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The original classification of hypersensitivity reactions has been expanded to encompass nine distinct types, including those mediated by antibodies (I-III), cells (IVa-c), tissues (V-VI), and direct responses to chemicals (VII).
In a groundbreaking move, the European Academy of Allergy and Clinical Immunology (EAACI) has released a comprehensive position paper addressing the need for an updated nomenclature for allergic diseases and hypersensitivity reactions. The rapid expansion of precision diagnostic tools, encompassing cutting-edge omic technologies, molecular diagnostics, advanced genetic and epigenetic editing, state-of-the-art imaging techniques, nano-technologies, and improved access of patients to extensive healthcare, has ushered in a new era of understanding allergic conditions.
This modern approach acknowledges the enormous wealth of unbiased data that has become available, enabling scientists and healthcare professionals to delve deeply into disease characterization. As a result, previously defined allergic disease classifications primarily based on symptoms are being transformed into a more precise system, emphasizing the identification of biomarkers and intricate pathogenetic and metabolic pathways.
The EAACI position paper introduces a novel nomenclature that adapts to contemporary diagnostic capabilities while respecting the historical classifications dating back to the early 20th century. Notably, hypersensitivity reactions, initially characterized by Gell and Coombs, have been broadened to include nine unique categories. These types encompass a wide spectrum of mechanisms, including antibody-based reactions (Types I-III), cell-mediated responses (Types IVa-c), tissue-driven mechanisms (Types V-VI), and direct reactions to chemicals (Type VII).
Types I-III are associated with both traditional clinical conditions and those recently identified. Types IVa-c are linked with T1, T2, and T3 responses. Types V-VI encompass scenarios involving epithelial barrier deficiencies and immune dysregulation induced by metabolic factors, while Type VII pertains to direct responses of cells and inflammation triggered by exposure to chemicals. It's important to note that in clinical practice, various combinations of these types may manifest.
These refined classifications serve to provide a more precise understanding of allergic diseases and hypersensitivity reactions, facilitating tailored treatment and management strategies. The EAACI's innovative approach recognizes the clinical relevance of this modern nomenclature, particularly in cases where multiple endotypes may overlap and evolve over a patient's lifetime. An additional article set to be released later this year will delve into the practical implications and significance of this approach in allergy practice, providing valuable insights for healthcare providers and patients alike.
This revolutionary nomenclature represents a pivotal step forward in the field of allergy and clinical immunology, offering a more accurate and personalized framework for the diagnosis, management, and treatment of allergic diseases and hypersensitivity reactions. The EAACI's commitment to adapting to the ever-evolving landscape of healthcare and diagnostics is evident in this forward-thinking position paper, promising a brighter future for those affected by these conditions.
Allergy
Nomenclature of allergic diseases and hypersensitivity reactions: Adapted to modern needs: An EAACI position paper
Marek Jutel et al.
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