Allergies: review of the evidence

Recent changes in our perceptions of allergic IgE-mediated disease are based on evidence indicating a prominent role for both the early- and late-phase responses. The relative importance of the late-phase inflammatory reaction suggests the need for a critical re-evaluation of both diagnosis and therapy. Skin testing remains the gold standard of laboratory procedures despite new technology. Corticosteroids, acting primarily as potent anti-inflammatory agents affecting the late response, are now seen as primary therapy for allergic disease. Other drugs without anti-inflammatory properties will likely play a secondary role in future. The use of immunotherapy is also changing; this treatment may play a more prominent clinical role as a modulator of the immune response, particularly the latephase reaction.