The origins of allergy from a systems approach

Ann Allergy Asthma Immunol. 2020 Nov;125(5):507-516. doi: 10.1016/j.anai.2020.07.013. Epub 2020 Jul 21.


Objective: The origins of allergic diseases have traditionally been explained by immunoglobulin E-mediated immune responses to account for asthma, atopic dermatitis, atopic rhinitis, and food allergy. Research insights into disease origins support a broader array of factors that predispose, initiate, or exacerbate altered immunity in allergic diseases, such as (1) inherent epithelial barrier dysfunction; (2) loss of immune tolerance; (3) disturbances in the gut; and (4) organ-specific microbiomes, diet, and age. Here, we discuss these influences that together form a better understanding of allergy as a systems disease.

Data sources: We summarize recent advances in epithelial dysfunction, environmental influences, inflammation, infection, alterations in the specific microbiome, and inherent genetic predisposition.

Study selections: We performed a literature search targeting primary and review articles.

Results: We explored microbial-epithelial-immune interactions underlying the early-life origins of allergic disorders and evaluated immune mechanisms suggesting novel disease prevention or intervention strategies. Damage to epithelial surfaces lies at the origin of various manifestations of allergic disease. As a sensor of environmental stimuli, the epithelium of the lungs, gut, and skin is affected by an altered microbiome, air pollution, food allergens in a changed diet, and chemicals in modern detergents. This collectively leads to alterations of lung, skin, or gut epithelial surfaces, driving a type 2 immune response that underlies atopic diseases. Treatment and prevention of allergic diseases include biologics, oral desensitization, targeted gut microbiome alterations, and changes in behavior.

Conclusion: Understanding the spectrum of allergy as a systems disease will allow us to better define the mechanisms of allergic disorders and improve their treatment.

Publication types

  • Review

MeSH terms

  • Asthma / immunology
  • Asthma / pathology
  • Dermatitis, Atopic / immunology
  • Dermatitis, Atopic / pathology
  • Disease Progression
  • Epithelium / immunology
  • Epithelium / metabolism
  • Food Hypersensitivity / immunology
  • Food Hypersensitivity / pathology
  • Gastrointestinal Microbiome / immunology*
  • Humans
  • Hypersensitivity / immunology*
  • Intestinal Mucosa / immunology*
  • Intestinal Mucosa / microbiology
  • Permeability
  • Respiratory Mucosa / immunology*
  • Rhinitis, Allergic / immunology
  • Rhinitis, Allergic / pathology
  • Skin / immunology*
  • Skin / pathology
  • Treatment Outcome