MODERN UNDERSTANDING OF IMMUNOLOGICAL REACTION AND CLASSIFICATION EAACI2023

In 1968, Coombs P.R. and Gell P.G. proposed a classification of allergic diseases based on the then available knowledge of immunology. Four types of reactions were identified: type I - immediate (IgE-mediated), type II - cytotoxic (mediated by antibodies and Fc-receptors of cells), type III - mediated by immune complexes and type IV - delayed type (T-cell-mediated). It turned out that the classification includes the pathogenesis of not only allergic, but also autoimmune, infectious and parasitic diseases. The rapid development of immunology at the end of the twentieth and beginning of this century revealed many new patterns that required updating the classification. In 2023, the European Association of Allergists and Clinical Immunologists (EAACI) proposed its own classification. It included the first 3 types from the Coombs P.R. and Gell P.G. classification, type IV cell-mediated reactions were divided into 3 subtypes: type IVa - T1 (type Th1), IVb - T2 (type Th2), IVc - T3 (type Th17). In addition, 3 more types were added: type V - with a violation of epithelial barriers, type VI metabolically induced immune dysregulation and VII - a direct inflammatory response to chemicals. Unfortunately, the EAACI2023 classification does not give a complete picture. It does not have a single classification principle: it relies on pathogenetic, etiological, or structural aspects. But the main drawback of this classification is that the authors continue to consider allergic diseases as a separate area, while there is nothing special about them. In fact, there is not a single mechanism of allergic diseases that are at least somehow different from immunological mechanisms. Moreover, all these mechanisms were formed in the process of evolution as protective mechanisms, and not at all as pathological ones. This article analyzes modern concepts of the immune system, based on which 6 types of immune reactions and 5 levels of their implementation are identified. In addition, 5 types of effector mechanisms of immune reactions are considered, forming a complex multi-level network of immune protection. The need for knowledge of immunology by doctors of any specialty for adequate use of immunodiagnostics and immunotherapy with bioengineered drugs is discussed.

1. № ссылки Авторы, название публикации и источника, где она опубликована, выходные данные ФИО, название публикации и источника на английском языке Интернет-адрес цитируемой статьи

2. Бычкова Н.В. Новая номенклатура аллергических заболеваний и реакций гиперчувствительности.// Цитокины и воспаление. – 2024. – Т.21, №1. – С. 5-21 Bychkova N.V. New nomenclature of allergic diseases and hypersensitivity reactions. // Cytokines and Inflammation (Russian) = Cytokiny I Vospalenie, Vol. 21, no 1, pp 5-21 doi: 10.17816/CI635046

3. Топтыгина А.П. Лимфоидный фолликул – территория иммунного ответа. // Иммунология. – 2012. – Т. 33, № 3. – С. 162-169. Toptygina A.P. Lymphoid follicle is the territory of immune response. // Immunology (Russian) = Immunologya,2012, Vol.33, no. 3, pp.162-169. ISSN: 0206-4952

4. (doi нет)

5. Топтыгина А.П. Неканонические функции В-клеток. // Российский иммунологический журнал. – 2013. – Т. 7 (16), № 1. – С. 17-26. Toptygina A.P. Noncanonical function B-cells. // Russian Journal of Immunology = Rossiyskiy immunologicheskiy zhurnal, 2013, Vol.7(16), no 1, pp. 17-26 (In Russ.) ISSN: 1028-7221

6. (doi нет)

7. Топтыгина А.П. Лимфоциты врожденного иммунитета. Неизвестная галактика. //Российский иммунологический журнал. – 2014. – Т. 8 (17), № 2. – С.121-133. Toptygina A.P. Innate Lymphoid cells. Unknown galaxy. // Russian Journal of Immunology = Rossiyskiy immunologicheskiy zhurnal,2014, Vol.8(17), no 2, pp. 121-133 (In Russ.)

8. ISSN: 1028-7221

9. (doi нет)

10. Топтыгина А.П. «Роль неканонических Т-клеток в гомеостазе и патологии» // Медицинская иммунология. – 2024. – Т. 26, № 3. – С. 301-316. Toptygina A.P. Role of non-canonical T cells in homeostasis and pathology // Medical Immunology (Russia)= Meditsinskaya Immunologiya, 2024, Vol. 26, no. 3, pp. 301-316. (In Russ.). doi: 10.15789/1563-0625-RON-2918

11. Coombs P.R., Gell P.G. Classification of allergic reactions responsible for clinical hypersensitivity and disease. In: RR Gell, ed. Clinical Aspects of Immunology. Oxford University Press, 1968, pp. 575-596. (doi нет)

12.

13. Johansson SG, Bieber T, Dahl R, et al. Revised nomenclature for allergy for global use: report of the nomenclature review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol., 2004, Vol. 113(5), pp. 832-836. doi:10.1016/j.jaci.2003.12.591

14. Jutel M, Agache I, Zemelka-Wiacek M, Akdis M, Chivato T, Del Giacco S, Gajdanowicz P, Gracia IE, Klimek L, Lauerma A, Ollert M, O'Mahony L, Schwarze J, Shamji MH, Skypala I, Palomares O, Pfaar O, Torres MJ, Bernstein JA, Cruz AA, Durham SR, Galli SJ, Gómez RM, Guttman-Yassky E, Haahtela T, Holgate ST, Izuhara K, Kabashima K, Larenas-Linnemann DE, von Mutius E, Nadeau KC, Pawankar R, Platts-Mills TAE, Sicherer SH, Park HS, Vieths S, Wong G, Zhang L, Bilò MB, Akdis CA. Nomenclature of allergic diseases and hypersensitivity reactions: Adapted to modern needs: An EAACI position paper. Allergy, 2023, Vol.78(11), pp. 2851-2874. doi: 10.1111/all.15889

15. Pichler WJ. Delayed drug hypersensitivity reactions. Ann Intern Med., 2003, Vol.139(8), pp. 683-693. doi:10.7326/0003-4819-139-8-200310210-00012

16. Niec R., Rudensky A., Fuchs E. Inflammatory adaptation in barrier tissues. Cell, 2021, Vol.184(13), pp. 3361-3375. doi: 10.1016/j.cell.2021.05.036

17. Shamji M. H., Ollert M., Adcock I. M., Bennett O., Favaro A., Sarama R., Riggioni C., Annesi-Maesano I., Custovic A., Fontanella S., Traidl-Hoffmann C., Nadeau K., Cecchi L., Zemelka-Wiacek M., Akdis C. A., Jutel M., Agache I. EAACI guidelines on environmental science in allergic diseases and asthma – Leveraging artificial intelligence and machine learning to develop a causality model in exposomics. Allergy, 2023, Vol.78, pp.1742–1757. doi: 10.1111/all.15667

18. Szegedi A., Komlósi Z. I., Kapitány A., Bata-Csörgő Z., Koncz G., Bácsi A. The Complex Nomenclature of Allergic Diseases and Hypersensitivity Reactions: An Addendum to the EAACI Position Paper. Allergy, 2025, Vol.80(4), pp.1162-1165. doi: 10.1111/all.16486