Neuroimmune interplay during type 2 inflammation: Symptoms, mechanisms, and therapeutic targets in atopic diseases

J Allergy Clin Immunol. 2024 Apr;153(4):879-893. doi: 10.1016/j.jaci.2023.08.017. Epub 2023 Aug 25.

Abstract

Type 2 inflammation is characterized by overexpression and heightened activity of type 2 cytokines, mediators, and cells that drive neuroimmune activation and sensitization to previously subthreshold stimuli. The consequences of altered neuroimmune activity differ by tissue type and disease; they include skin inflammation, sensitization to pruritogens, and itch amplification in atopic dermatitis and prurigo nodularis; airway inflammation and/or hyperresponsiveness, loss of expiratory volume, airflow obstruction and increased mucus production in asthma; loss of sense of smell in chronic rhinosinusitis with nasal polyps; and dysphagia in eosinophilic esophagitis. We describe the neuroimmune interactions that underlie the various sensory and autonomic pathologies in type 2 inflammatory diseases and present recent advances in targeted treatment approaches to reduce type 2 inflammation and its associated symptoms in these diseases. Further research is needed to better understand the neuroimmune mechanisms that underlie chronic, sustained inflammation and its related sensory pathologies in diseases associated with type 2 inflammation.

Keywords: Type 2 inflammation; asthma; atopic dermatitis; chronic rhinosinusitis with nasal polyposis; cytokines; eosinophilic esophagitis; neuroimmune; neuropeptides; prurigo nodularis; sensory neurons.

Publication types

  • Review

MeSH terms

  • Asthma*
  • Dermatitis, Atopic*
  • Humans
  • Inflammation
  • Pruritus / drug therapy
  • Sinusitis* / pathology