The role of immunoglobulin E in upper respiratory allergies: mechanisms and therapeutic strategies

This review focuses on the central role of Immunoglobulin E (IgE) in upper respiratory allergic diseases and associated therapeutic strategies. As the core immunoglobulin driving type 2 inflammation, IgE production is meticulously regulated by multiple cytokines and signaling pathways. Current therapeutic approaches primarily involve two strategies: direct inhibition of IgE generation and function, and promotion of Immunoglobulin G4 (IgG4) and Immunoglobulin A (IgA) production to competitively suppress IgE-mediated responses.For direct IgE inhibition, monoclonal antibodies such as omalizumab and dupilumab exert their effects by directly antagonizing IgE or blocking upstream inflammatory cytokines critical for IgE synthesis. A spectrum of other multitarget monoclonal antibodies and non-antibody biologics are also under active investigation. Allergen immunotherapy (AIT) represents the principal approach for enhancing IgG4 and IgA production, aiming to rebalance immune responses through modulation of cytokine profiles, induction of regulatory T cells, and augmentation of allergen-specific IgG4/IgA titres to neutralize allergens and attenuate type 2 inflammation. This article comprehensively dissects the molecular mechanisms underlying IgE biosynthesis, pathological roles in allergic inflammation, and therapeutic intervention strategies, thereby providing novel insights for optimizing treatment protocols and improving clinical outcomes in upper respiratory allergic disorders.