Nomenclature of allergic diseases and hypersensitivity reactions: Adapted to modern needs: An EAACI position paper

Marek Jutel^{1

2}, Ioana Agache³, Magdalena Zemelka-Wiacek¹, Mübeccel Akdis⁴, Tomás Chivato⁵, Stefano Del Giacco^{6

7}, Pawel Gajdanowicz¹, Ibon Eguiluz Gracia⁸, Ludger Klimek^{9

10}, Antti Lauerma¹¹, Markus Ollert^{12

13}, Liam O'Mahony¹⁴, Jürgen Schwarze¹⁵, Mohamed H Shamji^{16

17}, Isabel Skypala^{18

19}, Oscar Palomares²⁰, Oliver Pfaar²¹, Maria Jose Torres⁸, Jonathan A Bernstein²², Alvaro A Cruz²³, Stephen R Durham²⁴, Stephen J Galli²⁵, R Maximiliano Gómez²⁶, Emma Guttman-Yassky²⁷, Tari Haahtela²⁸, Stephen T Holgate²⁹, Kenji Izuhara³⁰, Kenji Kabashima³¹, Désirée E Larenas-Linnemann³², Erica von Mutius^{33

34

35}, Kari C Nadeau³⁶, Ruby Pawankar³⁷, Tomas A E Platts-Mills³⁸, Scott H Sicherer³⁹, Hae-Sim Park⁴⁰, Stefan Vieths⁴¹, Gary Wong⁴², Luo Zhang^{43

44}, M Beatrice Bilò⁴⁵, Cezmi A Akdis⁴

Affiliations

¹ Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland.
² ALL-MED Medical Research Institute, Wroclaw, Poland.
³ Faculty of Medicine, Transylvania University, Brasov, Romania.
⁴ Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.
⁵ School of Medicine, University CEU San Pablo, Madrid, Spain.
⁶ Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
⁷ Unit of Allergy and Clinical Immunology, University Hospital "Duilio Casula", Monserrato, Italy.
⁸ Allergy Unit, UMA-Regional University Hospital of Malaga, IBIMA-BIONAND, Malaga, Spain.
⁹ Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany.
¹⁰ Center for Rhinology and Allergology, Wiesbaden, Germany.
¹¹ Department of Dermatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
¹² Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg.
¹³ Department of Dermatology and Allergy Centre, Odense University Hospital, Odense Research Center for Anaphylaxis (ORCA), Odense, Denmark.
¹⁴ Departments of Medicine and Microbiology, APC Microbiome Ireland, National University of Ireland, Cork, Ireland.
¹⁵ Child Life and Health, Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK.
¹⁶ National Heart and Lung Institute, Imperial College London, London, UK.
¹⁷ NIHR Imperial Biomedical Research Centre, London, UK.
¹⁸ Department of Inflammation and Repair, Imperial College London, London, UK.
¹⁹ Royal Brompton and Harefield Hospitals, Part of Guys and St Thomas' NHS Foundation Trust, London, UK.
²⁰ Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University of Madrid, Madrid, Spain.
²¹ Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany.
²² Department of Internal Medicine, Division of Rheumatology, Allergy and Immunology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
²³ Fundaçao ProAR, Federal University of Bahia and GARD/WHO Planning Group, Salvador, Bahia, Brazil.
²⁴ Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College London, London, UK.
²⁵ Department of Pathology and Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, California, USA.
²⁶ Faculty of Health Sciences, Catholic University of Salta, Salta, Argentina.
²⁷ Department of Dermatology and the Laboratory for Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
²⁸ Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
²⁹ Academic Unit of Clinical and Experimental Sciences, University of Southampton, Southampton, UK.
³⁰ Department of Biomolecular Sciences, Division of Medical Biochemistry, Saga Medical School, Saga, Japan.
³¹ Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
³² Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, Mexico City, Mexico.
³³ Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, Munich, Germany.
³⁴ Institute of Asthma and Allergy Prevention, Helmholtz Centre Munich, Munich, Germany.
³⁵ German Center for Lung Research (DZL), Giesen, Germany.
³⁶ Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
³⁷ Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
³⁸ Department of Medicine, Division of Allergy and Clinical Immunology, University of Virginia School of Medicine, Charlottesville, Virginia, USA.
³⁹ Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁴⁰ Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea.
⁴¹ Paul-Ehrlich-Institut, Langen, Germany.
⁴² Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China.
⁴³ Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
⁴⁴ Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.
⁴⁵ Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona and Allergy Unit, Department of Internal Medicine, University Hospital of Marche, Ancona, Italy.

PMID: 37814905
DOI: 10.1111/all.15889

Nomenclature of allergic diseases and hypersensitivity reactions: Adapted to modern needs: An EAACI position paper

Marek Jutel et al. Allergy. 2023 Nov.

. 2023 Nov;78(11):2851-2874.

doi: 10.1111/all.15889. Epub 2023 Oct 10.

