Pediatric Allergy: Principles and Practice, 3e

721 Pages·2016·51.4 MB·English

by  Donald Y. M. Leung MD PhD

To our families and patients who have supported our
efforts to advance the care of asthma, allergy, and
immunology treatment for children. We would also like to
thank those children and families who participated in
studies that allowed us to make the changes in care
emphasized in this update.
Pediatric Allergy
PRINCIPLES AND PRACTICE
T h i r d E d i t i o n
Donald Y. M. Leung MD Cezmi A. Akdis MD
PhD FAAAAI
Professor of Immunology
Professor of Pediatrics Director
University of Colorado Swiss Institute of Allergy and Asthma
Edelstein Family Chair of Pediatric Allergy- Research (SIAF)
Clinical Immunology University of Zurich
National Jewish Health Davos, Switzerland
Denver, CO, USA Director (Speaker)
Christine Kühne – Center for Allergy
Stanley J. Szefler MD Research and Education (CK-CARE)
Chair iCAAAL
Director, Pediatric Asthma Research Program
International Coalition on Allergy Asthma
Breathing Institute
and Immunology
Section of Pediatric Pulmonary Medicine
Children’s Hospital Colorado
Hugh A. Sampson MD
Professor of Pediatrics
University of Colorado Denver School Kurt Hirschhorn Professor of Pediatrics
of Medicine Dean for Translational Biomedical Sciences
Aurora, CO, USA Director, Conduits (Mount Sinai’s CTSA
Program)
Francisco A. Bonilla MD PhD Director, Jaffe Food Allergy Institute
Department of Pediatrics
Associate Professor of Pediatrics
Icahn School of Medicine at Mount Sinai
Harvard Medical School
New York, NY, USA
Director, Clinical Immunology Program
Division of Immunology
Boston Children’s Hospital
Boston, MA, USA
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Edinburgh  London  New York  Oxford  Philadelphia  St Louis  Sydney  Toronto 2016
© 2016, Elsevier Inc. All rights reserved.
First edition 2003
Second edition 2010
Third edition 2016
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Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden
our understanding, changes in research methods, professional practices, or medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating
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With respect to any drug or pharmaceutical products identified, readers are advised to check the most
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ISBN: 978-0-323-29875-9
eISBN: 978-0-323-33946-9
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LIST OF CONTRIBUTORS
Mark J. Abzug, MD Edward M. Behrens, MD
Professor of Pediatrics Assistant Professor of Pediatrics
Associate Vice Chair for Academic Affairs Department of Pediatrics
Department of Pediatrics Joseph Lee Hollander Chair in Pediatric Rheumatology
University of Colorado School of Medicine Perelman School of Medicine at The University of
Children’s Hospital Colorado Pennsylvania
Aurora, CO, USA Chief of Pediatric Rheumatology
The Children’s Hospital of Philadelphia
Cezmi A. Akdis, MD Philadelphia, PA, USA
Professor of Immunology
Director Bruce G. Bender, PhD
Swiss Institute of Allergy and Asthma Research (SIAF) Professor and Head
University of Zurich Pediatric Behavioral Health
Davos, Switzerland National Jewish Health
Director (Speaker) Denver, CO, USA
Christine Kühne – Center for Allergy Research and Education
(CK-CARE) M. Cecilia Berin, PhD
Chair iCAAAL Associate Professor of Pediatrics
International Coalition on Allergy Asthma and Immunology Division of Allergy and Immunology
Icahn School of Medicine at Mount Sinai
Katrina Allen, MBBS BMedSc FRACP FAAAAI New York, NY, USA
PhD
Theme Director, Population Health, MCRI Brett P. Bielory, MD
Director, NHMRC Centre of Food and Allergy Research Resident
Paediatric Gastroenterologist/Allergist, RCH Department of Ophthalmology
Professor of Paediatrics, University of Melbourne New York Medical College
Murdoch Children’s Research Institute Westchester Medical Center
The Royal Children’s Hospital Valhalla, NY, USA
Victoria, VIC, Australia
Leonard Bielory, MD FACAAI FAAAAI FACP
Leonard B. Bacharier, MD Professor
Professor of Pediatrics & Medicine Rutgers University
Washington University School of Medicine RobertWood Johnson University Hospital
St. Louis Children’s Hospital Environmental and Occupational Health Sciences Institute
St. Louis, MO, USA University Asthma and Allergy Associates
Springfield, NJ, USA
Mark Ballow, MD
Professor of Pediatrics S. Allan Bock, MD
Division of Allergy and Immunology Clinical Professor
Department of Pediatrics Department of Pediatrics
University of South Florida/Morsani College of Medicine, All National Jewish Health
Children’s Hospital Denver, Colorado, USA
St Petersburg, FL, USA Department of Pediatrics
University of Colorado
Ashton Bartholow, BS Denver School of Medicine
