text:
Talk:Mail

Americentric
Mention of ZIP codes makes for a U.S.-centric page. Replace with mention of zip codes being insituted in the U.S. and postal codes in general as well. --Daniel C. Boyer

Military censorship
Added mention of military censorship. 141.219.41.163

Additional methods
Added mention of some additional methods of mail transport. Does anyone care to expand on them...? --Daniel C. Boyer

Rendered obsolete?
Perhaps it could be put somewhat better than "rendered obsolete"... --Daniel C. Boyer

Packages
Added mention that packages are also transported "by mail." --Daniel C. Boyer

Calligraphy
I am going to edit the stuff about calligraphy to provide more detail and a more NPOV. --Daniel C. Boyer
 * "The study of a fine form of hand-writing, in fact, has quite completely disappeared": again, this can hardly be said to be true. "Quite completely" means absolutely entirely, and no one can seriously maintain this.  --Daniel C. Boyer
 * I am going to remove most of this paragraph as it is not NPOV. --user:Daniel C. Boyer

Mail art
Somehow "mail art" should be mentioned or linked to in the article. --Daniel C. Boyer

4000 BC in China
Can someone explain the attribution of mail to 4000 B.C. in China. This seems like an extremely unlikely date given what we know about world history and the requisites of a mail system. --Davis Foulger
 * Talk to the Chinese. They claim to have invented everything. (Although it is a seriously loony date even for them – it's 2 millennia before the Yellow Emperor – it's necessary to put it back that far if they want to claim priority over Egypt and Mesopotamia.) — Llywelyn II   00:21, 3 October 2013 (UTC)

The Postal Service
I want to write an article on a band called "The Postal Service". I'm vaguely concerned because postal service redirects here. Is this OK? --Nelson 18:39, 1 Aug 2003 (UTC)
 * I think probably the solution is having postal service redirect here, Postal Service direct to your article, and have a little disambig block at the top of each. - Hephaestos 19:58, 1 Aug 2003 (UTC)
 * I think an even better solution is having all the postal service pages redirect here, Postal Service (disambiguation) mentioning both, and Postal Service (band) being about the quasi-notable musicians. — Llywelyn II   00:21, 3 October 2013 (UTC)

HTTP
The most recent change to this article (October 13, 2003) suggests that HTTP is itself an evolution of mail. I think this is strongly inaccurate beyond the level of extremely loose analogy (e.g. HTTP entails addresses). It might be reasonable to say that electronic mail is a evolution of mail (which in a limited sense it is), but not that HTTP is. Davis Foulger
 * Take it up with the Royal Mail who used the idea of a monopoly over any form of senders and receivers to grab control of modern mass media. — Llywelyn II   00:21, 3 October 2013 (UTC)

Poste Restante
No discussion about poste restante? --Kaihsu 09:36, 2004 Apr 27 (UTC)
 * Nope. — Llywelyn II   00:21, 3 October 2013 (UTC)

Charities
I added the comment about charities here because it didn't seem to fit the postcard article itself; however, ultimately I think that is where it should go.--NicholasJones 13:08, 2 Dec 2004 (UTC)

Sorting?
Is there no discussion of the sorting process anywhere? Shantavira 11:57, 29 Jan 2005 (UTC)
 * I was looking for this also. 119 08:13, 13 Apr 2005 (UTC)

Request for references
Hi, I am working to encourage implementation of the goals of the Verifiability policy. Part of that is to make sure articles cite their sources. This is particularly important for featured articles, since they are a prominent part of Wikipedia. The Fact and Reference Check Project has more information. Thank you, and please leave me a message when you have added a few references to the article. - Taxman 19:15, Apr 21, 2005 (UTC)

History I
The history of mail in this article seems to end just before the beginning of modern mail service. Are there any editors who can add something about how modern postal sytems, stamps, etc, began? It doesn't have to be thorough. Cheers, -Willmcw 08:47, Apr 27, 2005 (UTC)
 * Can somebody source the introduction of the envelope? I've seen it credited to Britain 1696. And mention V-mail? Trekphiler 12:15, 1 February 2007 (UTC)

Etymology of post
I'm curious about the etymology of 'post' in this context. Anyone? --Eamonnca1 (talk)
 * If this page doesn't cover it, see post office. — Llywelyn II   00:21, 3 October 2013 (UTC)
 * Joris added it a few weeks ago. 6th Common Sense (talk) 08:52, 27 December 2014 (UTC)
 * I am positive that what Joris wrote indeed is "post"'s correct source, I was informed that it will be deleted soon if we fail to provide sources. Unfortunately, the sources I find up to now, only go back to "Latin". Now - we do understand that "Latin" evolved from prior languages and that, as all languages, it borrowed words too. Anybody else knows how to source "Post" further back than "Latin"? 6th Common Sense (talk) 22:46, 27 February 2015 (UTC)

German mailbox
What about using the current Briefkasten image instead of the old the "old-style-replica Postbriefkasten" image at the bottom? -- Felix Wiemann 17:48, 20 January 2006 (UTC)

Spoken?
Hi all! Is there still a desire to see this article recorded for Spoken Wikipedia? I'd be willing to take it on if so. Ckamaeleon ((T)) 17:53, 16 March 2006 (UTC)

Another request for references
Hello! This article entirely lacks references and footnotes, which are a must for featured articles. I'm considering nominating it for removal from the list of featured articles unless references and footnotes are provided, and will most likely do so in a week, as there was already a previous request tha remained unanswered. Todor Bozh inov   → 17:30, 23 May 2006 (UTC)

Going out on a limb
I must entirely agree with Todor above, but I'm using this chink in the citation-armor of Wikipedia to brazenly assert my own POV. I think that the non-referencing author who added the note about the Teutonic Knights was actually thinking of the Knights Templar, who had a sprawling network of land holdings and estates and who in addition to a private postal service had something resembling a modern banking system, which allowed a pilgrim to deposit money with a Templar church in Europe and withdraw it when they reached Jerusalem. My understanding is that the Teutonics, on the other hand, were much more on the hack-and-slash end of the spectrum rather than the clever monk/scribe/administrator like the Templars. But that's purely a guess on my part, time affords me the arrogance but not the research to confirm it ;^). I guess you could consider this comment to be a sort of anti-citation.  Struthious Bandersnatch, Fourth Tildé of the Apocalypse 03:48, 8 May 2007 (UTC)

Citation style
Please switch the section marked over to footnote style to match the rest of the article. Kat, Queen of Typos 09:27, 25 November 2006 (UTC)
 * OK, done. Fayenatic london 18:19, 29 December 2006 (UTC)

Lacking a lot of info
I don't know how this article made it into featured status, but it has a lot of omissions.
 * Grammatical errors (it's/its, etc.)
 * Doesn't address the history of modern mail, just a bunch of ancient systems -- where's the penny black, for instance?
 * Gives little more than a few sentences about the history of postage stamps or the UPU, whereas a little information about them does belong here

