A Shift in Classical Concepts Regarding Pathophysiology, Driven by a Realistic Perception of the Pathogenesis of Allergic Reactions

This review proposes assessing the animal organism, its state of life, health, and response to external factors from the perspective of ontological constructivism, attempting to analyze the best-known, and thus accessible, components of the biological life process. The evolution of responses is examined in a sequence of stages termed by the author "natural lavage with mucosal secretions," "pre-inflammation," and then aseptic inflammation and antigen-dependent inflammation. Emphasis is placed on the fact that the immune system is a unified structure that interacts with antigens of both infectious and non-infectious origins according to a single algorithm. This supports the pathophysiological concept of inflammation as a typical, universal response of the body to exposure to a phlogogen of any origin, thereby substantiating the assertion that allergy is a particular manifestation of inflammation as a syndrome. A critical assessment is given to the current understanding of allergy pathogenesis, which distorts the cause-and-effect relationships in the sequence of processes that form the disease picture. A proposal has been put forward to consider biochemical reactions occurring on mucous membranes and skin within the microbiome's environment as neutralizing the antigenic properties of external protein structures through enzymatic breakdown into low-molecular-weight products. These products, upon penetrating the internal environment, lose their ability to trigger an inflammatory response involving the immune system. The duality of inflammation, in which localized and generalized forms are combined, is considered as a morphologically justified manifestation of opposing protective and destructive effects on the microorganism.