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Abstract
Burton Zweiman and Lawrence B. Schwartz, eds. New York, NY: Marcel Dekker, 2002; 581 pp; $195.00
The title of this recent addition to Marcel Dekker’s Clinical Allergy and Immunology series belies its scope. In the introduction to Inflammatory Mechanisms in Allergic Diseases, co-editor Burton Zweiman lists four areas that the text was written to address: the relative contribution of individual humoral and cellular inflammatory components in the pathogenesis of allergic diseases; their interaction; the pathogenic relation of the "immediate-phase" to the " late-phase" component; and the mechanisms underlying the various therapeutic approaches in allergic disease. He further states, "We have enlisted the participation of colleagues who are at the cutting edge of these areas. We believe that this text will considerably enhance your understanding of allergic inflammation and its role in human disease." After reading this monumental work, I do indeed agree that the authors of the subsequent 26 chapters are at the "cutting edge" of their areas of discussion, and the text did in fact enhance my understanding of the relationships between inflammation and human disease.
The first section is entitled "Components in the Allergic Inflammatory Response," and comprehensively reviews the multitude of cellular and humoral mechanisms that are part of the allergic process. The applicability of these mechanisms beyond the realm of " allergic" diseases is stressed by co-editor Lawrence B. Schwartz in his chapter on mast cells and basophils, noting that these cells are "... the primary effector cells in immediate hypersensitivity reactions, but also may participate in innate immune defense and in immunity against certain parasites." Sergio Romagnani’s chapter "Lymphocytes" is both more erudite and less esoteric than the title might indicate. He addresses T-helper cells and cytokines and his discussion of mechanisms includes the "Hygiene" hypothesis (with a wonderfully simple but informative figure drawn from another of his publications) and immunotherapeutic strategies. These subjects are addressed to various degrees elsewhere in the book, but in this particular chapter the author puts it together nicely. However, I would not wish to confront the chapter title "Effector Roles of IgE Antibodies: Targeting Allergen to the High-Affinity IgE Receptor for FcERI-Dependent Signaling and Antigen Presentation" early on a Monday morning, despite the gentle and understandable presentation by Bridget S. Wilson and Janet M. Oliver. The subject and content of the remaining chapters in this section are equally impressive.
The next section, "Allergic Inflammatory Mechanisms in Clinical Disorders," covers disorders that are interesting to a wider audience than the allergist. In addition to "Mechanisms of Allergic Rhinitis, " "Nasal Polyps and Sinusitis," "Allergic Eye Disorders," "Asthma," "Atopic Dermatitis," "Urticaria," and "Anaphylaxis and Inflammation," chapters in this section also cover "Nonanaphylactic Drug Disorders, " "Vasculitis," and "Allergic Bronchopulmonary Aspergillosis, Allergic Fungal Sinusitis, and Hypersensitivity Pneumonitis." I was actually captivated by the discussion of asthma by Saju S. Eapen and William W. Busse. After a polite and informal introduction, the reader is escorted through the land of asthma, visiting the theater of inflammation, with its cast of players and each of their roles. From the by-now familiar eosinophil and lymphocyte, to the more arcane cellular migration and adhesion molecules, I met them all. I recalled I had met them, actually at length, in the previous section, but whereas the first visit was analytical and detailed, here the players seemed more animated and interrelated. I had the same " familiar-yet-fresh" feeling with other chapters. The review of atopic dermatitis by Peck Y. Ong and Donald Y. M. Leung reminded me of a New Orleans restaurant. Following the anticipated appetizer of clinical features, I indulged in a complex Creole discussion of immunopathogenesis, genetics, and triggering factors, followed by a spicy Cajun discussion of management. Paul A. Greenberger’s concluding review of allergic fungal diseases including hypersensitivity pneumonitis was both instructive and refreshing.
The "world of tomorrow," or perhaps "this afternoon, " was visited in the next section, "Emerging Concepts in the Modulation of Allergic Inflammation." Pedro C. Avila, Jeffrey L. Kishiyama, and Daniel C. Adelman deliver a nice presentation of available pharmacologic approaches, although their discussion of zafirlukast and montelukast did not mention the question of complicating Churg-Strauss syndrome as much as I would have liked. "Synthetic and Genetically Engineered Allergen Derivatives for Specific Immunotherapy of Type 1 Allergy" is discussed by R. Valenta, S. Vrtala, M. Focke-Tejkl, and colleagues, and Donald MacGlashan, Jr., presents "Anti-IgE Antibody Therapy." Eva-Marie Varga and Stephen R. Durham present the saga of allergen injection immunotherapy beginning in 1911 and culminating with "... an optimistic outlook for the future treatment of allergic patients" while Joel N. Kline and Zuhair K. Ballas conclude with "DNA Immunomodulation of Asthma."
As noted in the introduction, the contributors are at the cutting edge of their areas; even I recognized their names. However, I am not a peer to these notables, and neither would be the widest audience for this volume. I would not have been offended if the discussion began at a simpler level; the patrician at times might have indulged this plebian more kindly. Similarly, a glossary defining the alphabet soup of abbreviations would have been most helpful.
Sadly noted as being archaic, the first definition of doctor offered in Webster’s New Collegiate Dictionary is "a teacher; a learned man." Having read this book, I believe I am a better-informed physician and more worthy of the title "doctor of medicine" in our modern society.
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