Bit of Trivia: as the first postage stamp was issued in the UK (the penny black), the UK is the only country which doesn't have to put its name on its postage stamps. I knew this from a book, but I also seem to recall reading it on Wikipedia a few months ago, but now it isn't here, at Postage stamp or UPU. That could be put back as well. 128.208.1.238 01:27, 31 August 2007 (UTC)
 * Why don't you fix some of the grammar instead of just putting a tag on the page? This is not an article about postage stamps, Penny Black or UPU but if you look at Postage stamps and postal history of Great Britain and Postage stamp design you will find the info you are looking for concerning the country not using its name on stamps—the appropriate place for this information. It was an FA in 2004 until 2006; the criteria has changed since then, so if you had been around you would see the difference in the development of the wiki. Be constructive and bold. Regarding the "ancient systems", that is about the mail systems not about stamps, stamp design, etc., and is part of history and background which is far better then some articles that only have modern information and no background or history. While this article does need some expansion it should not duplicate other data that already exist appropriately elsewhere. Cheers ww2censor 01:42, 31 August 2007 (UTC)
 * I'm sure you'll agree with me that there's a better place to put that bit of trivia than Postage stamp design. Surely UPU or Postage stamp would be more logical. As for the history, I just brought the penny black up as an example of the lack of the modern history. It's great that we have ancient systems, but we also firmly need the modern history. It would be like having an article about the history of Police describing Roman lictors at length, while forgetting bobbies and Peel. As for the corrections, I'm a better critic than a writer, I'm afraid. 128.208.1.238 00:14, 1 September 2007 (UTC)
 * Seems like there and Postal history of the United Kingdom should do fine. — Llywelyn II   00:21, 3 October 2013 (UTC)

Stealth postage
This should be included. --Daniel C. Boyer (talk) 13:11, 10 March 2008 (UTC)
 * Why? — Llywelyn II   00:21, 3 October 2013 (UTC)

missing topics?
I made a redirect from Registered post to Registered mail because that's how I've always remembered it, and I was searching wikipedia for both that and these: Registered delivery, Recorded delivery and Recorded post, all of which do not exist. Does anyone know where they could link to? Could someone add something about these systems (they were different in the UK when I was young!) to this article? -84user (talk) 15:30, 26 June 2008 (UTC)
 * I never heard it called "registered post", but a redirect seems ok. The Mail article is not supposed to cover all aspects of the mail. It should be a reasonably comprehensive overview but should not be overly US, or UK-centric. There are many redlinks on the List of philatelic topics and not doubt many missing topics that need attention. Imho it is best to concentrate to making specific articles better, such as the Mail, Aerophilately, Stamp collecting and Philately but it all takes time. Are you aware of the Portal:Philately and the WikiProject Philately? Cheers ww2censor (talk) 16:33, 26 June 2008 (UTC)
 * Yes, I went a bit overboard with redirects. I put each one in wikipedia's search box while looking for an article, or part of an article, about it. According to the UK "museum" there were such things as "Registered Postmarks" and "Registered Packets" though. I've now added those philately links to my watchlist. However, the subarticle on registered mail reads strange to me (a UK person). Registered and recorded did mean different, but related, things. I will try to expand that subarticle and include French and Italian views on the concept.-84user (talk) 23:11, 26 June 2008 (UTC)
 * Most of your redirects should more appropriately be directed to the specific terms, or sections. These could be part of a postal history section, that should be expanded, in Postage stamps and postal history of Great Britain. The main mail article should, as previously mentioned, not be either US or UK-centric. In fact some stuff should be moved from the article. It should be a worldwide article and therefore would not contain very detailed country information, unless historically significant. BTW "recorded delivery" has nothing to do with the registered mail service that I know of, unless you can show me a verifiable reference I am going to remove it. I will review your other edits and may need to redirect or revise them, so hope you don't object. Cheers ww2censor (talk) 23:22, 26 June 2008 (UTC)

Two missing topics
Two missing topics of interest to me:
 * 1) How did postal service develop in England (and in its colonies in North America)? In Jane Austen's famous stories, letters are sent and received, but the exact process is shrouded in mystery.
 * 2) Why does the USPS have a monopoly on first class mail? Did any government executive or legislator decided that competition by private firms would hurt the general public, or what? --Uncle Ed (talk) 14:08, 23 August 2008 (UTC)
 * For your first question, see Postal history of the United Kingdom and General Post Office. For your second, they decided that competition by private firms would hurt the post office's revenue. I'm sure if you dug hard enough in the Congressional Register, you could find the relevant quote, if you needed to source it for an article. — Llywelyn II   00:21, 3 October 2013 (UTC)

Delivery
I was looking for information to find out how often each country delivers first class mail? Do all countries take Sundays off like the US? Do some countries deliver 7 days per week? I've heard there are some countries that don't even deliver on weekends. Silkyworm (talk) 06:00, 21 November 2010 (UTC)silkyworm
 * I'm not sure that would be possible. There are parts of the US where mail delivery is still on a once weekly schedule. I'm sure it's all quite variable within countries. You could try working on improving weekend, Saturday, or Sunday, though, to talk about countries like the People's Republic of China who have no earthly reason to honor Saturday or Sunday but still treat the weekend essentially like Europeans. — Llywelyn II   00:21, 3 October 2013 (UTC)

Mail: correct use of the word
Is mail the system for carrying and delivering letters? Or can mail be considered the letters themselves? Is it mail, if it doesnt get delivered? MArc S., Danis 206.192.35.125 (talk) 17:34, 13 April 2012 (UTC)
 * Varies between British and American English. Etymologically, though, "mails" were the bags for the letters; can therefore be used by synecdoche for both the bag's contents and delivery; and become "mail" once they are sent even if (as in London fires or Chicago generally) they never arrive. — Llywelyn II   00:21, 3 October 2013 (UTC)

Template:Postal system
Postal system Is courier part of the postal system? Should it have a group within the navbox?
 * No, it's a parallel issue; but, yes, it should be mentioned among an "alternate" or "private systems" list. — Llywelyn II   00:21, 3 October 2013 (UTC)

Titles
Could one group be titled somehow to show the "flow", as in mailbox --> sorting station --> etc? Anna Frodesiak (talk) 04:09, 5 February 2013 (UTC)
 * — Llywelyn II   00:21, 3 October 2013 (UTC)

History II
There absolutely needs to be a general history of mail on Wikipedia, but this article's history section is becoming too long and losing the thread. It's quite interesting to see the different systems around the world (and we could use even more, like the Incas' beads) but for the purposes of this article almost everything before the 1630s could be dealt with along the lines of "modern general mail service developed out of the courier systems devised for royal use". There are so many similarities between these systems and so little relevance to modern mail service that it really isn't doing the readers a service by having two and three pages of how such similar systems repeatedly developed. — Llywelyn II   00:31, 3 October 2013 (UTC)