Authors

Affiliations

¹ Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland.
² ALL-MED Medical Research Institute, Wroclaw, Poland.
³ Faculty of Medicine, Transylvania University, Brasov, Romania.
⁴ Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.
⁵ School of Medicine, University CEU San Pablo, Madrid, Spain.
⁶ Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
⁷ Unit of Allergy and Clinical Immunology, University Hospital "Duilio Casula", Monserrato, Italy.
⁸ Allergy Unit, UMA-Regional University Hospital of Malaga, IBIMA-BIONAND, Malaga, Spain.
⁹ Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany.
¹⁰ Center for Rhinology and Allergology, Wiesbaden, Germany.
¹¹ Department of Dermatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
¹² Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg.
¹³ Department of Dermatology and Allergy Centre, Odense University Hospital, Odense Research Center for Anaphylaxis (ORCA), Odense, Denmark.
¹⁴ Departments of Medicine and Microbiology, APC Microbiome Ireland, National University of Ireland, Cork, Ireland.
¹⁵ Child Life and Health, Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK.
¹⁶ National Heart and Lung Institute, Imperial College London, London, UK.
¹⁷ NIHR Imperial Biomedical Research Centre, London, UK.
¹⁸ Department of Inflammation and Repair, Imperial College London, London, UK.
¹⁹ Royal Brompton and Harefield Hospitals, Part of Guys and St Thomas' NHS Foundation Trust, London, UK.
²⁰ Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University of Madrid, Madrid, Spain.
²¹ Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany.
²² Department of Internal Medicine, Division of Rheumatology, Allergy and Immunology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
²³ Fundaçao ProAR, Federal University of Bahia and GARD/WHO Planning Group, Salvador, Bahia, Brazil.
²⁴ Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College London, London, UK.
²⁵ Department of Pathology and Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, California, USA.
²⁶ Faculty of Health Sciences, Catholic University of Salta, Salta, Argentina.
²⁷ Department of Dermatology and the Laboratory for Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
²⁸ Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
²⁹ Academic Unit of Clinical and Experimental Sciences, University of Southampton, Southampton, UK.
³⁰ Department of Biomolecular Sciences, Division of Medical Biochemistry, Saga Medical School, Saga, Japan.
³¹ Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
³² Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, Mexico City, Mexico.
³³ Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, Munich, Germany.
³⁴ Institute of Asthma and Allergy Prevention, Helmholtz Centre Munich, Munich, Germany.
³⁵ German Center for Lung Research (DZL), Giesen, Germany.
³⁶ Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
³⁷ Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
³⁸ Department of Medicine, Division of Allergy and Clinical Immunology, University of Virginia School of Medicine, Charlottesville, Virginia, USA.
³⁹ Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁴⁰ Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea.
⁴¹ Paul-Ehrlich-Institut, Langen, Germany.
⁴² Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China.
⁴³ Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
⁴⁴ Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.
⁴⁵ Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona and Allergy Unit, Department of Internal Medicine, University Hospital of Marche, Ancona, Italy.

PMID: 37814905
DOI: 10.1111/all.15889

Erratum in

Correction to: Nomenclature of allergic diseases and hypersensitivity reactions: Adapted to modern needs: An EAACI position paper.
[No authors listed] [No authors listed] Allergy. 2024 Jan;79(1):269-273. doi: 10.1111/all.15983. Allergy. 2024. PMID: 38161149 No abstract available.

Abstract

The exponential growth of precision diagnostic tools, including omic technologies, molecular diagnostics, sophisticated genetic and epigenetic editing, imaging and nano-technologies and patient access to extensive health care, has resulted in vast amounts of unbiased data enabling in-depth disease characterization. New disease endotypes have been identified for various allergic diseases and triggered the gradual transition from a disease description focused on symptoms to identifying biomarkers and intricate pathogenetic and metabolic pathways. Consequently, the current disease taxonomy has to be revised for better categorization. This European Academy of Allergy and Clinical Immunology Position Paper responds to this challenge and provides a modern nomenclature for allergic diseases, which respects the earlier classifications back to the early 20th century. Hypersensitivity reactions originally described by Gell and Coombs have been extended into nine different types comprising antibody- (I-III), cell-mediated (IVa-c), tissue-driven mechanisms (V-VI) and direct response to chemicals (VII). Types I-III are linked to classical and newly described clinical conditions. Type IVa-c are specified and detailed according to the current understanding of T1, T2 and T3 responses. Types V-VI involve epithelial barrier defects and metabolic-induced immune dysregulation, while direct cellular and inflammatory responses to chemicals are covered in type VII. It is notable that several combinations of mixed types may appear in the clinical setting. The clinical relevance of the current approach for allergy practice will be conferred in another article that will follow this year, aiming at showing the relevance in clinical practice where various endotypes can overlap and evolve over the lifetime.

Keywords: EAACI position paper; allergic diseases; hypersensitivity; nomenclature; pathophysiology and mechanism.

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References

REFERENCES

1. Lötvall J, Akdis CA, Bacharier LB, et al. Asthma endotypes: a new approach to classification of disease entities within the asthma syndrome. J Allergy Clin Immunol. 2011;127(2):355-360. doi:10.1016/j.jaci.2010.11.037
1. Ozdemir C, Kucuksezer UC, Akdis M, Akdis CA. The concepts of asthma endotypes and phenotypes to guide current and novel treatment strategies. Expert Rev Respir Med. 2018;12(9):733-743. doi:10.1080/17476348.2018.1505507
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Nomenclature of allergic diseases and hypersensitivity reactions: Adapted to modern needs: An EAACI position paper

Affiliations

Nomenclature of allergic diseases and hypersensitivity reactions: Adapted to modern needs: An EAACI position paper

Authors

Affiliations

Erratum in

Abstract

References

REFERENCES

MeSH terms

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LinkOut - more resources

Full Text Sources

Medical