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The Late Phase Of The Immunoglobulin E-mediated Reaction: A Link Between Anaphylaxis And Common Allergic Disease?

G. Gleich
Published 1982 · Medicine

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Early workers observed that exposure of allergic patients to allergens provoked not only an immediate response but also a more prolonged (late) reaction. In 1873, Blackley,’ who was allergic to grass pollen, experienced sneezing and coryza lasting 6 to 8 hr after pollen inhalation. On another occasion he accidentally inhaled a large quantity of pollen and developed nasal, chest, and systemic symptoms that lasted for many hours and prevented him from working for 2 days. Prausnitz and Kustner* noted that the cutaneous inflammation associated with passive transfer of sensitivity lasted at least a day. In 1922, Cooke3 described his prolonged skin reaction to horse dander allergen; the lesion began with the typical wheal and flare but developed edema and erythema that was still evident the next day. In 1924, Vaughan4 called attention to the inflammation presenting at the site of skin tests. In 1952, Herxheimerj pointed out that the “late bronchial reaction” was “of great practical importance” and was associated with more severe asthma than the asthma in patients without late reactions. Nonetheless, it was not until Pepys et a1.6 called attention to dual skin reactions in patients with allergic bronchopulmonary aspergillosis that interest in late reactions was rekindled. The dual skin reactions in these patients showed deposition of IgG, IgM, and C3 as well as marked tissue infiltration by neutrophils, pointing to an Arthus reaction (type III) as the mechanism for the continuing inflammation. In keeping with that interpretation was the presence of precipitating antibody of both IgG and IgM isotypes. These observations suggested that the complement system is
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