Invention of EMail
This article suffers from the ongoing marketing campaign that electronic mail was invented by an individual in 1978. It is possible that this person first used the term EMAIL at that time. However, the claim that it was invented then is somewhat disputed by history. — Preceding unsigned comment added by Bigjimslade (talk • contribs) 16:50, 1 September 2014 (UTC)
 * I've tried to remove most of the claims. Let me know if I've missed any. Protonk (talk) 14:14, 11 September 2014 (UTC)

Formatting of see also section
The table in the "see also" section causes serious layout problems on mobile devices. "See also" section also normally have 100% font size; there's no particular reason to make it smaller and harder to read. Normally I would use div col and let the browser decide how many columns there should be, which on a mobile device might only be one or two due to small screen width. However, if there are three separate lists that would result in awkward vertical wrapping of lines, so I think it's best presented as a single list. -- Beland (talk) 16:52, 23 February 2015 (UTC)

Persian
I've reverted speculation that the word "post" comes from Persian. Modern dictionaries fairly consistently derive it from the past participle of Latin ponere. The theory of Persian origin requires a reliable source. -- Elphion (talk) 01:12, 16 April 2015 (UTC)

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Do second, third, and fourth class mail categories/concepts still exist at USPS?
Is this passage about First-Class Mail still correct? I see no reference to second, third, and fourth class mail on the USPS website.

"Delivery is given priority over second-class (newspapers and magazines), third class (bulk advertisements), and fourth-class mail (books and media packages)." — Preceding unsigned comment added by BlueSingularity (talk • contribs) 20:39, 22 April 2018 (UTC)

 * According to this webpage third and fourth class mail were combined and renamed as Standard Mail in 1996 under a Classification Reform. There are actually plenty of pages where mention is made but you have to dig around. Also Publication 32 gives some details but no dates. ww2censor (talk) 21:05, 22 April 2018 (UTC)

Bypass mail
Bypass mail redirects to Mail, but I can't find any specific information concerning "bypass mail" in this "mail"-article. -- Grauhederl (talk) 20:51, 12 March 2019 (UTC)

 * This is what it looked like before being redirected to Mail. It is probably more appropriate to be redirected to Royal Mail as it only appear to be a designation of theirs. ww2censor (talk) 22:28, 12 March 2019 (UTC)

 * Thank you. I was interested in Alaska bypass mail, got information on USPS website. -- Grauhederl (talk) 22:25, 14 March 2019 (UTC)

History - Other Systems
Should the tag on this section be swapped out for "lacks sufficient references" (rather than "cites no sources")? It does in fact cite a source at present. Tyris776 (talk) 04:06, 3 September 2019 (UTC)
 * I've updated the tag to More citations needed section instead.

Macedonia
You are the worst media Macedonian egsist Yoa are fake Please talk the truth 31.11.79.173 (talk) 20:17, 7 February 2023 (UTC)

title: Talk:Mail


text:
Seattle Wireless

Seattle Wireless was an American non-profit project created by Matt Westervelt and Ken Caruso in June 2000. It sought to develop a free, locally owned wireless community network using widely available, license-free technology wireless broadband Internet access. It is a metropolitan area network. As of 2016, Seattle Wireless is no longer operational.

Seattle Wireless was one of the first Community Wireless Networks and one of the first project focused wikis. It also had a short lived (7 episode) online television show, called Seattle Wireless TV. It was created by Peter Yorke and Michael Pierce and ran July 2003 - June 2004. SWTV was an early adopter of Bittorrent to distribute its shows.

license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/

title: Seattle Wireless


text:
United Federation of Planets

In the fictional universe of Star Trek, the United Federation of Planets (UFP) is the interstellar government with which, as part of its space force Starfleet, most of the characters and starships of the franchise are affiliated. Commonly referred to as "the Federation", it was introduced in the original Star Trek television series. The survival, success, and growth of the Federation and its principles of freedom have become some of the Star Trek franchise's central themes.

The Federation is an organization of numerous planetary sovereignties, including Earth and Vulcan. The franchise focuses on Starfleet, the exploration and defense arm of the Federation, rather than the government. Viewers are rarely given details of the internal workings of the government; however, many episodes refer to the rules and laws that the Federation imposes on the characters and their adventures.

Development
Early in the first season of Star Trek, Captain Kirk had said the Enterprise's authority came from the United Earth Space Probe Agency. Bases visited in the series were labeled "Earth Outposts". In August 1966, Gene L. Coon was hired by Gene Roddenberry as a writer for Star Trek. Actor William Shatner credits Coon with injecting the concepts of Starfleet, Starfleet Command and the United Federation of Planets into the show. One of the first teleplays Coon was credited with was "A Taste of Armageddon", where an ambassador on the Enterprise is referred to as a Federation official.

Eventually, the series became an allegory for the current events of the 1960s counterculture, placing great emphasis on an anti-war message and depicting the United Federation of Planets, a vast interstellar alliance founded on the enlightened principles of liberty, equality, justice, progress, and peaceful co-existence, as an idealistic version of the United Nations.

Reception
The optimistic view of the future present in the Federation has been highlighted as unique among most science fiction, showing how "evolved" and "civilized" the future could conceivably be. Much debate has centered on how the materialist application of a post-scarcity economy in the Federation is incompatible with its own idealist ethics. It has been described, along with the series as a whole, as a vehicle to explore what it means to be human, as well as exploring mankind's efforts to build a better society. Other writers have noted that Star Trek's Federation has the same logistical and philosophical difficulties of other utopian economic and political schemes that make it seem unrealistic. However, Star Trek has brought up this idea of slavery or coerced service labor being necessary for its utopian society in "The Measure of a Man", where Captain Jean-Luc Picard successfully defends Data's right to resign from Starfleet in a trial of his sentience, which extends the right not to work to robots alongside all other sentient beings following the in-universe year 42523.7 (2365 AD.).

In 2020, Screen Rant noted the Star Trek: The Next Generation episode "First Contact" for exploring the United Federation of Planets and how it sometimes struggles with contact with aliens.

In-universe portrayal
Like many things in Star Trek, episodes and films may reference entities or laws within the Federation, but viewers are never given a broad view of its inner workings. Many contemporary terms are assigned to the Federation, but parallels to current government bodies and their roles and responsibilities are pure speculation on the part of fans and critics.

In the timeline of Star Trek, the Federation was founded in 2161, after the events of Star Trek: Enterprise but before those of the other series in the franchise. Its founding members were Earth, Vulcan, Andoria, and Tellar. Over time it has expanded to include many more worlds through peaceful voluntary association. Some notable ones include Trill, Betazed, and Bolarus IX. References to the size of the Federation vary, with Captain Kirk stating in 2267 that humanity was on "a thousand planets and spreading out", while Captain Picard referred to the Federation (in 2373) as being made up of "over one hundred and fifty" planets, spread across 8,000 light-years. The Federation is a major galactic power, and at various times has been at war with other powers such as the Klingons, the Romulans and the Dominion. The Federation's space force is called Starfleet, and, although most of Star Trek depicts peaceful exploration of the galaxy, Starfleet is also capable of considerable military might. Section 31 is a paramilitary espionage agency, described by writer Ira Steven Behr as "...doing the nasty stuff that no one wants to think about.".

