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Die Klassifizierung nach immunologischen Endotypen, insbesondere des T2-Endotyps, gewinnt zunehmend an Bedeutung. Diese basiert auf der Hypersensitivit\u00e4tslehre nach Coombs und Gell, die zellvermittelte Typ-IV-Reaktionen als T1-, T2- und T3-Endotypen einteilt. Bei der chronischen Rhinosinusitis mit Nasenpolypen (CRSwNP) spielen genetische und epigenetische Ver\u00e4nderungen des mukosalen Immunsystems eine wesentliche Rolle. Die Identifizierung spezifischer Endotypen erm\u00f6glicht es, die Heterogenit\u00e4t der Erkrankung besser zu verstehen und ma\u00dfgeschneiderte Therapieans\u00e4tze zu entwickeln. Ziel dieser Arbeit ist es, die zugrunde liegenden immunologischen Mechanismen zu systematisieren und deren Relevanz f\u00fcr Diagnostik und Therapie darzustellen<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methodik<\/jats:title>\n            <jats:p>Die Europ\u00e4ische Akademie f\u00fcr Allergie und klinische Immunologie (EAACI) ver\u00f6ffentlichte k\u00fcrzlich eine aktualisierte Nomenklatur f\u00fcr immunologische \u00dcberempfindlichkeitsreaktionen. Die urspr\u00fcnglich von Coombs und Gell klassifizierten Antik\u00f6rper-vermittelten Reaktionen (Typ\u00a0I\u2013III) wurden erweitert. Die zellvermittelten Reaktionen umfassen nun: Typ\u00a0IVa (T1) \u2192 Th1-dominierte Reaktionen; Typ\u00a0IVb (T2) \u2192 Th2-dominierte Reaktionen; Typ\u00a0IVc (T3) \u2192 Th17-dominierte Reaktionen. Diese neuen Erkenntnisse zu T1-, T2- und T3-Signalwegen bilden die Grundlage dieser Arbeit. Weitere Mechanismen wie epitheliale Barrieredefekte (Typ\u00a0V), chemische Reaktionen (Typ\u00a0VI) und stoffwechselbedingte Immundysregulationen (Typ\u00a0VII) werden separat behandelt.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Ergebnisse<\/jats:title>\n            <jats:p>Die Endotypisierung zeigt deutliche regionale Unterschiede: Der T2-(Th2-hoch\u2011) Endotyp, der in Europa, Nord- und S\u00fcdamerika sowie Australien dominiert, zeichnet sich durch erh\u00f6hte Th2-Zytokine (IL\u20114, IL\u20115, IL-13) und eosinophile Entz\u00fcndungen aus. Der T1-(Th1-hoch\u2011) Endotyp zeigt eine dominante Interferon-Gamma-Aktivit\u00e4t und eine nichteosinophile, meist neutrophile Entz\u00fcndung. Der T3-(Th17-hoch\u2011) Endotyp ist durch eine erh\u00f6hte IL-17-Pr\u00e4senz gekennzeichnet und tritt sowohl bei eosinophiler als auch nichteosinophiler CRSwNP auf.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Schlussfolgerungen<\/jats:title>\n            <jats:p>Bei CRSwNP-Patienten k\u00f6nnen alle drei Hyperreaktivit\u00e4ts-Endotypen (T1, T2, T3) isoliert oder kombiniert auftreten. Der T2-Endotyp ist in Europa am h\u00e4ufigsten. Eine gezielte Endotypisierung erm\u00f6glicht differenzierte Therapieans\u00e4tze und neue Behandlungsoptionen.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00106-025-01600-9","type":"journal-article","created":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T21:40:17Z","timestamp":1744148417000},"page":"474-482","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Verschiedene immunologische Typen der CRSwNP im Kontext der neuen Europ\u00e4ischen EAACI-Nomenklatur","Different immunological types of CRSwNP in the context of the new European EAACI nomenclature"],"prefix":"10.1007","volume":"73","author":[{"given":"L.","family":"Klimek","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Becker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B.","family":"Haxel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Cuevas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P.","family":"Huber","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Chaker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"O.","family":"Pfaar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Laudien","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Beutner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Hagemann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"U.","family":"F\u00f6rster-Ruhrmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H.","family":"Olze","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B. 