Cytokines: clinical potentials for the allergic patient

Classic allergic responses occur as a result of mast cell-bound IgE being cross linked by allergen, causing degranulation and activation with release of multiple biologically active mediators. Such mediators may have a direct effects on target tissues and/or promote the inflammatory milieu typical of late-phase responses. The production of IgE is a normal T-cell dependent antibody response. It is the specificity for allergens that is aberrant, resulting in a hypersensitivity state. Recent work has demonstrated that small molecular weight substances called cytokines are responsible for many immunological activities such as IgE production, mast cell and eosinophil maturation, and proinflammatory mediators that directly contribute to the pathology of late-phase allergic responses. Differences are being sought in the relative production of various cytokines that can be correlated with disease activity. This should find clinical use in diagnosis, prognosis, and/or monitoring of specific immunotherapy. Additionally, therapeutic agents are being sought that have various agonist/antagonist properties to correct aberrant cytokine production. Such agents likely will have a central role in future therapy for allergic diseases.