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Am Fam Physician. 1998;58(3):800-802


Edited by Allen P. Kaplan. Pp. 896. Price, $120.00. 2d ed. Saunders, Curtis Center, Ste. 300, Independence Square West, Philadelphia, PA 19106-3399, 1997.

During the past 10 years, the state of the art of allergy management has evolved dramatically and this edition has been revised. All chapters more comprehensively address clinical immunology. This textbook is divided into five sections with 54 chapters, written by 86 authors. The plethora of contributors are all well known for their research and have added their strength to every part of the book. Revisions and updating include the immunologic and genetic mechanisms of allergic diseases, and diagnostic methods used (i.e., new allergens, diagnostic radiology, rhinoscopy and cloned allergenic fragments). The chemistry, presentation and processing of the antigens in the body and the body's response to these antigens are dealt with in detailed chapters. Most of the basic chapters contain well-written descriptions of the immune processes but may not be of interest to the family physician.

Since the last edition, there has been much research into the immune responses. This continued growth is reflected in the text. To present the immune system is challenging. One author suggested that the immune system is similar to a symphony orchestra because it is composed of many different “instruments” in cooperation together to generate and regulate the immune response.

Our editor chose to keep this work as a single volume, and it is meant to be used as a reference or a textbook. The first 40 percent of the book, which deals with immune mechanisms alone, could constitute a respectable textbook on the subject. The other 60 percent of the book focuses on the techniques of evaluating the allergic person, starting with the history and physical examination and continuing through diagnostic procedures and treatment. Clinicians will find much knowledge and expertise in this part of the text.

The chapters in section I relating to the immune system and inflammation are well-written with accurate, up-to-date information, but they will probably only interest the initiated. Some chapters deal with the assessment of allergic diseases and therapeutic modalities and offer practical treatments and options. However, a reader looking for a succinct how-to book on bedside diagnoses and treatment of common allergic disease should probably look elsewhere. The audience for this work is the practicing allergist, the allergy/immunology fellow preparing for boards, or physicians in related specialties who may need to update a specific subject. Each chapter is documented by pages of references. One chapter contained over 590 references. For the family practitioner, this is probably more information than is desired.

A few chapters are worth mentioning separately. The chapter on imaging techniques of nasal allergy and sinusitis gives relevant and accurate knowledge about the different severities of sinusitis and the imaging techniques that help in the diagnosis and treatment. Another new chapter in this edition, “Epidemiology and Genetics of Asthma and Allergy,” helps our understanding of the prevention of allergic diseases through genetic counseling and gene therapy. By understanding patients who are genetically at high risk for developing asthma, one could direct environmental controls to help prevent disease.

The clinical chapters included in this textbook are of more interest to the family practitioner. Although significant advancements have occurred in the treatment of patients with asthma and allergic disease, their morbidity has increased. As a consequence, billions of dollars are expended annually in the United States in the treatment of asthma. Because of the economic significance of asthma, most of the section on therapeutic modalities is devoted to this disease.

This edition is nicely produced with tables, charts and figures; however, many of the photographs of the skin and nasal anatomy could have been visualized better if they had been reproduced in color rather than in black and white.

In conclusion, Allergy serves as a useful reference book for the allergist, immunologist and anyone who studies allergic diseases. This is a comprehensive, detailed and up-to-date treatise on allergic diseases that includes other disorders of immunologic origin including autoimmunity, systemic mastocytosis and human immunodeficiency virus infections.

The strengths of this textbook provide ample reason for a family physician to consider acquiring it as a library resource for reference or for selective perusal. Its weaknesses, however, make it less suitable as a how-to-do book in clinical allergy.

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