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L.\u00a0Klimek erhielt Forschungsstipendien und\/oder Vortragshonorare von Allergy Therapeutics\/Bencard, Gro\u00dfbritannien\/Deutschland; ALK-Abell\u00f3, D\u00e4nemark; Allergopharma, Deutschland; ASIT Biotech, Belgien; AstraZeneca, Schweden, Bionorica, Deutschland; Biomay, \u00d6sterreich, Boehringer Ingelheim, Deutschland, Circassia, USA; Stallergene, Frankreich; Cytos, Schweiz; Curalogic, D\u00e4nemark; HAL, Niederlande; Hartington, Spanien; Lofarma, Italien; MEDA\/Mylan, Schweden\/USA; Novartis, Schweiz, Leti, Spanien; ROXALL, Deutschland; GlaxoSmithKline (GSK), Gro\u00dfbritannien; Sanofi, Frankreich und\/oder war beratend f\u00fcr die oben genannten pharmazeutischen Unternehmen t\u00e4tig. LK ist Herausgeber des Allergo Journal und des Allergo Journal International und er ist der derzeitige Pr\u00e4sident des AeDA (\u00c4rzteverbandes Deutscher Allergologen) und Chair der ENT Section im ROC der EAACI. M.\u00a0Gr\u00f6ger erhielt Studiengelder und\/oder Honorare und\/oder Reeisekostenunterst\u00fctzung von ALK-Abell\u00f3 Arzneimittel GmbH, Allergopharma GmbH & Co. KG, AstraZeneca GmbH, Bencard Allergie GmbH, Glaxo Smith Kline GmbH & Co. KG, HAL Allergie GmbH, LETI Pharma GmbH, Mylan Germany GmbH, Novartis Pharma GmbH, Phadia\u00a0\u2013 Thermo Fisher Scientific Inc., Sanofi-Aventis Deutschland GmbH, Shire Deutschland GmbH, und Stallergenes GmbH. B.P.\u00a0Ernst erhielt Honorare von GSK und Sanofi, au\u00dferhalb der eingereichten Arbeit. C.\u00a0Beutner war Referentin\/Beraterin f\u00fcr ALK-Abello, GlaxoSmithKline, Novartis, Sanofi-Genzyme und Astrazeneca. O.\u00a0Pfaar gibt Studiengelder und\/oder Honorare und\/oder Reeisekostenunterst\u00fctzung von ALK-Abell\u00f3, Allergopharma, Stallergenes Greer, HAL Allergy Holding B.V.\/HAL Allergie GmbH, Bencard Allergie GmbH\/Allergy Therapeutics, Laboratorios LETI\/LETI Pharma, GlaxoSmithKline, ROXALL Medizin, Novartis, Sanofi-Aventis and Sanofi-Genzyme, Med Update Europe GmbH, streamedup! GmbH, Pohl-Boskamp, John Wiley and Sons\/AS, Paul-Martini-Stiftung (PMS), Regeneron Pharmaceuticals Inc., RG Aerztefortbildung, Institut f\u00fcr Disease Management, Springer GmbH, AstraZeneca, IQVIA Commercial, Inmunotek\u00a0S.L., Ingress Health, Wort&Bild Verlag, Verlag ME, Procter&Gamble, ALTAMIRA, Meinhardt Congress GmbH, Deutsche Forschungsgemeinschaft, Thieme, Deutsche AllergieLiga e.\u202fV., AeDA, Alfried-Krupp Krankenhaus, Red Maple Trials Inc., K\u00f6niglich D\u00e4nisches Generalkonsulat, Medizinische Hochschule Hannover, ECM Expro&Conference Management, Technical University Dresden, Lilly, Japanese Society of Allergy, Forum f\u00fcr Medizinische Fortbildung, Dustri-Verlag, Pneumolive, ASIT Biotech, LOFARMA, Almirall, Paul-Ehrlich-Institut an, alle au\u00dferhalb der vorliegenden \u00dcbersichtsarbeit; und er ist Vizepr\u00e4sident\/Vice President der European Academy of Allergy and Clinical Immunology (EAACI) und Mitglied des Vorstandes\/ExCom der EAACI, Mitglied des erweiterten Vorstandes der Deutschen Gesellschaft f\u00fcr Allergologie und Klinische Immunologie (DGAKI); Koordinator, Haupt-oder Ko-Autor von verschiedenen Leitlinien und Positionspapieren in der Rhinologie und Allergologie; und er ist Associate Editor der Zeitschriften Allergy und Clinical Translational Allergy (CTA). S.\u00a0Becker, B.\u00a0Haxel, P.\u00a0Huber, A.\u00a0Chaker, M.\u00a0Laudien, J.\u00a0Hagemann, U.\u00a0F\u00f6rster-Ruhrmann, H.\u00a0Olze, A.\u00a0Beule, C.\u00a0Rudack, A.S.\u00a0Hoffmann und C.\u00a0Betz geben an, dass kein Interessenkonflikt besteht.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Interessenkonflikt"}},{"value":"F\u00fcr diesen Beitrag wurden von den Autor\/-innen keine Studien an Menschen oder Tieren durchgef\u00fchrt. F\u00fcr die aufgef\u00fchrten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Interessenkonflikt"}}]}}