When the system responsible for type 2 inflammation gets out of control, it can cause a variety of medical complications/ShutterStock
The immune system evolved to protect us from a wide variety of threats, external and internal. However, sometimes we need protection precisely when this system gets out of control. We know that a wide variety of different diseases, starting from asthma, through atopic dermatitis (which is known as "asthma of the skin") and the disease that causes the development of polyps in the nose (nasal polyposis), stem from a common source, called type 2 inflammation. Prof. Yuval Tal, The director of the immunology and allergy unit at Hadassah Hospital, explains what this inflammation is, what causes it and what can be done to treat it?
What is type 2 inflammation?
The immune system is designed to allow us to deal with a wide variety of threats, and type 2 inflammation is an inflammation caused by the action of the part of the immune system that is supposed to fight, among other things, the penetration of parasites into the body. Today, in an increasing number of cases, we suffer from a variety of diseases as a result of an overreaction of this arm of the immune system - which instead of fighting parasitic diseases, for example, identifies non-dangerous factors as a danger and attacks them.
When the system responsible for type 2 inflammation gets out of control, it can cause a variety of medical complications. Type 2 inflammation is the cause of the variety of allergies we suffer from - when the system identifies an external factor, for example a food component, flower pollen or dust, as a threat. Sometimes, the out-of-control type 2 inflammation can occur regardless of exposure to the allergen, and then the disease that is caused depends on the organ or tissue where the inflammatory response is focused: if it's the lungs, we'll suffer from asthma. In the sinuses, type 2 inflammation will cause chronic sinusitis with polyps in the nose (nasal polyposis) - a chronic disease that leads to the repeated development of polyps in the nose, in the skin the result will be the skin disease atopic dermatitis, and in the esophagus a disease called EoE (eosinophilic esophagitis) is created, which causes narrowing of the esophagus and increasing difficulties and increase by swallowing.
Prof. Yuval Tel/PR
Is there an increase in the incidence of type 2 inflammatory diseases?
In recent years, an increasing number of patients are diagnosed with type 2 inflammatory diseases, and there are several reasons for this, which complement each other. First, living in the modern world we are exposed to parasites in particular and infections in general. As a result, the arm of the immune system that is designed to fight parasitic diseases overreacts to stimuli that should not be threatening. For example, studies show that people who grew up with dogs, and apparently people who were exposed to more infections, are less likely to suffer from allergies in adulthood.
A second influencing factor is global warming, which causes both the extension of the flowering season in many areas of the world, and weather events that may cause a more widespread distribution of allergens. To cause an allergy, repeated exposures to an allergen are necessary, and increasing the frequency of allergens will increase the likelihood of developing chronic allergies and their severity.
Changes in lifestyles also lead to an increase in the diagnosis of these diseases. Most of the diseases of type 2 inflammation cause damage to the quality of life, which can be very significant in the case of some cases. However, in most cases, these are not life-threatening diseases. When the standard of living increases and knowledge is more accessible, many have the options to deal with medical problems caused by type 2 inflammation. A
final factor that encourages diagnosis is the improvement in the therapeutic options for these diseases, which encourages many to seek a medical solution to problems that previously seemed unsolvable.
If so, what are the existing treatments for diseases resulting from type 2 inflammation?
In recent years, there has been enormous progress in the treatment of type 2 inflammation. In the past, treatment focused on administering steroids that suppressed the immune system in an indiscriminate manner, or old-generation antihistamines that crossed the blood-brain barrier and caused many side effects such as drowsiness and impaired cognition. Today there is a more advanced generation of antihistamines that do not cross the blood-brain barrier and allow for a targeted, safe and side-effect-free response to many allergic reactions. Even instead of the steroid ointments that were used in the past to treat inflammatory reactions in the skin, today there are more specific ointments that know how to reduce the inflammation without the many side effects of the old ointments.
Beyond that, the growing understanding of the inflammatory processes underlying type 2 inflammation, and the development of dedicated biological treatments - antibodies that act directly on a certain protein involved in the inflammatory process - make it possible to suppress the inflammation in a selective and targeted manner without harming the function of the immune system and without causing significant side effects. In the type 2 inflammatory process there are several known proteins that are at the focus of the inflammatory process. Direct action against them is able to greatly help patients who so far have not found a solution in the existing treatments, such as severe asthma patients who manage to balance for the first time or patients who undergo repeated surgeries to remove polyps from the nose. Sometimes one treatment may provide an answer to several diseases that originate from a similar inflammatory process. Today, with the help of the new treatments and the possibility of self-injection at home, patients report a significant improvement in symptoms and an improvement in the quality of life in the variety of diseases based on type 2 inflammation.
What does the future hold for the treatment of this type of inflammation?
In order to adapt the advanced treatment to the characteristics of each and every patient, a lot of experience is needed, a sensitive "ear" to the specific characteristics of the patient, and sometimes also trial and error until the appropriate treatment is found. Today, in research in the academy, as well as in a limited number of leading medical centers, there are already precise molecular tools that make it possible to obtain a profile of the immune response of each patient in order to find the "Achilles heel" of the inflammatory response against which action will lead to the optimal response. In the coming years, it can be safely estimated that these tools will become more common and accessible and will allow a much larger number of patients to receive accurate and personalized treatment for their illnesses.
For more information or questions, contact the attending physician.
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