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As one of the five designated immunoglobulin isotypes, immunoglobulin E (IgE) plays a significant role in atopic conditions by inducing immediate hypersensitivity reactions. IgE also contributes significantly to the body's immune response to parasitic infections, which are more prevalent in third-world countries. A fraction of IgE antibodies is found in the plasma. IgE antibodies are predominantly found in the tissues, firmly attached to effector cells, such as mast cells and basophils, by high-affinity IgE Fc receptor (Fc epsilon RI) and low-affinity IgE receptor (Fc epsilon RII). These two receptors facilitate the immunologic responses that are carried out by IgE. This activity describes the pathophysiology of an allergic reaction and highlights the interprofessional team's role in managing these patients. Objectives: Identify the function of the IgE molecule. Describe the pathophysiology of an allergic reaction. Review the presentation of a patient suffering from an allergic reaction. Outline interprofessional team strategies for improving care coordination and communication to advance the management of an allergic reaction and improve outcomes. Access free multiple choice questions on this topic.

Immunoglobulin E(IgE), named in 1968, is the last of the five human immunoglobulins to be discovered and is typically associated with the diverse manifestations of allergic diseases.[1] As one of the five designated immunoglobulin isotypes, immunoglobulin E (IgE) plays a major role in atopic conditions by inducing immediate hypersensitivity reactions.[2] IgE also contributes significantly to the body’s immune response to parasitic infections, which are more prevalent in third-world countries. A fraction of IgE antibodies is found in the plasma. IgE antibodies are predominantly found in the tissues, firmly attached to effector cells, such as mast cells and basophils, by high-affinity IgE Fc receptor (Fc epsilon RI) and low-affinity IgE receptor (Fc epsilon RII).[3] These two receptors facilitate the immunologic responses that are carried out by IgE. As a complex cell-surface receptor with a molecular weight of 49 kDa, Fc epsilon RI binds the Fc domain of IgE with an affinity of 10 M instead of Fc epsilon RII with a notably lower affinity. Fc epsilon RI’s structure is expressed differently based on the effector cell type on which it is presented. For example, an alpha-beta gamma tetramer is seen on mast cells and basophils. In contrast, a trimeric alpha-beta isoform is found on other cell types, such as Langerhans and dendritic cells. Fc epsilon RI activation facilitates immediate hypersensitivity reactions that can manifest as sneezing, urticaria, acute bronchospasm, and secretory diarrhea and can even lead to cardiovascular collapse and fatal systemic anaphylactic reactions. These immediate hypersensitivity reactions utilize alpha beta gamma receptors to activate mast cells and basophils. The mechanism behind this reaction starts with the binding of antigens to the Fc epsilon RI-bound IgE. This triggers the immediate release of histamine and synthesis of prostaglandins and leukotrienes and stimulates the delayed secretion of cytokine and chemokine.[4]

The management of allergic patients is best done with an interprofessional team that includes clinicians, immunologists, and pharmacists. The key is to prevent allergies, and this requires patient education. Caregivers and parents should be told to avoid triggers of allergic reactions. In addition, for those with allergies, carrying rapidly injectable epinephrine pens can be lifesaving. A systematic review and meta-analysis demonstrated the significant contribution of pharmacists to achieving clinical outcomes, adherence to medications, and drug-related problems s in efficiently managing autoimmune disorders.[34] [Level 2a]

Nursing can educate patients about the signs and symptoms of allergies and avoid triggers. The pharmacist can educate the patients about drugs that can trigger drug-induced hypersensitivity reactions. Clinicians, including nurse practitioners, may participate in the proper diagnosis. An allergist/immunologist may use the basophil activation test (BAT) and skin tests to evaluate IgE-mediated allergic reactions to food, insect, drugs, and chronic urticaria.[35]

Clinical nurse specialists can monitor for the signs of anaphylaxis, such as urticaria, hypotension, and shortness of breath. Pharmacists can monitor the patients for adverse drug reactions from drug therapy. Immunologists can monitor patients with severe asthma and add omalizumab (Anti-IgE) therapy when indicated according to GINA guidelines.[36][37]