The Federation is depicted as a democratic republic, led by a President based in Paris on Earth. Presidential powers include issuing pardons and declaring states of emergency. This president is supported by a cabinet. The Federation also has a supreme court and a legislature, the Federation Council, with delegates from its various member worlds. A constitution and a charter have both been referred to as founding documents of the Federation.

Several planets are shown to desire Federation membership. Joining the Federation is a complicated process, and requires meeting various criteria. Disqualifying criteria include caste-based discrimination and violations of sentient rights. A single, unified government is not required for admission, but is desirable. Most Starfleet personnel are Federation citizens. Non-citizens can join Starfleet, but the process is more difficult, as with all non-Federation races.

The Federation's counterpart in the Mirror Universe is the Terran Empire, a human-dominated authoritarian state which has formed an empire by conquest.

Future of the Federation
In the Short Treks episode "Calypso", taking place at an unknown time in the distant future, the character of Craft refers to the "V'draysh". Little is said about the V'draysh, except that it is at war with Alcor IV, and that the V'draysh people are searching for artifacts from ancient human history. The writer of this episode, Michael Chabon, stated that the name "V'draysh" is intended to be a syncope for the word "Federation".

In the 32nd century setting of the third season of Star Trek: Discovery, the Federation had undergone a near-total collapse precipitated by "The Burn", a galaxy-wide disaster. This shrunk the Federation from a peak of 350 worlds to just 38, notably excluding both Earth and Ni'Var (formerly known as Vulcan). During the fourth season, the Federation is in the process of rebuilding itself; Starfleet Academy is reopened, new shipbuilding facilities are commissioned, and many former member worlds such as Trill, Ni'Var and Earth rejoin.

Non-canon references
In non-canon sources like the original 1975 Star Trek Star Fleet Technical Manual, Johnson's Worlds of the Federation, and roleplaying games, the Federation's five founding members were Earth (or Terra), Vulcan, Tellar, Andor, and Alpha Centauri. Some non-canon works assert that founding member Alpha Centauri is home to a human race (transplanted by the Preservers from classical third-century BC Greece) known as, variously, Centaurans, Centaurians, or Centauri.

The 1980-to-2188 historical guide Star Trek Spaceflight Chronology posits the Federation as being incorporated at 'the first Babel Interplanetary Conference' in 2087.

In books such as the Star Trek Star Fleet Technical Manual and the novel Articles of the Federation, the Federation's founding document is the Articles of Federation.

title: United Federation of Planets


text:
Allergy

Allergies, also known as allergic diseases, are various conditions caused by hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include hay fever, food allergies, atopic dermatitis, allergic asthma, and anaphylaxis. Symptoms may include red eyes, an itchy rash, sneezing, coughing, a runny nose, shortness of breath, or swelling. Note that food intolerances and food poisoning are separate conditions.

Common allergens include pollen and certain foods. Metals and other substances may also cause such problems. Food, insect stings, and medications are common causes of severe reactions. Their development is due to both genetic and environmental factors. The underlying mechanism involves immunoglobulin E antibodies (IgE), part of the body's immune system, binding to an allergen and then to a receptor on mast cells or basophils where it triggers the release of inflammatory chemicals such as histamine. Diagnosis is typically based on a person's medical history. Further testing of the skin or blood may be useful in certain cases. Positive tests, however, may not necessarily mean there is a significant allergy to the substance in question.

Early exposure of children to potential allergens may be protective. Treatments for allergies include avoidance of known allergens and the use of medications such as steroids and antihistamines. In severe reactions, injectable adrenaline (epinephrine) is recommended. Allergen immunotherapy, which gradually exposes people to larger and larger amounts of allergen, is useful for some types of allergies such as hay fever and reactions to insect bites. Its use in food allergies is unclear.

Allergies are common. In the developed world, about 20% of people are affected by allergic rhinitis, about 6% of people have at least one food allergy, and about 20% have or have had atopic dermatitis at some point in time. Depending on the country, about 1–18% of people have asthma. Anaphylaxis occurs in between 0.05–2% of people. Rates of many allergic diseases appear to be increasing. The word "allergy" was first used by Clemens von Pirquet in 1906.

Signs and symptoms
Many allergens such as dust or pollen are airborne particles. In these cases, symptoms arise in areas in contact with air, such as the eyes, nose, and lungs. For instance, allergic rhinitis, also known as hay fever, causes irritation of the nose, sneezing, itching, and redness of the eyes. Inhaled allergens can also lead to increased production of mucus in the lungs, shortness of breath, coughing, and wheezing.

Aside from these ambient allergens, allergic reactions can result from foods, insect stings, and reactions to medications like aspirin and antibiotics such as penicillin. Symptoms of food allergy include abdominal pain, bloating, vomiting, diarrhea, itchy skin, and hives. Food allergies rarely cause respiratory (asthmatic) reactions, or rhinitis. Insect stings, food, antibiotics, and certain medicines may produce a systemic allergic response that is also called anaphylaxis; multiple organ systems can be affected, including the digestive system, the respiratory system, and the circulatory system. Depending on the severity, anaphylaxis can include skin reactions, bronchoconstriction, swelling, low blood pressure, coma, and death. This type of reaction can be triggered suddenly, or the onset can be delayed. The nature of anaphylaxis is such that the reaction can seem to be subsiding but may recur throughout a period of time.

Skin
Substances that come into contact with the skin, such as latex, are also common causes of allergic reactions, known as contact dermatitis or eczema. Skin allergies frequently cause rashes, or swelling and inflammation within the skin, in what is known as a "weal and flare" reaction characteristic of hives and angioedema.

With insect stings, a large local reaction may occur in the form of an area of skin redness greater than 10 cm in size that can last one to two days. This reaction may also occur after immunotherapy.

Cause
Risk factors for allergies can be placed in two broad categories, namely host and environmental factors. Host factors include heredity, sex, race, and age, with heredity being by far the most significant. However, there has been a recent increase in the incidence of allergic disorders that cannot be explained by genetic factors alone. Four major environmental candidates are alterations in exposure to infectious diseases during early childhood, environmental pollution, allergen levels, and dietary changes.

Dust mites
Dust mite allergy, also known as house dust allergy, is a sensitization and allergic reaction to the droppings of house dust mites. The allergy is common and can trigger allergic reactions such as asthma, eczema, or itching. It is the manifestation of parasitosis. The mite's gut contains potent digestive enzymes (notably peptidase 1) that persist in their feces and are major inducers of allergic reactions such as wheezing. The mite's exoskeleton can also contribute to allergic reactions. Unlike scabies mites or skin follicle mites, house dust mites do not burrow under the skin and are not parasitic.

