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Die Klassifizierung nach immunologischen Endotypen findet immer mehr Eingang in die Krankheitsdefinition, vor allem bei der chronischen Rhinosinusitis mit Nasenpolypen (CRSwNP). Hierbei spielen genetische und epigenetische Ver\u00e4nderungen im mukosalen Immunsystem eine wichtige Rolle. Die Identifizierung von Endotypen kann dazu beitragen, die Heterogenit\u00e4t innerhalb der Erkrankung zu verstehen und personalisierte Behandlungsans\u00e4tze zu entwickeln. Im Teil\u00a01 dieser Publikation hatten wir die immunologischen Klassifizierungen der Hypersensitivit\u00e4tsreaktionen vom Typ\u00a0IV dargestellt (T1-, T2-, und T3-Endotypen).<\/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) hat in einem k\u00fcrzlich erschienenen Positionspapier eine Aktualisierung der Nomenklatur f\u00fcr immunologische \u00dcberempfindlichkeitsreaktionen auf der Basis von neun verschiedenen immunologischen Reaktionstypen vorgestellt. Die urspr\u00fcnglich von Coombs und Gell klassifizierten antik\u00f6rpervermittelten Reaktionen vom Typ\u00a0I, Typ\u00a0II und Typ\u00a0III wurden erweitert und detailliert beschrieben. Epitheliale Barrieredefekte werden als Typ\u00a0V dieser Hypersensitivit\u00e4tsreaktionen definiert und werden im hier vorliegenden Teil\u00a02 dieser Publikationsreihe er\u00f6rtert.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ergebnisse<\/jats:title>\n                    <jats:p>Der Typ\u00a0V geht mit einer Beeintr\u00e4chtigung der epithelialen Barrierefunktion einher und f\u00fchrt zu einer fehlerhaften und andauernden Aktivierung des mukosalen Immunsystems und folglich zu chronischen Entz\u00fcndungen. Neben dem Defekt der Epithelbarriere ist hieran wesentlich die mikrobielle Dysbiose mit Dysregulation der Immunantwort beteiligt, einschlie\u00dflich einer umfassenden Aktivierung von Th1, Th2 und Th17 in Verbindung mit dem Verlust von regulatorischen T\u2011 und B\u2011Zellen (Treg) und (Breg). Hinzu kommen die Bildung von Serum-(s)IgE f\u00fcr Inhalations- oder Nahrungsmittelallergene, die Aktivierung von Makrophagen (M\u03c6) und die Freisetzung von proinflammatorischen Zytokinen, Chemokinen und Entz\u00fcndungsmediatoren (Histamin, Leukotriene). Der Verlust der Barrierefunktion kann auf Defekte in mehreren wesentlichen Komponenten zur\u00fcckzuf\u00fchren sein, darunter Strukturelemente, Tight-Junction-Proteine, sch\u00fctzende Antiproteasen, die Expression antimikrobieller Proteine, der Transport von Ionen, Protonen, Wasser oder antimikrobiellen Stoffen und andere Mechanismen. Mit dem Verlust der Barriere verbunden ist die Aktivierung sensorischer Nervenfasern in der Schleimhaut, die zur Entwicklung entz\u00fcndlicher Symptome beitragen.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Schlussfolgerung<\/jats:title>\n                    <jats:p>Bei Patienten mit CRSwNP k\u00f6nnen immunologische Hyperreaktivit\u00e4tsreaktionen unterschiedlicher Typen \u2013\u00a0insbesondere der Typ-IV-, Typ-V- und Typ-VI-Hypersensitivit\u00e4t\u00a0\u2013 sowohl isoliert als auch in Kombination auftreten. W\u00e4hrend Typ-IV- und Typ-VI-Reaktionen ma\u00dfgeblich zur zellul\u00e4ren Entz\u00fcndungsantwort und chronischen Persistenz beitragen, gewinnen Typ-V-Reaktionen, die durch fehlgeleitete Rezeptorsignalisierungen charakterisiert sind, zunehmend an Bedeutung im Kontext epithelialer Barrieredefekte und gest\u00f6rter mukosaler Regeneration. Ziel des vorliegenden zweiten Teils dieser \u00dcbersichtsarbeit ist es, die Mechanismen der Typ-V-Hypersensitivit\u00e4tsreaktionen darzustellen und deren Implikationen f\u00fcr eine erweiterte Diagnostik und therapeutische Ans\u00e4tze bei CRSwNP zu diskutieren.