Book Review

Allergy and Allergic Diseases: The new mechanisms and therapeutics

N Engl J Med 1999; 340:1374-1375April 29, 1999

Article

Allergy and Allergic Diseases: The new mechanisms and therapeutics
Edited by Judah A. Denburg. 591 pp. Totowa, N.J., Humana Press, 1998. $145. ISBN: 0-89603-404-6

Clinicians caring for patients with asthma and allergic diseases have known for several years that major changes are occurring in the diagnosis and treatment of asthma and allergy. First of all, for reasons that are not entirely clear, the prevalence of these diseases has increased strikingly in the past decade. Asthma now affects 5 to 8 percent of the population, and in some areas of the country, as many as 10 to 15 percent of people have asthma. Second, a concerted international effort is afoot to improve the overall effectiveness of asthma care. Finally, a host of new medications for asthma and allergy have been introduced recently. These changes reflect the rapidly growing interest among clinicians, scientists, and persons in industry to find better means to treat these common disorders.

In Allergy and Allergic Diseases, Denburg attempts to capture the excitement in allergy research by presenting an organized review of recent advances in the field. This book attempts to compile new information in all areas that affect or influence allergic disease and asthma, such as genetics, epidemiology, immunology, physiology, and molecular biology of the cell. New data regarding candidate atopy genes, the characteristics of molecules such as chemokines and cytokines, and the behavior of different types of cells such as epithelial cells and lymphocytes are clearly presented in an understandable format that lays the groundwork for understanding additional advances that will occur in the next decade.

Denburg centers the discussion on the allergic type of inflammation that characterizes allergy and asthma. He has assembled more than 50 international authorities and clinical investigators. There are 31 chapters. The initial chapters discuss the classic elements of allergic reactions (eosinophils, mast cells, and IgE) and include a review of the molecular mechanisms of isotype switching to IgE and signal-transduction pathways for mast cells and eosinophils. Another chapter discusses possible explanations for the rapid increase in the prevalence of asthma. Other sections describe new concepts regarding the different types of cells that have critical roles in allergic inflammation, including T_H1 and T_H2 cells, CD8+ T cells, dendritic cells, and epithelial cells of the lung. In addition, there are sections that attempt to integrate the early chapters and discuss the overall pathogenesis of allergic rhinitis, eczema, urticaria, asthma, and allergic conjunctivitis.

The book is written for allergists, pulmonologists, dermatologists, and otolaryngologists, as well as clinical investigators starting out in this area who wish to have an up-to-date understanding of the new science that explains allergic disease. The book presents a broad overview of the field at a level that is easy to understand. The discussions are relatively brief and simple, perhaps a requirement for a one-volume book that covers such a broad topic. There is a fair amount of overlap in the discussions, but the overlap emphasizes the idea that immune responses induced and amplified by T_H2 lymphocytes have a critical role in the pathogenesis of allergic disease.

Since the book is intended for those new to the field, more figures and the use of color figures in addition to the black-and-white illustrations might have improved the clarity of the discussions. Furthermore, it is disappointing that there is little mention of antigen immunotherapies and pharmacotherapies that are being developed, on the basis of the new understanding of allergic disease. These therapies include anti-IgE and anti–interleukin-5 monoclonal antibodies, peptide immunotherapy, complementary DNA vaccines, and therapies with potent cytokines and leukotriene antagonists. However, it is difficult to include in a textbook every piece of new information in a rapidly moving field. Nevertheless, the book provides an advanced understanding of the current state of the field and leaves the reader receptive to new concepts and therapies for allergic disease that will soon be forthcoming.

Dale T. Umetsu, M.D., Ph.D.
Stanford University, Stanford, CA 94305-5208