The mechanisms of antiinflammatory steroid action in allergic diseases.

Since the recognition of the antiinflammatory actions of adrenal extracts, the adrenal glucocorticosteroids (hereinafter referred to as steroids) have been the mainstay in the therapy of severe allergic diseases of the skin, the nasal airways, and the lungs. In fact, if their use was not accompanied by undesirable side effects, steroids easily might be the only drugs used. A great deal of progress has been made in our efforts to understand the mechanisms of antiinflammatory steroid action; the purpose of this review is to discuss our present state of knowledge, with an emphasis on steroid actions in the allergic, IgE-mediated diseases. The review has been divided into three major parts: the in vivo actions of steroids, in the clinical setting and in experimental model systems; the in vitro actions of steroids, in particular the effects of steroids on inflammatory cell types likely to be important effectors of allergic disease; and the theories of steroid action, again from the perspective of their antiallergic effects.