Reply

Abstract

Dr. Marinkovich feels that my colleagues and I have ignored complement activation as a possible pathogenic factor in the development of late-phase reactions (LPRs). That is not the case. We reported years ago that there was evidence of increased Hageman factor/Kallikrein activation in skin-chamber fluids, overlying developing LPR.1Atkins PC Miragliotta G Talbot SF Zweiman B Kaplan AP Activation of plasma Hageman factor and Kallikrein in ongoing allergic reaction in the skin.J Immunol. 1987; 139: 2744-2748PubMed Google Scholar The complement component levels in such fluids were not significantly different than those found in control site–chamber fluids. More recently, we found evidence of increased fibrin formation in chamber fluids overlying developing LPRs.2Atkins PC Kaplan AP von Allmen C Moskovitz A Zweiman B Activation of the coagulation pathway during ongoing allergic reaction in the skin.J Allergy Clin Immunol. 1992; 89: 552-559Abstract Full Text PDF PubMed Scopus (10) Google Scholar Although IgG antibodies against the challenge antigens may well be present in our subject, we think it is unlikely that they play a pathogenic role in LPR development. Studies by others have shown decreased LPR expression in individuals recently treated with allergy injection therapy.3Nish WA Charlesworth EN Davis TL Whisman BA Valtier S Charlesworth MG et al.The effect of immunotherapy on the cutaneous late phase response to antigen.J Allergy Clin Immunol. 1994; 93: 484-493Abstract Full Text PDF PubMed Scopus (50) Google Scholar It is well known that levels of IgG antibodies against the relevant antigens are markedly increased in such treated individuals.