessive type 2 response to normally innocuous environmental antigens, and are a growing health care concern in developed nations. Commonly prescribed treatments provide effective symptomatic relief, but are unable to consistently ameliorate the underlying cause of allergic disease: the excessive generation of allergen specific Th2 cells. IL-12 and IL-18 are potent inducers of type 1 immunity, and, as such, have been proposed as candidates for treatment of allergic diseases. This review critically assesses the potential of recombinant IL-12 and IL-18 immunotherapy to redirect both de novo and established allergic responses in animal models of human allergic disease to clinically protective immune responses.
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