Atopic diseases are complex, with many immunological participants, but the central element in their expression is IgE antibody. In an atopic individual, the immune system pathologically reacts to environmental substances by producing IgE, and these allergen-specific IgE antibodies confer to IgE receptor-bearing cells responsiveness to the environmental substances. Mast cells and basophils are central to the immediate hypersensitivity reaction that is mediated by IgE. In humans, there are various other immune cells, notably dendritic cells and B cells, which can also bind IgE. For mast cells, basophils and dendritic cells, the receptor that binds IgE is the high affinity receptor, FcεRI. For B cells and a few other cell types, the low affinity receptor, FcεRII, provides the cell a means to sense the presence of IgE. This overview will focus on events following activation of the high-affinity receptor because FcεRI generates the classical immediate hypersensitivity reaction.