Neuroimmune mechanisms of type 2 inflammation in the skin and lung
Open accessAbstract
Type 2 inflammation has a major role in barrier tissues such as the skin and airways and underlies common conditions including atopic dermatitis (AD) and asthma. Cytokines including interleukin 4 (IL-4), IL-5, and IL-13 are key immune signatures of type 2 inflammation and are the targets of multiple specific therapeutics for allergic diseases. Despite shared core immune mechanisms, the distinct structures and functions of the skin and airways lead to unique therapeutic responses. It is increasingly recognized that the nervous system has a major role in sensing and directing inflammatory processes. Indeed, crosstalk between type 2 immune activation and somatosensory functions mediates tissue-specific signatures such as itching in the skin. However, neuroimmune interactions are shaped by distinct neuronal and immune landscapes, and differ between the skin and airways. In the skin, dorsal root ganglia-derived neurons mediate pruritus via type 2 cytokines and neurogenic inflammation by mast cell or basophil activation. Conversely, vagal ganglia-derived neurons regulate airway immune responses by releasing neuropeptides/neurotransmitters such as calcitonin gene-related peptides, neuromedin U, acetylcholine, and noradrenaline. Sensory neuron-derived vasoactive intestinal peptide forms a feedback loop with IL-5, amplifying eosinophilic inflammation in the airways, a mechanism that is absent in the skin. These differences influence the efficacy of cytokine-targeted therapies. For instance, IL-4/IL-13-targeted therapies like dupilumab demonstrate efficacy in AD and allergic airway diseases, whereas IL-5-targeted therapies are effective in eosinophilic asthma but not AD. Understanding these neuroimmune interactions underscores the need for tailored therapeutic approaches to address allergic diseases where barrier tissues are involved.
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The type 2 cytokine milieu downregulates antimicrobial peptides, facilitating microbial colonization, particularly by Staphylococcus aureus, which amplifies inflammation through superantigen production and Th2 polarization.
“Furthermore, this cytokine milieu downregulates antimicrobial peptides, facilitating microbial colonization, particularly by Staphylococcus aureus, which amplifies inflammation through superantigen production and Th2 polarization.”
From The Cutaneous Immune Microenvironment in Selected Inflammatory Skin Diseases: Linking Histopathology, Mechanisms, and Targeted Therapy (2026) · cites this paper as [8]
IL-4/IL-13-JAK-STAT6 signaling results in transcriptional repression of epidermal differentiation genes such as filaggrin, loricrin, and involucrin, and enzymes involved in ceramide synthesis, thereby impairing barrier integrity.
“This results in transcriptional repression of essential epidermal differentiation genes such as filaggrin, loricrin, and involucrin, as well as enzymes involved in ceramide synthesis, thereby directly impairing barrier integrity.”
From The Cutaneous Immune Microenvironment in Selected Inflammatory Skin Diseases: Linking Histopathology, Mechanisms, and Targeted Therapy (2026) · cites this paper as [8]
Atopic dermatitis is driven by a complex interaction between epidermal barrier defects and immune dysregulation, with the IL-4/IL-13-JAK-STAT6 axis representing a central pathogenic pathway.
“Atopic dermatitis is driven by a complex interaction between epidermal barrier defects and immune dysregulation, with the IL-4/IL-13–JAK–STAT6 axis representing a central pathogenic pathway.”
From The Cutaneous Immune Microenvironment in Selected Inflammatory Skin Diseases: Linking Histopathology, Mechanisms, and Targeted Therapy (2026) · cites this paper as [8]
Type 2 inflammatory cytokines IL-4 and IL-13 signal through JAK-dependent pathways and lead to activation of STAT6.
“Type 2 inflammatory cytokines, IL-4 and IL-13, signal through JAK-dependent pathways and lead to activation of STAT6.”
From The Cutaneous Immune Microenvironment in Selected Inflammatory Skin Diseases: Linking Histopathology, Mechanisms, and Targeted Therapy (2026) · cites this paper as [8]
Epithelial-derived alarmins such as TSLP, IL-25, and IL-33 activate dendritic cells and group 2 innate lymphoid cells (ILC2s), promoting Th2 differentiation and perpetuating cytokine release.
“In parallel, epithelial-derived alarmins such as TSLP, IL-25, and IL-33 activate dendritic cells and group 2 innate lymphoid cells (ILC2s), promoting Th2 differentiation and perpetuating cytokine release [7,8,9].”
From The Cutaneous Immune Microenvironment in Selected Inflammatory Skin Diseases: Linking Histopathology, Mechanisms, and Targeted Therapy (2026) · cites this paper as [8]
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Tinca, A. C., Cozac-Szoke, A. R., & Cotoi, O. S. (2026) · Dermatopathology · doi:10.3390/dermatopathology13020022 · Cited by 1 · see citing works
- Authors
- Tamari, M., & Ver Heul, A. M.
- Affiliations
- National Research Institute for Child Health and Development (JP)
- Corresponding author
- Tamari, Masato
- ORCID
- Tamari, Masato
- Venue
- Allergology International
- Publisher
- Elsevier BV
- Published
- 2025-04
- Volume
- 74
- Issue
- 2
- Pages
- 177-186
- ISSN
- 1323-8930 (ISSN-L)
- OpenAlex
- W4408260060
- Cited by
- 17
- References
- 134
- Citations by year
- 2026: 10 · 2025: 7
- FWCI
- 2.91
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Allergology International (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Digital Commons@Becker (Washington University School of Medicine) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Mishima Kaiun Memorial Foundation (2024A-105)
- National Center for Child Health and Development (2024C-18)
- Japanese Society of Allergology
- Japan Society for the Promotion of Science (24K23471)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (AR080219)
- Topics
- Health Sciences › Medicine › Dermatology › Dermatology and Skin Diseases
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Life Sciences › Neuroscience › Neurology › Vagus Nerve Stimulation Research
- Keywords
- type 2 inflammation, neuroimmune interactions, atopic dermatitis, allergic asthma, pruritus, dorsal root ganglion neurons, calcitonin gene-related peptide, neuromedin U, vasoactive intestinal peptide, mast cells, basophils, eosinophilic inflammation, IL-4/IL-13, IL-5, dupilumab, barrier tissues, skin, respiratory tract
- MeSH terms
- Animals, Asthma, Dermatitis, Atopic, Humans, Inflammation, Lung, Skin, Neuroimmunomodulation, Cytokines
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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