In vivo diagnostic procedures for IgE-mediated allergic disorders

IgE-mediated allergic diseases include atopic diseases, such as eczema or respiratory allergies that are characterized by chronic allergic inflammation, as well as anaphylaxis stemming from clinically important sensitizations to foods, drugs, or venoms, to name the most important categories. It has long been acknowledged that the release of histamine by basophils and mast cells is a hallmark of IgE-mediated diseases. Recent insights into the immunomodulatory role of histamine and its four receptor types and specific aspects of the allergic inflammation have contributed to an increased interest about the mechanisms underlying their interplay. This interest is further fueled by the sharp rise in the prevalence of IgE-mediated diseases in westernized societies during the last decades and the resulting significant increase of the associated socioeconomic burden. In vivo diagnostic procedures, including skin testing and provocation tests, have proved to be valuable, yet simple tools for the investigation of allergic diseases both by clinicians and researchers as well as for influencing management decisions. Skin testing for IgE-mediated diseases is extensively used as a surrogate approach for the detection of allergen-specific IgE antibodies, currently being the diagnostic cornerstone for many allergic responses. Furthermore, provocation tests have evolved into an important approach for the diagnostic confirmation or the elucidation of the clinical relevance of suspected allergens, often being the golden standard for allergy diagnosis.