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There are some allergic reactions that are not caused by Immunoglobulin E. Until now, academic medicine didn't give them much consideration, but the bulk of scientific studies that substantiates them is such that ignoring them would amount to willful blindness.

Italian version of this article available

Every day we visit people who have complex symptoms that involve all of the body's systems. The majority of doctors are unprepared to face phenomena of this kind.   When confronted with a patient who complains of particular symptoms like pain in the joints, stomach pains, reflux, colitis, cough, asthma, skin allergies after eating a food, the usual answer is that "there is no connection between the symptoms.

In the best scenario, however, a better-informed doctor will ask the patient to take a food allergy test without knowing that, since 2004 to today, scientific knowledge of food allergy phenomena and their causes has undergone an enormous evolution. What's more, today food allergies are divided into immediate allergies (tied to Immunoglobulin E) and delayed food allergies (tied to a cellular reaction that is favored by some other types of antibodies).

An examination that only considers the former leads to responses without practical meaning. But the same phenomenon that is well known for food reactivity is also being observed today for contact with other types of allergens. Even in the case of typical dust mite allergy  symptoms (for the most part respiratory) in which the IgE components are absent, we need to consider a form of delayed allergy, of a cellular form whose symptoms are similar to that of a classic dust allergy, even though it isn't obvious.

The same principal that is accepted for food intolerances (known today as delayed food allergies) will probably have a scientific explanation in future years, but evidence of the existence of this phenomenon is strong and unquestionable.

Recent scientific studies that are well-founded and unassailable have established that:

• We are all allergic and intolerant to everything and only an active regulation of Immune System can lead to the cure (this is why almost all of us hear that we have an intolerance or an allergy: we have it since birth. The symptoms only show up when the regulation of it is out of control).
• Many allergies and food intolerances are tied to delayed phenomena, modulated by cellular reactions and not simply by IgE type antibodies (as was formerly believed).
• There are alternative routes to the classic allergic expression that give rise to the same phenomena but will never be identifiable with the classic tests.

The diagnoses that have been performed up to now are incomplete, to say the least. On this subject, a scientific work created turmoil in the academic world just a few months ago: the American scientist, Fred Finkelman discovered that there are at least two different ways in which the allergy can be activated (Finkelman FD. J Allergy Clin Immunol 2007;120:506-15;. This study was performed on mice, animals whose immunological characteristics are very similar to those of human beings.

This study confirmed something that we have been asserting for some time, that is, that all of the classic allergological analyses that have been performed up to now have been partial at best. The description of this two-way allergy, the classic one (with IgE present) and the alternative one (without IgE), is so close to the classic model of delayed food hypersensitivities (intolerances) that it supports our belief that this second type of allergy is (as Sampson already disclosed) a model that always exists within the body, more or less side by side with the IgE type reaction.

Let's examine these two expressions in detail:

1. classic route modulated by IgE, by histamine, stimulated by small quantities of antigen, also in the presence of low quantities of antibodies.
2. alternative route triggered by white blood cells (especially macrophages), with the participation of the PAF (Platelet Activating Factor), modulated by the IgE (Immunoglobulin G), stimulated by large quantities of antigens, repeated over extended periods, in the presence of significant quantities of antibodies.

Therefore we are being faced with an extraordinary discovery that should make us fully reconsider the way in which allergies develop or are regulated. We need to remember that, aside from the IgE, there are antibodies that are formed at the moment in which tolerance with regard to the classic allergy begins to develop and as such should never be considered entirely harmful

Dottor Attilio Speciani
Clinical Allergist and Immunologist

Italian version of this article available