While allergic mast cell (MC) degranulation occurs by FceRI aggregation and varies in strength among subjects, the analogous pseudo-allergic route was recently uncovered to proceed via MRGPRX2. Here, we examine interindividual variability in skin MC responses to FceRI triggering vs those evoked by MRGPRX2. While population-based variability is comparable between the routes, FceRI-and MRGPRX2-stimulated pathways are completely independent from each other, and responsiveness to one has therefore no predictive value for the other. Conversely, degranulation triggered by compound 48/80 is highly correlated to the process elicited by substance P. MRGPRX2 mRNA shows pronounced population-based variability (coefficient of variation 102.9%). Surprisingly, stem cell factor (SCF) as the MC-supportive mediator par excellence potently inhibits pseudo-allergic degranulation, while it simultaneously promotes allergic stimulation via FceRI. We conclude that SCF can have selective MCdampening functions. Clinically, the data imply that subjects highly reactive in one pathway are not automatically hyper-responsive in terms of the alternative route. 1 In many instances, activation proceeds through the allergic route, which comprises three components: the high-affinity IgE receptor (FceRI) on the MC surface, IgE directed against a specific allergen bound to FceRI, and the allergen itself which aggregates two or more FceRI entities to ignite a cascade which culminates in exocytosis.
1-3There are clinical reactions that resemble allergies, but do not involve immunological MC degranulation, yet do depend on degranulating MCs, and are therefore dubbed pseudo-allergic or allergoid/ anaphylactoid. They can be triggered in all subjects, that is, also in nonatopic individuals. After decades of uncertainty as to the responsible receptor, the clinically relevant "second route" was finally uncovered to proceed via the G protein-coupled receptor (GPCR) MRGPRX2 (or murine Mrgprb2).
4,5Ligands encompass various drugs, antimicrobial peptides, and neuropeptides such as substance P (SP), making the receptor quite universal.