Allergens and Allergen Immunotherapy 3rd ed. (rev., expanded) - F. Richard, S. Bukantz, J. Bousquet (Marcel Dekker, 2004) WW

831 Pages·2004·7.63 MB·English

Allergens and Allergen
Immuno therapy

Third Edition, Revised and Expanded

edited by
Richard F. Lockey
Samuel C. Bukantz
University of South Florida College of Medicine and
James A. Haley Veterans’ Hospital
Tampa, Florida, U.S.A.

Jean Bousquet
Montpellier University
Montpellier, France

M A R C E L

MARCEL
DEKKER,
INC.

D E K K E R
NEW YORK . BASEL

The second edition of this book was edited by Richard F. Lockey and Samuel C. Bukantz.

Although great care has been taken to provide accurate and current information, neither
the author(s) nor the publisher, nor anyone else associated with this publication, shall be
liable for any loss, damage, or liability directly or indirectly caused or alleged to be caused
by this book. The material contained herein is not intended to provide specific advice or
recommendations for any specific situation.

Trademark notice: Product or corporate names may be trademarks or registered
trademarks and are used only for identification and explanation without intent to
infringe.

Library of Congress Cataloging-in-Publication Data
A catalog record for this book is available from the Library of Congress.

ISBN: 0-8247-5650-9

This book is printed on acid-free paper.

Headquarters
Marcel Dekker, Inc., 270 Madison Avenue, New York, NY 10016, U.S.A.
tel: [phone]; fax: [phone]

Distribution and Customer Service
Marcel Dekker, Inc., Cimarron Road, Monticello, New York 12701, U.S.A.
tel: [phone]; fax: [phone]

Eastern Hemisphere Distribution
Marcel Dekker AG, Hutgasse 4, Postfach 812, CH-4001 Basel, Switzerland
tel: [phone]; fax: [phone]

World Wide Web
http://www.dekker.com

The publisher offers discounts on this book when ordered in bulk quantities. For more
information, write to Special Sales/Professional Marketing at the headquarters address
above.

Copyright © 2004 by Marcel Dekker, Inc. All Rights Reserved.

Neither this book nor any part may be reproduced or transmitted in any form or by any
means, electronic or mechanical, including photocopying, microfilming, and recording, or
by any information storage and retrieval system, without permission in writing from the
publisher.

Current printing (last digit):

10 9 8 7 6 5 4 3 2 1

PRINTED IN THE UNITED STATES OF AMERICA

CLINICAL ALLERGY AND IMMUNOLOGY

1.
2.

3.

4.

5.
6.

7.

8.

9.

10.

11.

12.

13.
14.

15.

16.

Series Editors

MICHAEL
A. KALINER, M.D.
Medical Director
Institute for Asthma and Allergy
Washington, D. C.

RICHARD
F. LOCKEY,
M.D.
Professor of Medicine, Pediatrics, and Public Health
Joy McCann Culverhouse Professor of Allergy and Immunology
Director, Division of Allergy and Immunology
University of South Florida College of Medicine
and James A. Haley Veterans Hospital
Tampa, Florida

Sinusitis: Pathophysiology and Treatment, edited by Howard M. Druce
Eosinophils in Allergy and Inflammation, edited by Gerald 3. Gleich and A.
Barry Kay
Molecular and Cellular Biology of the Allergic Response, edited by Arnold 1.
Levinson and Yvonne Paterson
Neuropeptides in Respiratory Medicine, edited by Michael A. Kaliner, Peter J.
Barnes, Gert H. H. Kunkel, and James N. Baraniuk
Provocation Testing in Clinical Practice, edited by Sheldon L. Spector
Mast Cell Proteases in Immunology and Biology, edited by George H.
Caughey
Histamine and HI-Receptor Antagonists in Allergic Disease, edited by F.
Estelle R. Simons
lmmunopharmacology of Allergic Diseases, edited by Robert G. Townley and
Devendra K. Agrawal
Indoor Air Pollution and Health, edited by €mil J. Bardana, Jr., and Anthony
Montanaro
Genetics of Allergy and Asthma: Methods for Investigative Studies, edited by
Malcolm N. Blumenthal and Bengt Bjorksten
Allergic and Respiratory Disease in Sports Medicine, edited by John M.
Weiler
Allergens and Allergen Immunotherapy: Second Edition, Revised and Expanded,
edited by Richard F. Lockey and Samuel C. Bukantz
Emergency Asthma, edited by Barry 15. Brenner
Food Hypersensitivity and Adverse Reactions, edited by Marianne Frieri and
Brett Kettelhut
Diagnostic Testing of Allergic Disease, edited by Stephen F. Kemp and
Richard F. Lockey
Inflammatory Mechanisms in Allergic Diseases, edited by Burton Zweiman
and Lawrence B. Schwartz

17. Histamine and HI -Antistarnines in Allergic Disease: Second Edition, Revised
and Expanded, edited by F. Estelle R. Simons
18. Allergens and Allergen Immunotherapy: Third Edition, Revised and Expanded,
edited by Richard F. Lockey, Samuel C. Bukantz, and Jean Bousquet

ADDITIONAL VOLUMES IN PREPARATION

Graft-vs.-Host Disease: Third Edition, edited by James L. M, Ferrara,
Kenneth Cooke, and H. Joachim Deeg