Foods
A wide variety of foods can cause allergic reactions, but 90% of allergic responses to foods are caused by cow's milk, soy, eggs, wheat, peanuts, tree nuts, fish, and shellfish. Other food allergies, affecting less than 1 person per 10,000 population, may be considered "rare". The most common food allergy in the US population is a sensitivity to crustacea. Although peanut allergies are notorious for their severity, peanut allergies are not the most common food allergy in adults or children. Severe or life-threatening reactions may be triggered by other allergens and are more common when combined with asthma.

Rates of allergies differ between adults and children. Children can sometimes outgrow peanut allergies. Egg allergies affect one to two percent of children but are outgrown by about two-thirds of children by the age of 5. The sensitivity is usually to proteins in the white, rather than the yolk.

Milk-protein allergies—distinct from lactose intolerance—are most common in children. Approximately 60% of milk-protein reactions are immunoglobulin E–mediated, with the remaining usually attributable to inflammation of the colon. Some people are unable to tolerate milk from goats or sheep as well as from cows, and many are also unable to tolerate dairy products such as cheese. Roughly 10% of children with a milk allergy will have a reaction to beef. Lactose intolerance, a common reaction to milk, is not a form of allergy at all, but due to the absence of an enzyme in the digestive tract.

Those with tree nut allergies may be allergic to one or to many tree nuts, including pecans, pistachios, pine nuts, and walnuts. In addition, seeds, including sesame seeds and poppy seeds, contain oils in which protein is present, which may elicit an allergic reaction.

Allergens can be transferred from one food to another through genetic engineering; however genetic modification can also remove allergens. Little research has been done on the natural variation of allergen concentrations in unmodified crops.

Latex
Latex can trigger an IgE-mediated cutaneous, respiratory, and systemic reaction. The prevalence of latex allergy in the general population is believed to be less than one percent. In a hospital study, 1 in 800 surgical patients (0.125 percent) reported latex sensitivity, although the sensitivity among healthcare workers is higher, between seven and ten percent. Researchers attribute this higher level to the exposure of healthcare workers to areas with significant airborne latex allergens, such as operating rooms, intensive-care units, and dental suites. These latex-rich environments may sensitize healthcare workers who regularly inhale allergenic proteins.

The most prevalent response to latex is an allergic contact dermatitis, a delayed hypersensitive reaction appearing as dry, crusted lesions. This reaction usually lasts 48–96 hours. Sweating or rubbing the area under the glove aggravates the lesions, possibly leading to ulcerations. Anaphylactic reactions occur most often in sensitive patients who have been exposed to a surgeon's latex gloves during abdominal surgery, but other mucosal exposures, such as dental procedures, can also produce systemic reactions.

Latex and banana sensitivity may cross-react. Furthermore, those with latex allergy may also have sensitivities to avocado, kiwifruit, and chestnut. These people often have perioral itching and local urticaria. Only occasionally have these food-induced allergies induced systemic responses. Researchers suspect that the cross-reactivity of latex with banana, avocado, kiwifruit, and chestnut occurs because latex proteins are structurally homologous with some other plant proteins.

Medications
About 10% of people report that they are allergic to penicillin; however, of that 10%, 90% turn out not to be. Serious allergies only occur in about 0.03%.

Insect stings
One of the main sources of human allergies is insects. An allergy to insects can be brought on by bites, stings, ingestion, and inhalation.

Toxins interacting with proteins
Another non-food protein reaction, urushiol-induced contact dermatitis, originates after contact with poison ivy, eastern poison oak, western poison oak, or poison sumac. Urushiol, which is not itself a protein, acts as a hapten and chemically reacts with, binds to, and changes the shape of integral membrane proteins on exposed skin cells. The immune system does not recognize the affected cells as normal parts of the body, causing a T-cell - mediated immune response. Of these poisonous plants, sumac is the most virulent. The resulting dermatological response to the reaction between urushiol and membrane proteins includes redness, swelling, papules, vesicles, blisters, and streaking.

Estimates vary on the population fraction that will have an immune system response. Approximately 25% of the population will have a strong allergic response to urushiol. In general, approximately 80–90% of adults will develop a rash if they are exposed to 0.0050 mg of purified urushiol, but some people are so sensitive that it takes only a molecular trace on the skin to initiate an allergic reaction.

Genetics
Allergic diseases are strongly familial: identical twins are likely to have the same allergic diseases about 70% of the time; the same allergy occurs about 40% of the time in non-identical twins. Allergic parents are more likely to have allergic children, and those children's allergies are likely to be more severe than those in children of non-allergic parents. Some allergies, however, are not consistent along genealogies; parents who are allergic to peanuts may have children who are allergic to ragweed. The likelihood of developing allergies is inherited and related to an irregularity in the immune system, but the specific allergen is not.

The risk of allergic sensitization and the development of allergies varies with age, with young children most at risk. Several studies have shown that IgE levels are highest in childhood and fall rapidly between the ages of 10 and 30 years. The peak prevalence of hay fever is highest in children and young adults and the incidence of asthma is highest in children under 10.

Ethnicity may play a role in some allergies; however, racial factors have been difficult to separate from environmental influences and changes due to migration. It has been suggested that different genetic loci are responsible for asthma, to be specific, in people of European, Hispanic, Asian, and African origins.

Hygiene hypothesis
Allergic diseases are caused by inappropriate immunological responses to harmless antigens driven by a TH2-mediated immune response. Many bacteria and viruses elicit a TH1-mediated immune response, which down-regulates TH2 responses. The first proposed mechanism of action of the hygiene hypothesis was that insufficient stimulation of the TH1 arm of the immune system leads to an overactive TH2 arm, which in turn leads to allergic disease. In other words, individuals living in too sterile an environment are not exposed to enough pathogens to keep the immune system busy. Since our bodies evolved to deal with a certain level of such pathogens, when they are not exposed to this level, the immune system will attack harmless antigens, and thus normally benign microbial objects—like pollen—will trigger an immune response.

The hygiene hypothesis was developed to explain the observation that hay fever and eczema, both allergic diseases, were less common in children from larger families, which were, it is presumed, exposed to more infectious agents through their siblings, than in children from families with only one child. It is used to explain the increase in allergic diseases that have been seen since industrialization, and the higher incidence of allergic diseases in more developed countries. The hygiene hypothesis has now expanded to include exposure to symbiotic bacteria and parasites as important modulators of immune system development, along with infectious agents.