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00106-025-01705-1","type":"journal-article","created":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T15:35:03Z","timestamp":1767022503000},"page":"174-182","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"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":"74","author":[{"given":"L.","family":"Klimek","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Becker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Haxel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Cuevas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Huber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Chaker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O.","family":"Pfaar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Laudien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Beutner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Hagemann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"U.","family":"F\u00f6rster-Ruhrmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Olze","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"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; Stallergenes, 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 Reisekostenunterst\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-Abell\u00f3, GlaxoSmithKline, Novartis, Sanofi-Genzyme und AstraZeneca. B.\u00a0Haxel erhielt Studiengelder und\/oder Honorare und\/oder Reisekostenunterst\u00fctzung von ALK-Abell\u00f3, Berlin Chemie, Stallergenes Greer, Celltrion Healthcare Deutschland GmbH, Bencard Allergie GmbH\/Allergy Therapeutics, NIOX GmbH, Laboratorios LETI\/LETI Pharma, GlaxoSmithKline, Novartis, Sanofi-Aventis and Sanofi-Genzyme und AstraZeneca. O.\u00a0Pfaar gibt Studiengelder und\/oder Honorare und\/oder Reisekostenunterst\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 \u00c4rztefortbildung, Institut f\u00fcr Disease Management, Springer GmbH, AstraZeneca, IQVIA Commercial, Inmunotek S.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 Vorstands\/Executive Committee (ExCom) der EAACI, Mitglied des erweiterten Vorstandes der Deutschen Gesellschaft f\u00fcr Allergologie und Klinische Immunologie (DGAKI); Koordinator, Haupt- oder Koautor von verschiedenen Leitlinien und Positionspapieren in der Rhinologie und Allergologie; und er ist Associate Editor der Zeitschriften Allergy und Clinical Translational Allergy (CTA). H.\u00a0Olze erhielt Studiengelder und\/oder Vortragshonorare von AstraZeneca GmbH, Glaxo Smith Kline GmbH & Co. KG, Mylan Germany GmbH, Novartis Pharma GmbH, Sanofi-Aventis Deutschland GmbH und Eli Lilly and Company und\/oder war beratend f\u00fcr die oben genannten pharmazeutischen Unternehmen t\u00e4tig. M.\u00a0Laudien erhielt Unterst\u00fctzung, Vortrags- und Beraterhonorare, Zusammenarbeit in den letzten 5\u00a0Jahren von\/mit Olympus Deutschland GmbH, Olympus Europa SE & CO. KG, CSL Behring, Novartis Pharma GmbH, Sanofi-Aventis Deutschland GmbH, Brainlab Sales GmbH, GlaxoSmithKline GmbH & Co. KG, John Grube Foundation, AEDA, Meinhardt Congress GmbH, AstraZeneca, Celltrion, Stryker, MMMI, Karl Storz, Bess Medizintechnik, Medtronic, Fiagon AG Medical Technologies. A.S.\u00a0Hoffmann erhielt Honorare f\u00fcr Beratert\u00e4tigkeiten\/Vortr\u00e4ge von Sanofi-Genzyme, GSK, AstraZeneca, AEDA, Novartis Pharma GmbH, Medtronic, au\u00dferhalb der eingereichten Arbeit. S.\u00a0Becker, P.\u00a0Huber, A.\u00a0Chaker, J.\u00a0Hagemann, U.\u00a0F\u00f6rster-Ruhrmann, A.\u00a0Beule, C.\u00a0Rudack 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"}}]}}