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

Marek Jutel*, Ioana Agache*, Magdalena Zemelka-Wiacek, Mübeccel Akdis, Tomás Chivato, Stefano del Giacco, Pawel Gajdanowicz, Ibon Eguiluz Gracia, Ludger Klimek, Antti Lauerma, Markus Ollert, Liam O'Mahony, Jürgen Schwarze, Mohamed H. Shamji, Isabel Skypala, Oscar Palomares, Oliver Pfaar, Maria Jose Torres, Jonathan A. Bernstein, Alvaro A. CruzStephen R. Durham, Stephen J. Galli, R. Maximiliano Gómez, Emma Guttman-Yassky, Tari Haahtela, Stephen T. Holgate, Kenji Izuhara, Kenji Kabashima, Désirée E. Larenas-Linnemann, Erica von Mutius, Kari C. Nadeau, Ruby Pawankar, Tomas A.E. Platts-Mills, Scott H. Sicherer, Hae Sim Park, Stefan Vieths, Gary Wong, Luo Zhang, M. Beatrice Bilò, Cezmi A. Akdis*

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

37 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)2851-2874
Number of pages24
JournalAllergy: European Journal of Allergy and Clinical Immunology
Issue number11
Early online date10 Oct 2023
Publication statusPublished - Nov 2023


  • allergic diseases
  • EAACI position paper
  • hypersensitivity
  • nomenclature
  • pathophysiology and mechanism


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