Epidemiological data support the hygiene hypothesis. Studies have shown that various immunological and autoimmune diseases are much less common in the developing world than the industrialized world, and that immigrants to the industrialized world from the developing world increasingly develop immunological disorders in relation to the length of time since arrival in the industrialized world. Longitudinal studies in the third world demonstrate an increase in immunological disorders as a country grows more affluent and, it is presumed, cleaner. The use of antibiotics in the first year of life has been linked to asthma and other allergic diseases. The use of antibacterial cleaning products has also been associated with higher incidence of asthma, as has birth by caesarean section rather than vaginal birth.

Stress
Chronic stress can aggravate allergic conditions. This has been attributed to a T helper 2 (TH2)-predominant response driven by suppression of interleukin 12 by both the autonomic nervous system and the hypothalamic–pituitary–adrenal axis. Stress management in highly susceptible individuals may improve symptoms.

Other environmental factors
Allergic diseases are more common in industrialized countries than in countries that are more traditional or agricultural, and there is a higher rate of allergic disease in urban populations versus rural populations, although these differences are becoming less defined. Historically, the trees planted in urban areas were predominantly male to prevent litter from seeds and fruits, but the high ratio of male trees causes high pollen counts, a phenomenon that horticulturist Tom Ogren has called "botanical sexism".

Alterations in exposure to microorganisms is another plausible explanation, at present, for the increase in atopic allergy. Endotoxin exposure reduces release of inflammatory cytokines such as TNF-α, IFNγ, interleukin-10, and interleukin-12 from white blood cells (leukocytes) that circulate in the blood. Certain microbe-sensing proteins, known as Toll-like receptors, found on the surface of cells in the body are also thought to be involved in these processes.

Parasitic worms and similar parasites are present in untreated drinking water in developing countries, and were present in the water of developed countries until the routine chlorination and purification of drinking water supplies. Recent research has shown that some common parasites, such as intestinal worms (e.g., hookworms), secrete chemicals into the gut wall (and, hence, the bloodstream) that suppress the immune system and prevent the body from attacking the parasite. This gives rise to a new slant on the hygiene hypothesis theory—that co-evolution of humans and parasites has led to an immune system that functions correctly only in the presence of the parasites. Without them, the immune system becomes unbalanced and oversensitive. In particular, research suggests that allergies may coincide with the delayed establishment of gut flora in infants. However, the research to support this theory is conflicting, with some studies performed in China and Ethiopia showing an increase in allergy in people infected with intestinal worms. Clinical trials have been initiated to test the effectiveness of certain worms in treating some allergies. It may be that the term 'parasite' could turn out to be inappropriate, and in fact a hitherto unsuspected symbiosis is at work. For more information on this topic, see Helminthic therapy.

Acute response
In the initial stages of allergy, a type I hypersensitivity reaction against an allergen encountered for the first time and presented by a professional antigen-presenting cell causes a response in a type of immune cell called a TH2 lymphocyte, a subset of T cells that produce a cytokine called interleukin-4 (IL-4). These TH2 cells interact with other lymphocytes called B cells, whose role is production of antibodies. Coupled with signals provided by IL-4, this interaction stimulates the B cell to begin production of a large amount of a particular type of antibody known as IgE. Secreted IgE circulates in the blood and binds to an IgE-specific receptor (a kind of Fc receptor called FcεRI) on the surface of other kinds of immune cells called mast cells and basophils, which are both involved in the acute inflammatory response. The IgE-coated cells, at this stage, are sensitized to the allergen.

If later exposure to the same allergen occurs, the allergen can bind to the IgE molecules held on the surface of the mast cells or basophils. Cross-linking of the IgE and Fc receptors occurs when more than one IgE-receptor complex interacts with the same allergenic molecule and activates the sensitized cell. Activated mast cells and basophils undergo a process called degranulation, during which they release histamine and other inflammatory chemical mediators (cytokines, interleukins, leukotrienes, and prostaglandins) from their granules into the surrounding tissue causing several systemic effects, such as vasodilation, mucous secretion, nerve stimulation, and smooth muscle contraction. This results in rhinorrhea, itchiness, dyspnea, and anaphylaxis. Depending on the individual, allergen, and mode of introduction, the symptoms can be system-wide (classical anaphylaxis) or localized to specific body systems. Asthma is localized to the respiratory system and eczema is localized to the dermis.

Late-phase response
After the chemical mediators of the acute response subside, late-phase responses can often occur. This is due to the migration of other leukocytes such as neutrophils, lymphocytes, eosinophils, and macrophages to the initial site. The reaction is usually seen 2–24 hours after the original reaction. Cytokines from mast cells may play a role in the persistence of long-term effects. Late-phase responses seen in asthma are slightly different from those seen in other allergic responses, although they are still caused by release of mediators from eosinophils and are still dependent on activity of TH2 cells.

Allergic contact dermatitis
Although allergic contact dermatitis is termed an "allergic" reaction (which usually refers to type I hypersensitivity), its pathophysiology involves a reaction that more correctly corresponds to a type IV hypersensitivity reaction. In type IV hypersensitivity, there is activation of certain types of T cells (CD8+) that destroy target cells on contact, as well as activated macrophages that produce hydrolytic enzymes.

Diagnosis
Effective management of allergic diseases relies on the ability to make an accurate diagnosis. Allergy testing can help confirm or rule out allergies. Correct diagnosis, counseling, and avoidance advice based on valid allergy test results reduce the incidence of symptoms and need for medications, and improve quality of life. To assess the presence of allergen-specific IgE antibodies, two different methods can be used: a skin prick test, or an allergy blood test. Both methods are recommended, and they have similar diagnostic value.

Skin prick tests and blood tests are equally cost-effective, and health economic evidence shows that both tests were cost-effective compared with no test. Early and more accurate diagnoses save cost due to reduced consultations, referrals to secondary care, misdiagnosis, and emergency admissions.

Allergy undergoes dynamic changes over time. Regular allergy testing of relevant allergens provides information on if and how patient management can be changed to improve health and quality of life. Annual testing is often the practice for determining whether allergy to milk, egg, soy, and wheat have been outgrown, and the testing interval is extended to 2–3 years for allergy to peanut, tree nuts, fish, and crustacean shellfish. Results of follow-up testing can guide decision-making regarding whether and when it is safe to introduce or re-introduce allergenic food into the diet.

Skin prick testing
Skin testing is also known as "puncture testing" and "prick testing" due to the series of tiny punctures or pricks made into the patient's skin. Tiny amounts of suspected allergens and/or their extracts (e.g., pollen, grass, mite proteins, peanut extract) are introduced to sites on the skin marked with pen or dye (the ink/dye should be carefully selected, lest it cause an allergic response itself). A negative and positive control are also included for comparison (eg, negative is saline or glycerin; positive is histamine). A small plastic or metal device is used to puncture or prick the skin. Sometimes, the allergens are injected "intradermally" into the patient's skin, with a needle and syringe. Common areas for testing include the inside forearm and the back.