To our coeditor,
Samuel C. Bukantz—the compleat teacher,
author, editor, researcher, and clinician

R.F.L
J.B.

v

Series Introduction

As I look at my library, the most obviously well-read book is the first edition of Allergen
Immunotherapy. That book helped me establish plans for private practice and served
me very well. The second edition, Allergens and Allergen Immunotherapy, provided many
useful additions to my treatment plans for immunotherapy. Now, there is a third edition,
extending the knowledge and applications of the first two books. I might suggest that this
book be required reading for all practitioners who prescribe allergy immunotherapy.
Where else is theory and practice in such an important subject so well combined and in
such useful detail? This book takes the principles of allergens, immunotherapy, and the
treatment of allergic disease to a very practical but evidence-based level.
The background for immunotherapy is provided in historical and immunological
terms, as well as in aerobiological principles. These chapters provide a solid basis for
understanding why we give immunotherapy. Unless one understands the allergens,
their importance, and how to decide which is causing patient-related disease, then proper
decision-making regarding immunotherapy cannot be applied. Chapters on specific aller-
gens are essential to practitioners prescribing immunotherapy.
As part of my practice, I see patients who have had unsuccessful treatments with
allergen immunotherapy. Many of the patients were poor candidates for allergy
immunotherapy from the beginning and others were given improper mixes of allergens,
administered incorrectly. This book addresses these issues using a very practical approach,
detailing how and when to give immunotherapy, for how long, and to which patients.
Potential problems encountered in the course of immunotherapy are described and solu-
tions presented.
One of the major advances in prescribing immunotherapy has been the recognition
that the constitution of the mixtures and preserving allergenicity are essential to efficacy,
and that using sufficient allergen concentration is a minimal prerequisite for long-term
benefit. Chapters detailing allergen preparation and administration offer information that
is essential to the decision-making process, and these concepts have changed over the past
10 years. Experienced allergists will benefit from re-reading these chapters.
The range of clinical problems for which immunotherapy is an option is described
in detail. The usefulness of immunotherapy in allergic rhinoconjunctivitis and asthma, as
well as in hymenoptera sensitivity, is presented. Other desensitizations, including drug
allergy, are outlined, as are novel treatments such as the newly introduced monoclonal

anti-IgE therapy. This is not a clinical allergy text, but it raises and answers the questions
of who should get immunotherapy and what to expect. Other forms of treatment besides
immunotherapy and their use along with immunotherapy are covered, as are potential
future extensions of this treatment. There is limited use of sublingual-swollen immuno-
therapy in the United States; however, this is a popular form of treatment for mild allergic
disease in Europe and the data are presented here.
I find this text to be compelling in its comprehensive approach to the most impor-
tant disease-modifying treatment available for allergic rhinitis and allergic asthma. It
should be read by allergists who want to know where we are with proper immunotherapy
and where we are going with this treatment modality. It should be read by those clinicians
who use alternative approaches to immunotherapy in order to recognize why allergen
immunotherapy is effective and what goes into proper preparation and administration
of effective immunotherapy. And, it should be read by clinicians whose patients are
receiving immunotherapy to be certain that the immunotherapy prescribed has been
ordered appropriately and is being administered correctly.
I am pleased to add this volume to our series of venerable books.

Michael A. Kaliner

vi
Series Introduction

vii

Preface

The first edition of Allergen Immunotherapy, published in 1991, contains 13 chapters. The
second edition, Allergens and Allergen Immunotherapy published eight years later,
expanded to 33 chapters in order to more precisely define the biochemical and molecular
characteristics of the allergen groups, the methods of their manufacture and standardization,
and the techniques of their administration in the treatment of allergic diseases.
Global contributions to the understanding of the basic mechanism of the allergic
reaction has improved the efficacy of immunotherapy of allergic disease. Many of the
scientific contributions have come from around the world, and this prompted the addition
of Dr. Jean Bousquet of Marseilles as co-editor. Dr. Bousquet, well-known for his studies
of the immunotherapy of allergic diseases and asthma, has been influential in the selection
of additional investigators, whose contributions are included in this third edition, and the
book has been expanded to 41 chapters.

The chapters have been grouped into five parts.
Part I, Basics
Details the mechanisms of IgE-mediated disease and how immunotherapy
affects that mechanism and alters the course of the disease.
Part II, Allergens
Describes inhalational, ingested, and injected allergens as well as
those, like latex and drugs, that may have multiple sites of introduction.
Part III, Immunotherapy Techniques
Describes the manufacture and standardization of
the allergens for injection and their labeling as allergen vaccines as recommended in 1998
by the World Health Organization.
Part IV, Other Types of Immunotherapy
Describes inhalational and oral routes of admin-
istration, the value of DNA vaccines, anti-IgE therapy, and novel approaches to
immunotherapy with inhalant allergens.
Part V, Prevention and Management of Adverse Effects
Details how to avoid and treat
adverse effects as well as how to prevent and treat anaphylaxis.

All chapters have been updated and organized in a manner that will facilitate use of
this volume as a reference source for the use of allergens in immunotherapy.
Particularly interesting, in Part IV, is the chapter by Li and Sampson on the possi-
bility of immunotherapeutic management of food allergy. In their opinion, “Establishment
of animal models of food hypersensitivity, including sensitization by the oral route and