Regulation of IgE by T follicular helper cells

Abstract

Allergies to food and environmental antigens have steeply grown to epidemic proportions. IgE antibodies are key mediators of allergic disease, including life‐threatening anaphylaxis. There is now compelling evidence that one of the hallmarks of anaphylaxis‐inducing IgE molecules is their high affinity for allergen, and the cellular pathway to high‐affinity IgE is typically through sequential switching of IgG B cells. Further, in contrast to the previously held paradigm that a subset of CD4+ T cells called Th2 cells promotes IgE responses, recent studies suggest that T follicular helper cells are crucial for inducing anaphylactic IgE. Here we discuss recent studies that have enabled us to understand the nature, induction, and regulation of this enigmatic antibody isotype in allergic sensitization.

Roles of follicular helper and regulatory T cells in allergic diseases and allergen immunotherapy

“…High‐affinity IgE is more pathogenic at inducing allergic responses than low‐affinity IgE 88 . Nevertheless, how T FH cells instruct high‐affinity IgE production remains largely unknown.…”

Ovomucoid‐specific IgD increases in children who naturally outgrow egg allergy in a cross‐sectional study

“…High-affinity, but not low-affinity IgE is known to cause anaphylaxis. 5 A recent study found that OVM-sIgE avidity was more effective at differentiating clinically reactive egg-allergic patients from those tolerant of heated egg compared to EW-sIgE. 4 We found that the ratio of OVM-sIgE to OVM-sIgD or sIgG4 in the CAE group was significantly higher compared to the PAE, OGE, and NEA groups (Figure 2).…”

IgE in the pathophysiology and therapy of food allergy

“…However, it was reported that a distinct T FH population, named T FH 13, can produce both IL‐4 and IL‐13, and is induced in response to allergens but not helminths [65]. T FH 13 was required for the production of high‐affinity IgE capable of inducing anaphylactic responses in mouse models, and was also identified in the same study in the blood of patients with food allergies [65, 66] (Fig. 1).…”