If the patient is allergic to the substance, then a visible inflammatory reaction will usually occur within 30 minutes. This response will range from slight reddening of the skin to a full-blown hive (called "wheal and flare") in more sensitive patients similar to a mosquito bite. Interpretation of the results of the skin prick test is normally done by allergists on a scale of severity, with +/− meaning borderline reactivity, and 4+ being a large reaction. Increasingly, allergists are measuring and recording the diameter of the wheal and flare reaction. Interpretation by well-trained allergists is often guided by relevant literature. In general, a positive response is interpreted when the wheal of an antigen is ≥3mm larger than the wheal of the negative control (eg, saline or glycerin). Some patients may believe they have determined their own allergic sensitivity from observation, but a skin test has been shown to be much better than patient observation to detect allergy.

If a serious life-threatening anaphylactic reaction has brought a patient in for evaluation, some allergists will prefer an initial blood test prior to performing the skin prick test. Skin tests may not be an option if the patient has widespread skin disease or has taken antihistamines in the last several days.

Patch testing
Patch testing is a method used to determine if a specific substance causes allergic inflammation of the skin. It tests for delayed reactions. It is used to help ascertain the cause of skin contact allergy or contact dermatitis. Adhesive patches, usually treated with several common allergic chemicals or skin sensitizers, are applied to the back. The skin is then examined for possible local reactions at least twice, usually at 48 hours after application of the patch, and again two or three days later.

Blood testing
An allergy blood test is quick and simple and can be ordered by a licensed health care provider (e.g., an allergy specialist) or general practitioner. Unlike skin-prick testing, a blood test can be performed irrespective of age, skin condition, medication, symptom, disease activity, and pregnancy. Adults and children of any age can get an allergy blood test. For babies and very young children, a single needle stick for allergy blood testing is often gentler than several skin pricks.

An allergy blood test is available through most laboratories. A sample of the patient's blood is sent to a laboratory for analysis, and the results are sent back a few days later. Multiple allergens can be detected with a single blood sample. Allergy blood tests are very safe since the person is not exposed to any allergens during the testing procedure.

The test measures the concentration of specific IgE antibodies in the blood. Quantitative IgE test results increase the possibility of ranking how different substances may affect symptoms. A rule of thumb is that the higher the IgE antibody value, the greater the likelihood of symptoms. Allergens found at low levels that today do not result in symptoms cannot help predict future symptom development. The quantitative allergy blood result can help determine what a patient is allergic to, help predict and follow the disease development, estimate the risk of a severe reaction, and explain cross-reactivity.

A low total IgE level is not adequate to rule out sensitization to commonly inhaled allergens. Statistical methods, such as ROC curves, predictive value calculations, and likelihood ratios have been used to examine the relationship of various testing methods to each other. These methods have shown that patients with a high total IgE have a high probability of allergic sensitization, but further investigation with allergy tests for specific IgE antibodies for a carefully chosen of allergens is often warranted.

Laboratory methods to measure specific IgE antibodies for allergy testing include enzyme-linked immunosorbent assay (ELISA, or EIA), radioallergosorbent test (RAST), fluorescent enzyme immunoassay (FEIA), and chemiluminescence immunoassay (CLIA).

Other testing
Challenge testing: Challenge testing is when tiny amounts of a suspected allergen are introduced to the body orally, through inhalation, or via other routes. Except for testing food and medication allergies, challenges are rarely performed. When this type of testing is chosen, it must be closely supervised by an allergist.

Elimination/challenge tests: This testing method is used most often with foods or medicines. A patient with a suspected allergen is instructed to modify his diet to totally avoid that allergen for a set time. If the patient experiences significant improvement, he may then be "challenged" by reintroducing the allergen, to see if symptoms are reproduced.

Unreliable tests: There are other types of allergy testing methods that are unreliable, including applied kinesiology (allergy testing through muscle relaxation), cytotoxicity testing, urine autoinjection, skin titration (Rinkel method), and provocative and neutralization (subcutaneous) testing or sublingual provocation.

Differential diagnosis
Before a diagnosis of allergic disease can be confirmed, other plausible causes of the presenting symptoms should be considered. Vasomotor rhinitis, for example, is one of many illnesses that share symptoms with allergic rhinitis, underscoring the need for professional differential diagnosis. Once a diagnosis of asthma, rhinitis, anaphylaxis, or other allergic disease has been made, there are several methods for discovering the causative agent of that allergy.

Prevention
Giving peanut products early may decrease the risk of allergies while only breastfeeding during at least the first few months of life may decrease the risk of dermatitis. There is no good evidence that a mother's diet during pregnancy or breastfeeding affects the risk of allergies, nor is there evidence that delayed introduction of certain foods is useful. Early exposure to potential allergens may actually be protective.

Fish oil supplementation during pregnancy is associated with a lower risk. Probiotic supplements during pregnancy or infancy may help to prevent atopic dermatitis.

Management
Management of allergies typically involves avoiding the allergy trigger and taking medications to improve the symptoms. Allergen immunotherapy may be useful for some types of allergies.

Medication
Several medications may be used to block the action of allergic mediators, or to prevent activation of cells and degranulation processes. These include antihistamines, glucocorticoids, epinephrine (adrenaline), mast cell stabilizers, and antileukotriene agents are common treatments of allergic diseases. Anticholinergics, decongestants, and other compounds thought to impair eosinophil chemotaxis are also commonly used. Although rare, the severity of anaphylaxis often requires epinephrine injection, and where medical care is unavailable, a device known as an epinephrine autoinjector may be used.

Immunotherapy
Allergen immunotherapy is useful for environmental allergies, allergies to insect bites, and asthma. Its benefit for food allergies is unclear and thus not recommended. Immunotherapy involves exposing people to larger and larger amounts of allergen in an effort to change the immune system's response.

Meta-analyses have found that injections of allergens under the skin is effective in the treatment in allergic rhinitis in children and in asthma. The benefits may last for years after treatment is stopped. It is generally safe and effective for allergic rhinitis and conjunctivitis, allergic forms of asthma, and stinging insects.

To a lesser extent, the evidence also supports the use of sublingual immunotherapy for rhinitis and asthma. For seasonal allergies the benefit is small. In this form the allergen is given under the tongue and people often prefer it to injections. Immunotherapy is not recommended as a stand-alone treatment for asthma.

Alternative medicine
An experimental treatment, enzyme potentiated desensitization (EPD), has been tried for decades but is not generally accepted as effective. EPD uses dilutions of allergen and an enzyme, beta-glucuronidase, to which T-regulatory lymphocytes are supposed to respond by favoring desensitization, or down-regulation, rather than sensitization. EPD has also been tried for the treatment of autoimmune diseases, but evidence does not show effectiveness.

A review found no effectiveness of homeopathic treatments and no difference compared with placebo. The authors concluded that based on rigorous clinical trials of all types of homeopathy for childhood and adolescence ailments, there is no convincing evidence that supports the use of homeopathic treatments.

