Cezmi Akdis, Director of the Swiss Institute of Allergy and Asthma Research in Davos, is rethinking the foundations of chronic disease. He argues that the most transformative shift in the last three decades is moving away from viewing allergy as an IgE-driven problem toward seeing it as a failure of immune tolerance.
Akdis’s early work defined human regulatory T and B cells, showing the immune system is a symphony of checks and balances. This frames chronic inflammation as a problem of regulatory balance, not just an overactive response.
His epithelial barrier theory posits that barrier dysfunction in the skin, airways, and gut is the primary gateway to dysregulated immunity. Environmental factors like pollutants, detergents, and microplastics damage epithelial barriers, increasing permeability and triggering alarmins like TSLP, IL-25, and IL-33.
Akdis advocates integrating barrier biology, microbiome data, and immune profiling into a precision medicine framework. He calls for preventing exposure to toxic substances, warning that micro and nanoplastic pollution will be a major threat. The goal is restoring immune homeostasis, not just suppressing symptoms.