α-Gal and other recent findings that have informed our understanding of anaphylaxis.
To summarize the current understanding of anaphylaxis with an emphasis on major findings that have been reported within the last ten years. Queries relating to anaphylaxis, IgE and mast cells were conducted with PubMed and Google Scholar searching for primary articles and review papers. We focused on articles written in English and which were reported in major allergy and immunology journals. Anaphylaxis represents an extreme manifestation of a form of allergic immunity which appears to have evolved to protect against 'toxic' threats which present at skin and mucosal barriers. The factors which have contributed to a rise in anaphylaxis are increasingly appreciated to relate to changes in hygiene and microbial ecology which have occurred with industrialization. Induction of allergen-specific IgG4 is often part of the allergic response and is associated with protection against anaphylaxis. The recognition of the α-Gal syndrome suggests that carbohydrates can be epitopes which are relevant to anaphylaxis and that IgE-mediated reactions do not always occur 'immediately'. Our understanding of anaphylaxis has advanced significantly over the past ten years. It is anticipated that ongoing research will build on this foundation to further advance our knowledge of anaphylaxis and also translate into clinically meaningful therapies.