Book Review

Allergy and Allergic Diseases

N Engl J Med 1998; 338:1631-1632May 28, 1998

Article

Allergy and Allergic Diseases
Edited by A.B. Kay. 1738 pp. in two volumes, illustrated. Boston, Blackwell Science, 1997. $275. ISBN: 0-86542-867-0

The past decade has seen an explosion in our understanding of the allergic process. The immunologic pathways, cytokines, and inflammatory cells that participate in allergic diseases have all been subject to intense scrutiny. In parallel, an expanding pharmacopeia has become available to the practitioner who manages allergic diseases, and for the first time many agents are based on an understanding of specific inflammatory pathways in allergic disease. But, despite this increased understanding and the new pharmacologic agents, the worldwide epidemic of allergic disorders continues. This epidemic was first described with respect to asthma, but more recently an increased incidence of other allergic diseases, and of atopy itself, has been identified. Numerous theories have been put forward to explain this epidemic, ranging from misadventures with symptomatically effective superficial therapies to a diminished incidence of protective infections in early childhood. The former is thought to have led to an increase in allergic diseases because of the use of drugs that merely cover up chronic inflammatory conditions, and the latter has been attributed to a failure of the developing immune system to receive the signals needed for a protective immune response mediated by type 1 helper T cells, rather than an allergic response mediated by type 2 helper T cells.

Allergy and Allergic Diseases joins several other textbooks in this field and, for the first time, brings an international and particularly European perspective to bear on allergy. In contrast to the position allergy and immunology holds in North America as a unified discipline under both pediatrics and internal medicine, allergy, or allergology as it is commonly called in Europe, is often not addressed in a particular course of study and is frequently not recognized as an independent discipline.

This multiauthored textbook, under the direction of Dr. Kay, a senior and respected allergist at the Imperial College School of Medicine at the National Heart and Lung Institute, attempts to convey the excitement and breadth of the field of allergy and immunology and also, I believe, tries to put this discipline solidly into the educational structure in medical subdisciplines in Europe. As the newest of the multiauthored and often multivolume textbooks, this book is organized along classic lines, dealing first with the immunologic bases of the allergic response and then with the cells and mediators responsible for allergic inflammation. This introduction is followed by descriptions of the pharmacology and physiology of allergic diseases and then by discussions of specific allergic diseases and their management.

The book is unique in providing a framework for interpreting many of the studies that are currently being published. It brings the reader an understanding of the molecular and cellular techniques that underlie in vitro studies of allergic disease and the principal animal models used in investigations of allergy and asthma. These rich sources of reference material will interest investigators and students of the research aspects of this discipline. The detailed presentation of allergens, including their biochemistry and cloning, brings together a wide variety of scholarship in an area that is all too commonly omitted from other textbooks. Also unique to this book is a discussion of the practice of allergy as a medical specialty, a topic presumably not necessary in North American textbooks.

As the newest textbook, Allergy and Allergic Diseases is up to date, clinically relevant, and highly readable, with informative graphics. Particularly timely are chapters on the genetics of atopy and reviews of the inflammatory mechanisms of allergic disease, with particularly thorough attention to the late-phase reaction. The chapter on the pathology of asthma has effective photomicrographs, demonstrating many of the more recent advances in our understanding of microscopic inflammatory changes in allergic airway disease. There is also an interesting pictorial atlas with many clear and classic examples relevant to the cutaneous and ocular manifestations of allergic disease.

This book is an extremely useful and timely addition to the field of allergy and immunology. It has a particularly European perspective, and it accomplishes its unstated task of placing allergy and immunology as a central discipline in the modern practice of medicine and pediatrics in Europe. The price is high, as is usual for this style of multiauthored textbook, and a more casual American reader may find the focus on basic sciences, particularly animal models and molecular techniques, arcane as applied to the practical management of allergic diseases. Students of allergy and immunology, particularly fellows in training and faculty members in this discipline, should make this book a part of their academic library.

Stephen Wasserman, M.D.
University of California, San Diego, School of Medicine, San Diego, CA 92103