fcmedicineФундаментальная и клиническая медицинаFundamental and Clinical Medicine2500-07642542-0941КемГМУ10.23946/2500-0764-2026-11-2-28-37fcmedicine-1201Research ArticleПАТОЛОГИЧЕСКАЯ ФИЗИОЛОГИЯPATHOPHYSIOLOGYСовременные представления о патогенезе анафилаксииContemporary concepts of anaphylaxis pathogenesishttps://orcid.org/0000-0003-4705-3823БыковЮ. В.BykovYu. V.

Быков Юрий Витальевич, кандидат медицинских наук, доцент кафедры анестезиологии и реаниматологии с курсом дополнительного профессионального образования

355020, г. Ставрополь, ул. Мира, д. 310

Dr. Yuri V. Bykov, Cand. Sci. (Medicine), Associate Professor of the Department of Anesthesiology and Intensive Care Medicine with a course of additional professional education

Mira St., 310, Stavropol, 355020

yubykov@gmail.comСтавропольский государственный медицинский университетРоссияStavropol State Medical UniversityRussian Federation2026240620261122837Copyright © Быков Ю.В., 20262026Быков Ю.В.Bykov Y.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://fcm.kemsmu.ru/jour/article/view/1201

Анафилаксия представляет собой острое жизнеугрожающее состояние, характеризующееся быстрым развитием системных нарушений и высоким риском неблагоприятного исхода. Классически патогенез анафилаксии связывается с IgE-опосредованной активацией тучных клеток и базофилов с последующим высвобождением медиаторов воспаления, приводящих к вазодилатации, повышению сосудистой проницаемости и бронхоспазму. Однако в последние годы сформировалось новое представление о мультифакторной природе данного синдрома, включающее системные, клеточные и молекулярные механизмы, выходящие за рамки традиционной аллергологической парадигмы. Целью статьи является формирование интегративной патофизиологической модели анафилаксии на основе анализа современных экспериментальных и клинических данных с выходом за рамки классической IgE-опосредованной парадигмы. В работе проанализированы ключевые патофизиологические пути, включая IgE- и не-IgE-опосредованную активацию тучных клеток, комплемент- и контакт-зависимые каскады, нейроиммунные взаимодействия, эндотелиальную дисфункцию, а также роль митохондриальной дисрегуляции и оксидативного стресса. Особое внимание уделено фенотипической гетерогенности анафилаксии и ее связи с формированием артериальной гипотензии, сосудистой утечки и шока. Представленные данные обосновывают необходимость пересмотра классических представлений о патогенезе анафилаксии и формируют основу для дальнейших фундаментальных исследований и разработки таргетных подходов к диагностике и терапии.

Anaphylaxis is an acute life-threatening condition characterized by rapid onset of systemic disturbances and a high risk of adverse outcomes. Classically, the pathogenesis of anaphylaxis has been attributed to IgE-mediated activation of mast cells and basophils with subsequent release of inflammatory mediators leading to vasodilation, increased vascular permeability, and bronchospasm. However, in recent years, a new understanding of the multifactorial nature of this syndrome has emerged, incorporating systemic, cellular, and molecular mechanisms that extend beyond the traditional allergological paradigm. The aim of this article is to provide a comprehensive review of contemporary concepts of anaphylaxis pathogenesis with an emphasis on the integration of immune, vascular, neurogenic, and metabolic mechanisms. The paper analyzes key pathophysiological pathways, including IgE- and non-IgE-mediated mast cell activation, complementand contact-dependent cascades, neuroimmune interactions, endothelial dysfunction, as well as the role of mitochondrial dysregulation and oxidative stress. Particular attention is given to the phenotypic heterogeneity of anaphylaxis and its association with the development of arterial hypotension, vascular leakage, and shock. The presented data substantiate the need to revise classical views on the pathogenesis of anaphylaxis and provide a foundation for further fundamental research and the development of targeted diagnostic and therapeutic approaches

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The authors declare that there are no conflicts of interest present.