Am. J. Respir. Crit. Care Med., Volume 165, Number 1, January 2002, 22-26

Increases in Allergen-Specific IgE in BAL after Segmental Allergen Challenge in Atopic Asthmatics

DUNCAN R. WILSON, TERRY G. MERRETT, EVA M. VARGA, LYN SMURTHWAITE, HANNAH J. GOULD, MICHAEL KEMP, JAMES HOOPER, STEPHEN J. TILL, and STEPHEN R. DURHAM

Upper Respiratory Medicine, Imperial College School of Medicine at the National Heart and Lung Institute, London; Allergy Diagnostics Laboratory, Abingdon; Randall Centre for Molecular Mechanisms of Cell Function, Kings College, London; and Biochemistry Department, Royal Brompton and Harefield NHS Trust, London, United Kingdom

IgE is important in both early and late allergic responses. Increases in the numbers of RNA transcripts coding for IgE have been observed in the bronchial mucosa of asthmatics and in the nasal mucosa of hay fever patients both during natural allergen exposure and after nasal allergen challenge, suggesting that IgE may be synthesized locally in the mucosa. In this study we have examined bronchoalveolar lavage (BAL) taken before and 24 h after bronchoscopic segmental allergen challenge from 18 atopic asthmatic patients, looking for evidence of increases in IgE protein. Allergen-specific IgG and total and allergen-specific IgE were measured in BAL using a fluoroenzyme immunoassay. There was a significant increase in allergen-specific IgE (Ku/L) in the BAL after allergen challenge {before [median (interquartile range)] 0 (0, 0); after 0.35 (0, 1.87): p = 0.009} which was not observed for allergen-specific IgG (p = 1.0) or for IgE specific to an allergen to which the subject was sensitized but was not used for provocation (p = 1.0). Correction for corresponding increases in total IgE, albumin, and urea in BAL did not affect the observed changes in allergen-specific IgE. These data indicate that allergen provocation results in a selective local accumulation of isotype-specific and allergen-specific IgE antibody within the bronchi, independent of alterations in circulating IgE.

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