'Entopy': local allergy paradigm

Summary Cite this as: D. G. Powe, A. J. Bonnin and N. S. Jones, Clinical & Experimental Allergy, 2010 (40) 987–997. Allergy is defined as an immediate hypersensitivity type I immunological disease, which can be IgE or non‐IgE driven, and in the latter case may be antibody or cell mediated. Atopy...

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Published in:Clinical and experimental allergy 2010-07, Vol.40 (7), p.987-997
Main Authors: Powe, D. G., Bonnin, A. J., Jones, N. S.
Format: Article
Language:English
Subjects:
Allergies
B-Lymphocytes - immunology
Biological and medical sciences
Disease
Eczema
Fundamental and applied biological sciences. Psychology
Fundamental immunology
Humans
Hypersensitivity, Immediate - immunology
Immunoglobulin E - metabolism
Mucous Membrane - immunology
Th2 Cells - immunology
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Summary:Summary Cite this as: D. G. Powe, A. J. Bonnin and N. S. Jones, Clinical & Experimental Allergy, 2010 (40) 987–997. Allergy is defined as an immediate hypersensitivity type I immunological disease, which can be IgE or non‐IgE driven, and in the latter case may be antibody or cell mediated. Atopy is a term used to describe individuals with a genetic predisposition for developing IgE‐mediated allergic disease. But more recently, it has become evident that IgE‐mediated disease can occur in non‐atopic subjects. While it is now generally accepted that mucosal local IgE has a role in the expression of atopic allergic disease, the concept of ‘local allergy’ in non‐atopic subjects has been proposed, with the term ‘entopy’ given to this condition. Although there is increasing evidence supporting this paradigm, entopy is only applicable to a proportion of non‐atopic patients, suggesting that other disease mechanisms exist to explain non‐atopic disease. This review considers the evidence for local mucosal allergy in atopic and non‐atopic individuals with an emphasis on diseases affecting the upper airways and eye. Furthermore, the diagnosis, treatment and relationship between local allergy and conventional (systemic) allergy are discussed, and alternative disease mechanisms predominantly involving antibodies or their sub‐components (free light chain Igs) are postulated to explain the ‘entopy’ paradigm. This review is intended to provide an improved understanding of the mechanisms and causes of local mucosal hypersensitivity.
ISSN:0954-7894
1365-2222
DOI:10.1111/j.1365-2222.2010.03536.x