Pediatric Allergy - Principles and Practice - Expert Consult (Leung, Pediatric Allergy), Second Edition
These are exciting times for physicians who treat children and investigators interested in mechanisms underlying diseases in the area of pediatric allergy, asthma, and clinical immunology. There has been a well-documented rise in the prevalence of this group of diseases during the past three decades. Protection against microbial infection and treatment of hypersensitivity reactions to environmental triggers have become primary goals for the practicing pediatrician. As a result, investigators at academic centers and in the pharmaceutical industry have partnered to understand mechanisms underlying these diseases and have developed evidence- and mechanism-based approaches for the management and treatment of these illnesses. In addition, the National Institutes of Health through the National Institutes of Allergy and Infectious diseases and the National Heart, Lung, and Blood Institute have formed networks and collaborative studies to study allergic/immunologic diseases, such as food allergy and asthma. The need to document and summarize this recent remarkable increase in information justifies this new textbook in the field of pediatric allergy and clinical immunology for practicing physicians and investigators interested in this area.
It is often said, ‘Children are not simply small adults.’ In no other subspecialty is this more true than in pediatric allergy and immunology, where the immune system and allergic responses are developing in different host organs. This early age of onset of disease offers special opportunities for prevention and intervention, which cannot be carried out once disease processes have been established in the older child and adult. Indeed, many diseases that pediatricians see in clinical practice are complex diseases thought to result from a multigene predisposition in combination with exposure to an unknown environmental agent. However, the age at which the host is exposed to a particular environmental agent and the resultant immune response is increasingly being recognized as important factors. Furthermore, determining the appropriate time for intervention will be important in defining a window of opportunity to induce disease remission. For example, endotoxin is a known trigger of established asthma in adults but the ‘hygiene hypothesis’ in children suggests that early exposure to endotoxin prior to the onset of allergies may actually prevent allergic responses and thus account for the low prevalence of allergic disease in children living on farms. New information is available on controlling asthma in early childhood but our current treatment does not alter the natural history of the disease.
Pediatric Allergy: Principles and Practice are aimed at updating the reader on the pathophysiology of allergic responses and the atopic triad (asthma, allergic rhinitis, and atopic dermatitis), the mechanisms underlying specific allergic and immunologic diseases, and their socio-economic impact and new treatment approaches that take advantage of emerging concepts of the pathobiology of these diseases. An outstanding group of authors who are acknowledged leaders in their fields has been assembled because of their personal knowledge, expertise, and involvement with their subject matter in children. Every effort has been made to achieve prompt publication of this book, thus ensuring that the content of each chapter is ‘state of the art.’
Section A presents general concepts critical to an understanding of the impact and causes of allergic diseases. These include reviews of the epidemiology and natural history of allergic disease, genetics of allergic disease and asthma, the biology of inﬂammatory-effector cells, regulation of IgE synthesis, and the developing immune system and allergy. Section B reviews an approach to the child with recurrent infection and specific immunodeficiency and autoimmune diseases that pediatricians frequently encounter. Section C updates the reader on a number of important and emerging immune-directed therapies including immunoglobulin therapy, bone marrow transplantation, immunizations, gene therapy, and stem cell therapy. Section D examines the diagnosis and treatment of allergic disease. The remainder of the book is devoted to the management and treatment of asthma and a number of specific allergic diseases such as upper airway disease, food allergy, allergic skin, and eye diseases, drug allergy, latex allergy, insect hypersensitivity, and anaphylaxis. In each chapter, the disease is discussed in the context of its differential diagnoses, key concepts, evaluations, environmental triggers, and concepts of emerging and established treatments.
Major advances in this second edition include updates on new genetic advances in allergic diseases, inﬂammatory conditions and immunodeficiencies, new biomarkers to monitor allergic diseases, recent revisions in asthma guidelines emphasizing a step-care approach to control asthma, appropriate evaluation of drug allergy, and a better understanding of drug cross-reactivity to eliminate the difficulty prescribing antibiotics in the pediatric population, the role of new biologics and immunomodulatory therapy in the treatment of inﬂammatory diseases and emerging evidence that barrier dysfunction can drive allergic disease.
We would like to thank each of the contributors for their time and invaluable expertise, which were vital to the success of this book. The editors are also grateful to Joanne Scott (Deputy Head of Development), Claire Bonnett (Acquisitions Editor), Joannah Duncan (Project Manager), and Kirsten Lowson (Senior Editorial Assistant), who have played a major role in editing and organizing this textbook, as well as the production staff at Elsevier Ltd for their help in the preparation of this book.