ABSTRACT
Allergic respiratory disease (ARD) is a chronic, lifelong inflammatory IgE-mediated disease naturally progressing to severe phenotypes and negatively impacting patients’ social life, school performance, and work productivity. The clarification of their underlying immune mechanisms is crucial to develop effective therapies and to prevent disease progression.
Historically, ARD has been regarded as an immune systemic condition due to the presence of free-IgE antibodies in serum or bound to the surface of skin mast cells. Nevertheless, evidence has demonstrated that the synthesis of IgE mainly occurs at the mucosal level where its functional activities are more prominent. Moreover, patients with local allergic rhinitis (LAR) exhibit nasal mucosal allergic reactions in the absence of systemic atopy. These advances reinforce the idea of ARD as a “mucosal immune condition” whose systemic repercussion is merely reflecting the immune processes occurring in the airways.
In this chapter, a description of the mucosal immune system of the airways is presented, with special focus on B cells, antibody production, and IgE immune responses. Moreover, the role of mucosal IgE synthesis in the main respiratory allergic diseases will be analyzed. Finally, the epidemiology, natural evolution, diagnosis, and therapeutic options of LAR are discussed.
