• Aleksey Gareev Director of the PE “Medical Laboratory of Simesta”
Keywords: pathogenesis of allergic diseases, evolution of protective reactions, antigenicity, immunogenicity, microbiome, epitopes, protein destruction, passive diffusion, dissociation, isoelectric state, personalized diagnosis and therapy


The review is devoted to a separate analysis of cause-and-effect relationships in allergology. Evaluating the assumptions made more than a hundred years ago, canonical for modern specialists, the well-known facts are listed that change the distorted sequence of the causes of an allergic disease: the consequences must be perceived as clinical manifestations.
Emphasis is placed on the fact that “allergy” is a separate manifestation of inflammation, which from a pathophysiological point of view is a universal, typical response to the effect of a phlogogen, regardless of its nature, including the carrying antigenic factor. This determines the stages in the dynamics of the occurrence of an allergic reaction. The causative factor is the introduction of phlogogen into the internal environment of the macroorganism. As a result of the antigenic structure of the phlogogen, the immune system induces a response, which is expressed in the appointment of an IgE-mediated reaction to interact with protein structures in the normal mode for it. The characteristics of “hypersensitivity” are inherent in any acute inflammatory reaction.
An analysis is given of the evolutionary development of defense mechanisms that involve IgE-mediated reactions inherent exclusively in placental mammals as the highest link in the phylogenesis of the animal world. This fact excludes the induction of IgE as a cause of an allergic reaction from current ideas.
The mechanism of resorption of weak electrolytes, which include aqueous solutions of proteins, through the mucous membranes and skin is described.
The decisive importance of the microbiome in the process of destruction of biological substrates, including proteins, which takes place at the border of the external and internal environment of the macroorganism, is emphasized.
The completeness of the breakdown of protein structures to amino acids ensures the tolerance of the immune system.
The microbiome is an integral chimeric organ of a macroorganism; attempts to evaluate the role of the individual components of such an organ lead to a distorted view of reality. The principles on which the sustainability and reproduction of the microbiome microecosystem are based need to be understood as soon as possible. Without this, it is impossible to formulate full-fledged, and therefore effective, approaches in targeted, personalized treatment of allergic conditions.
Proposals are made to develop additional methods for the laboratory diagnosis of allergic diseases using the principles of epitope allergology, which should provide additional information when choosing personalized therapies. It is stated that ASIT can be applied exclusively for palliative purposes


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