According to the National Center for Complementary and Integrative Health, U.S., the evidence is relatively strong that saline nasal irrigation and butterbur are effective, when compared to other alternative medicine treatments, for which the scientific evidence is weak, negative, or nonexistent, such as honey, acupuncture, omega 3's, probiotics, astragalus, capsaicin, grape seed extract, Pycnogenol, quercetin, spirulina, stinging nettle, tinospora, or guduchi.

Epidemiology
The allergic diseases—hay fever and asthma—have increased in the Western world over the past 2–3 decades. Increases in allergic asthma and other atopic disorders in industrialized nations, it is estimated, began in the 1960s and 1970s, with further increases occurring during the 1980s and 1990s, although some suggest that a steady rise in sensitization has been occurring since the 1920s. The number of new cases per year of atopy in developing countries has, in general, remained much lower.

Changing frequency
Although genetic factors govern susceptibility to atopic disease, increases in atopy have occurred within too short a period to be explained by a genetic change in the population, thus pointing to environmental or lifestyle changes. Several hypotheses have been identified to explain this increased rate. Increased exposure to perennial allergens may be due to housing changes and increased time spent indoors, and a decreased activation of a common immune control mechanism may be caused by changes in cleanliness or hygiene, and exacerbated by dietary changes, obesity, and decline in physical exercise. The hygiene hypothesis maintains that high living standards and hygienic conditions exposes children to fewer infections. It is thought that reduced bacterial and viral infections early in life direct the maturing immune system away from TH1 type responses, leading to unrestrained TH2 responses that allow for an increase in allergy.

Changes in rates and types of infection alone, however, have been unable to explain the observed increase in allergic disease, and recent evidence has focused attention on the importance of the gastrointestinal microbial environment. Evidence has shown that exposure to food and fecal-oral pathogens, such as hepatitis A, Toxoplasma gondii, and Helicobacter pylori (which also tend to be more prevalent in developing countries), can reduce the overall risk of atopy by more than 60%, and an increased rate of parasitic infections has been associated with a decreased prevalence of asthma. It is speculated that these infections exert their effect by critically altering TH1/TH2 regulation. Important elements of newer hygiene hypotheses also include exposure to endotoxins, exposure to pets and growing up on a farm.

History
Some symptoms attributable to allergic diseases are mentioned in ancient sources. Particularly, three members of the Roman Julio-Claudian dynasty (Augustus, Claudius and Britannicus) are suspected to have a family history of atopy. The concept of "allergy" was originally introduced in 1906 by the Viennese pediatrician Clemens von Pirquet, after he noticed that patients who had received injections of horse serum or smallpox vaccine usually had quicker, more severe reactions to second injections. Pirquet called this phenomenon "allergy" from the Ancient Greek words ἄλλος allos meaning "other" and ἔργον ergon meaning "work".

All forms of hypersensitivity used to be classified as allergies, and all were thought to be caused by an improper activation of the immune system. Later, it became clear that several different disease mechanisms were implicated, with a common link to a disordered activation of the immune system. In 1963, a new classification scheme was designed by Philip Gell and Robin Coombs that described four types of hypersensitivity reactions, known as Type I to Type IV hypersensitivity. With this new classification, the word allergy, sometimes clarified as a true allergy, was restricted to type I hypersensitivities (also called immediate hypersensitivity), which are characterized as rapidly developing reactions involving IgE antibodies.

A major breakthrough in understanding the mechanisms of allergy was the discovery of the antibody class labeled immunoglobulin E (IgE). IgE was simultaneously discovered in 1966–67 by two independent groups: Ishizaka's team at the Children's Asthma Research Institute and Hospital in Denver, USA, and by Gunnar Johansson and Hans Bennich in Uppsala, Sweden. Their joint paper was published in April 1969.

Diagnosis
Radiometric assays include the radioallergosorbent test (RAST test) method, which uses IgE-binding (anti-IgE) antibodies labeled with radioactive isotopes for quantifying the levels of IgE antibody in the blood.

The RAST methodology was invented and marketed in 1974 by Pharmacia Diagnostics AB, Uppsala, Sweden, and the acronym RAST is actually a brand name. In 1989, Pharmacia Diagnostics AB replaced it with a superior test named the ImmunoCAP Specific IgE blood test, which uses the newer fluorescence-labeled technology.

American College of Allergy Asthma and Immunology (ACAAI) and the American Academy of Allergy Asthma and Immunology (AAAAI) issued the Joint Task Force Report "Pearls and pitfalls of allergy diagnostic testing" in 2008, and is firm in its statement that the term RAST is now obsolete:

"The term RAST became a colloquialism for all varieties of (in vitro allergy) tests. This is unfortunate because it is well recognized that there are well-performing tests and some that do not perform so well, yet they are all called RASTs, making it difficult to distinguish which is which. For these reasons, it is now recommended that use of RAST as a generic descriptor of these tests be abandoned."

The updated version, the ImmunoCAP Specific IgE blood test, is the only specific IgE assay to receive Food and Drug Administration approval to quantitatively report to its detection limit of 0.1kU/L.

Medical specialty
An allergist is a physician specially trained to manage and treat allergies, asthma, and the other allergic diseases. In the United States physicians holding certification by the American Board of Allergy and Immunology (ABAI) have successfully completed an accredited educational program and evaluation process, including a proctored examination to demonstrate knowledge, skills, and experience in patient care in allergy and immunology. Becoming an allergist/immunologist requires completion of at least nine years of training. After completing medical school and graduating with a medical degree, a physician will undergo three years of training in internal medicine (to become an internist) or pediatrics (to become a pediatrician). Once physicians have finished training in one of these specialties, they must pass the exam of either the American Board of Pediatrics (ABP), the American Osteopathic Board of Pediatrics (AOBP), the American Board of Internal Medicine (ABIM), or the American Osteopathic Board of Internal Medicine (AOBIM). Internists or pediatricians wishing to focus on the sub-specialty of allergy-immunology then complete at least an additional two years of study, called a fellowship, in an allergy/immunology training program. Allergist/immunologists listed as ABAI-certified have successfully passed the certifying examination of the ABAI following their fellowship.

In the United Kingdom, allergy is a subspecialty of general medicine or pediatrics. After obtaining postgraduate exams (MRCP or MRCPCH), a doctor works for several years as a specialist registrar before qualifying for the General Medical Council specialist register. Allergy services may also be delivered by immunologists. A 2003 Royal College of Physicians report presented a case for improvement of what were felt to be inadequate allergy services in the UK. In 2006, the House of Lords convened a subcommittee. It concluded likewise in 2007 that allergy services were insufficient to deal with what the Lords referred to as an "allergy epidemic" and its social cost; it made several recommendations.

Research
Low-allergen foods are being developed, as are improvements in skin prick test predictions; evaluation of the atopy patch test, wasp sting outcomes predictions, a rapidly disintegrating epinephrine tablet, and anti-IL-5 for eosinophilic diseases.

title: Allergy