The current definition of
allergy is a group of
IgE-mediated diseases. However, a large portion of patients with clinical manifestations of
allergies do not exhibit elevated serum levels of
IgE (sIgEs). In this article, three key factors, ie soluble
allergens, sIgEs and mast cells or basophils, representing the causative factors, messengers and primary effector cells in allergic
inflammation, respectively, were discussed. Based on current knowledge on allergic diseases, we propose that allergic diseases are a group of diseases mediated through activated mast cells and/or basophils in sensitive individuals, and allergic diseases include four subgroups: (1)
IgE dependent; (2) other
immunoglobulin dependent; (3) non-
immunoglobulin mediated; (4) mixture of the first three subgroups. According to our proposed definition, pseudo-
allergic-reactions, in which mast cell or basophil activation is not mediated via
IgE, or to a lesser extent via
IgG or
IgM, should be non-
IgE-mediated allergic diseases. Specific
allergen challenge tests (SACTs) are gold standard tests for diagnosing
allergies in vivo, but risky. The identification of surface membrane activation markers of mast cells and basophils (CD203c, CCR3, CD63, etc) has led to development of the basophil activation test (BAT), an in vitro specific
allergen challenge test (SACT). Based on currently available laboratory
allergy tests, we here propose a laboratory examination procedure for
allergy.