Book Review

Therapeutic Immunology

N Engl J Med 1997; 336:1265April 24, 1997

Article

Therapeutic Immunology
Edited by K. Frank Austen, Steven J. Burakoff, Fred S. Rosen, and Terry B. Strom. 675 pp., illustrated. Cambridge, Mass., Blackwell Science, 1996. $165. ISBN: 0-86542-375-X

The progress of medicine in the past half-century is nowhere better illustrated than in the elucidation of the immune system and with it the emergence of a multifaceted armamentarium for treating both immunologic diseases themselves and nonimmunologic diseases that can only be treated by manipulating the immune system. Several experienced clinical scientists in the field of immunology have taken on the challenge of assembling a compendium focused on the many forms of immunologic therapy.

In 52 pithy chapters, this book deals with an astounding array of immunologic treatments, ranging from standbys such as corticosteroids and allergy desensitization to solid-organ transplantation and the emerging areas of cytokine therapy and gene therapy. The book is inclusive but, because of the pace of advances, it does not cover such new and exciting subjects as antibodies against tumor necrosis factor α and the CD40 ligand, nor does it consider new vaccines, including DNA vaccines.

The chapters are most useful when they focus on fundamental principles; it is obvious that the basis of a therapy will outlast the therapy itself. This approach is brilliantly realized in the chapters centering on cyclosporine, the principles of therapy with intravenous immune globulin, the basis of organ transplantation, and the fundamentals of gene therapy. These discussions are little gems.

Not every chapter conforms to this high standard, however. In some cases there is a lack of focus, as when the discussion of certain forms of organ transplantation inappropriately turns to surgical approaches, or when a chapter on cytokine therapy does not discuss the biology of the cytokine that actually bears on the therapy. In other cases, deficiencies arise from an approach that is so neutral that it does not draw sufficiently on the author's wisdom and experience, as in the discussion of sulfasalazine, which does not compare this form of therapy with other treatments for inflammatory bowel disease, or in the discussion of allergy desensitization, which does not consider the place of this therapy in treating asthma. But these criticisms are quibbles in the face of the excellence of the overall enterprise.

This book will be useful to generalists seeking an analysis of a particular form of immunologic therapy, as well as to card-carrying immunologists and allergists who require a wider knowledge of their field.

Warren Strober, M.D.
Thomas A. Fleisher, M.D.
National Institutes of Health, Bethesda, MD 20892