Numerous allergens have proteolytic activities. It has been speculated that this property may contribute to their allergenicity. Therefore, we have evaluated the effect of different physiological protease inhibitors (PI) on the regulation of human IgE synthesis. Unexpectedly, the serine PI, alpha-1 antitrypsin, also called alpha-1 protease inhibitor (alpha1PI), induced a potent and selective dose-dependent increase of IgE and IgG4 production by human tonsillar B cells stimulated with the IgE and IgG4 switch factors, IL-4 and anti-CD40 mAb. The other serine PI tested were inefficient. Furthermore, this effect of alpha1PI was accompanied by an increase in (1) germ-line and mature sigma mRNA transcription, (2) proliferation and (3) membrane CD23 and CD21 expression, while the expression of other molecules involved in the regulation of IgE synthesis was unchanged. Since CD23-CD21 pairing plays a crucial role in the up-regulation of IgE synthesis, we have tested whether blocking this interaction affected alpha1PI-increased IgE production. The neutralizing anti-CD23 mAb, Mab 25, partly reversed the IgE increase caused by alpha1PI. Moreover, alpha1PI potentiation of IgE synthesis was prevented by elastase, a natural substrate of alpha1PI, thereby suggesting that alpha1PI may inhibit endogenous B cell enzyme(s) involved in the down-regulation of IgE synthesis. Alpha1PI also potentiated IgE and IgG4 production by IL-4-stimulated peripheral blood mononuclear cells but was not a switch factor for IgE and IgG4 as it was unable to replace IL-4 or anti-CD40 mAb in inducing IgE and IgG4 production. In conclusion, this study shows that alpha1PI acts as a potent co-stimulus for IgE and IgG4 synthesis and suggests that the equilibrium between protease/ protease inhibitor participates in the control of human IgE and IgG4 synthesis.