CRC ALRGN IMNOTHRP SUBCUT SUBLING ORAL PDF

Preface

Greetings and welcome to this fifth edition of Allergens and Allergen Immunotherapy: Subcutaneous, Sublingual, and Oral. The 5th edition has been particularly rewarding because of the great progress made since the fourth edition was published in 2008. The book has grown from its first edition published in 1991 with 13 chapters to the current fifth edition containing 38 chapters.

The authors of the chapters are literally a Who's Who in the world of allergy and immunology as well as allergens and allergen immunotherapy. What's new in the fifth edition? Additional chapters have been added on Immunologic Responses to Oral Allergen Immunotherapy, in vitro Testing for Allergic Diseases, Preparing Sublingual Allergen Vaccines, Recombinant and Modified Vaccines, Adjuvants Used for Allergen Immunotherapy, and Adverse Effects Associated with Oral Allergen Immunotherapy. Each of the original chapters is meticulously updated and referenced.

The knowledge and experience of physicians vary widely with respect to sublingual immunotherapy. The book now has six chapters addressing sublingual immunotherapy as well as three chapters devoted to oral allergen immunotherapy, primarily as it relates to food allergy. The chapters continue to be grouped into five sections.

Section I, Basics: Details the history of the subject, definitions, immunologic responses, and knowledge about allergen nomenclature, so critical to the understanding of the formulation of an allergen vaccine.

Section II, Allergens: Describes the inhalational, ingested, and injected allergens. The major and minor allergens and their cross-reactivity with other allergens are discussed. Biologic and immunologic characteristics of almost all allergens are included.

Section III, Immunotherapy Techniques: Covers details of the manufacture and standardization of allergens for injection and ingestion, instructions for their use, different routes of administration, and the labeling of allergen vaccines.

Section IV, Other Types of Immunotherapy: Discusses immunotherapy for food and latex allergy, alternative routes of immunotherapy, DNA vaccines, anti-IgE therapy, and novel approaches with inhalant and food allergens.

Section V, Prevention and Management of Adverse Effects: Explains how to minimize, recognize, and treat adverse effects, including anaphylaxis. Instructions and consent forms are included for both subcutaneous and sublingual immunotherapy.

In the opinion of the editors, what are the strengths of this book? First and foremost, it is the most detailed treatise on allergens and allergen immunotherapy in the world; second, it is written by experts on each particular subject; third, the editors have spent a great deal of time to assure that each chapter covers the topic at hand and is appropriately referenced; and fourth, it gives a perspective as to where the field is headed in reference to future techniques to be utilized to treat allergic diseases. All of this information is provided in this single source, facilitating the application of the science to clinical care.

The understanding of allergens and allergen immunotherapy has indeed come a long way. RFL was first introduced to the specialty by his father, Stephen D. Lockey, Jr., MD, who practiced allergy and immunology beginning in the late 1940s, in Lancaster, PA, USA. He was formally introduced to the subject at the University of Michigan, Ann Arbor, MI, during his training from January 1968 to December 1969. DKL was introduced to the specialty of allergy and immunology while working as a resident with Phillip Lieberman, MD, at the Center for Health Sciences, University of Tennessee, Memphis, TN in 1979 and subsequently during his training at the University of South Florida College of Medicine, Tampa, FL, from July 1983 to June 1985.

Think about what has occurred since that time. First, allergen immunotherapy was on shaky grounds from the standpoint of evidence-based medicine until the well-designed, controlled trials of Lowell, Franklin, Norman, and others who followed and the subsequent summary of the literature sponsored by the World Health Organization in a treatise on allergen immunotherapy in 1998 entitled "WHO Position Paper—Allergen Immunotherapy: Therapeutic Vaccines for Allergic Diseases," edited by Drs. J. Bousquet, et al. (Bousquet J, Lockey RF, Malling HJ (eds): WHO Position Paper-Allergen Immunotherapy: Therapeutic Vaccines for Allergic Diseases. Allergy 1998; 53(44): 1–42), which documents once and for all the evidence that supports its use in treating allergic diseases. Subsequently, new forms of allergen immunotherapy have evolved, in particular, sublingual immunotherapy, which has gradually complemented subcutaneous immunotherapy. Now, pharmaceutical firms are underwriting, at great cost, major, multicenter, properly configured and powered studies to document its efficacy and how it should be utilized. Likewise, oral allergen immunotherapy, particularly to treat food allergy, an epidemic that now affects up to 8% of pediatric subjects in some parts of the world, is being researched and even being utilized. Other forms of allergen immunotherapy, such as the epicutaneous and intralymphatic administration of vaccines, the application of modified allergens and the use of adjuvants or immunomodulators with immunotherapy, are under development.

The future, not only to treat but also to prevent allergic diseases, appears to be very promising. Perhaps, rather than try to alter the course of these diseases, it will be very possible to prevent these diseases in a cost-effective manner, particularly in patients who are genetically predisposed.

All of us in the specialty can be very proud that allergen immunotherapy was the first type of immunotherapy used to treat diseases. Now, various forms of immunotherapy are used to treat a variety of different problems including cancer and autoimmune diseases.

It is a great honor and pleasure for the two editors to work with so many wonderful colleagues throughout the world to bring this book to completion. Please read and enjoy what has always defined and will continue to define the specialty of allergy and clinical immunology. The editors are confident that the application of the information contained in this book will improve the health of patients with allergic diseases throughout the world.

We would like to acknowledge the late Samuel C. Bukantz, MD, the founding father of the Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida College of Medicine, and the Section Chief of Allergy and Immunology, James A. Haley Veterans' Hospital. Dr. Bukantz was a co-editor of the first several editions of this book and his expertise, intelligence and hard work are still apparent throughout the book. Dr. Bukantz anticipated that, with time, it would be possible to prevent allergic diseases, which now appears realistic. He is profoundly missed by all in the Division.

The editors especially thank Ms. Geeta Gehi, who has been absolutely essential in completing this 5th edition. We gratefully acknowledge her help. We also thank Ms. Peggy Hales for her assistance.