Research Assistant Denver, CO, USA
Allegheny Singer Research Institute
Pittsburgh, PA, USA Mark Boguniewicz, MD
Professor, Division of Allergy-Immunology
Allan Becker, MD FRCPC Department of Pediatrics
Professor and Head National Jewish Health
Section of Allergy and Clinical Immunology University of Colorado School of Medicine
Department of Pediatrics and Child Health Denver, CO, USA
University of Manitoba
Winnipeg, MB, Canada
viii
List of Contributors ix
Francisco A. Bonilla, MD PhD Ronina A. Covar, MD
Associate Professor of Pediatrics Associate Professor
Harvard Medical School Department of Pediatrics
Director, Clinical Immunology Program National Jewish Health
Division of Immunology University of Colorado “School of Medicine”
Boston Children’s Hospital Denver, CO, USA
Boston, MA, USA
Benjamin P. Davis, MD
A. Wesley Burks, MD Cincinnati Children’s Hospital Medical Center
Executive Dean, School of Medicine Division of Allergy and Immunology
Curnen Distinguished Professor and Chair Cincinnati, OH, USA
Department of Pediatrics
The University of North Carolina Fatma Dedeoglu, MD
Chapel Hill, NC, USA Assistant Professor of Pediatrics
Harvard Medical School
Andrew Bush, MB BS (Hons) MA MD FRCP Division of Immunology
FRCPCH FERS Rheumatology Program
Professor of Paediatrics and Head of Section (Paediatrics), Boston Children’s Hospital
Imperial College Boston, MA, USA
Professor of Paediatric Respirology
National Heart and Lung Institute Pascal Demoly, MD PhD
Consultant Paediatric Chest Physician Professor and Head
Royal Brompton Harefield NHS Foundation Trust Allergy Unit, Département de Pneumologie et Addictologie,
London, UK Hôpital Arnaud de Villeneuve
University Hospital of Montpellier
Kenny H. Chan, MD Montpellier, France
Professor of Otolaryngology UMR-S 1136 INSERM, IPLESP, UPMC Paris 06, Sorbonne
University of Colorado Universités,
School of Medicine Paris, France
Children’s Hospital Colorado
Aurora, Colorado, USA Peyton A. Eggleston, MD
Professor Emeritus
Mirna Chehade, MD MPH Division of Pediatric Allergy and Immunology
Associate Professor of Pediatrics and Medicine Johns Hopkins University School of Medicine
Director, Mount Sinai Center for Eosinophilic Disorders Baltimore, MD, USA
Jaffe Food Allergy Institute
Icahn School of Medicine at Mount Sinai Robert Eisenberg, MD
New York, NY, USA Professor of Medicine, Emeritus
Department of Medicine
Anca M. Chiriac, MD Perelman School of Medicine at the University of
Assistant Professor Pennsylvania
Allergy Unit, Département de Pneumologie et Addictologie Philadelphia, PA, USA
Hôpital Arnaud de Villeneuve
University Hospital of Montpellier Thomas A. Fleisher, MD
Montpellier, France Chief, Department of Laboratory Medicine
UMR-S 1136 INSERM, IPLESP, UPMC Paris 06, Sorbonne NIH Clinical Center
Universités National Institutes of Health
Paris, France Bethesda, MD, USA
Lisa Cicutto, RN ACNP(cert) PhD CAE Luz Fonacier, MD
Director Professor of Medicine
Community Outreach and Research, National Jewish Health State University of New York at Stony Brook
Director Head of Allergy and Training Program Director
Clinical Science Program, University of Colorado Denver Winthrop University Hospital
AMC Mineola, NY, USA
Denver, Colorado, USA
Deborah A. Gentile, MD
Samuel A. Collins, MA MB BS MRCPCH Director of Research
Clinical Research Fellow Division of Allergy, Asthma, and Immunology Allegheny
Clinical and Experimental Sciences General Hospital Pittsburgh, PA, USA
University of Southampton Professor of Medicine Temple University School of Medicine
Southampton, UK Philadelphia, PA, USA
x List of Contributors
James E. Gern, MD Daniel J. Jackson, MD
Professor of Pediatrics and Medicine Assistant Professor
Divisions of Allergy and Immunology Department of Pediatrics
University of Wisconsin School of Medicine and Public Section of Allergy, Immunology & Rheumatology
Health University of Wisconsin-Madison
Madison, WI, USA Madison, WI, USA
Marion Groetch, MS RDN Stacie M. Jones, MD
Director of Nutrition Services Professor of Pediatrics
Jaffe Food Allergy Institute Chief, Allergy and Immunology
Kravis Children’s Hospital Dr. and Mrs. Leeman King Chair in Pediatric Allergy
Icahn School of Medicine at Mount Sinai University of Arkansas for Medical Sciences
New York, NY, USA Arkansas Children’s Hospital
Little Rock, AR, USA
Susanne Halken, MD DMSci
Professor Meyer Kattan, MD CM
Consultant in Pediatric Allergology Professor of Pediatrics at Columbia University Medical Center
Hans Christian Andersen Children’s Hospital, Director, Pediatric Pulmonary Division
Odense University Hospital Department of Pediatrics
Odense C, Denmark Columbia University College of Physicians and Surgeons
New York, NY, USA
Robert G. Hamilton, PhD D(AMBLI) FAAAAI
Professor of Medicine and Pathology Brian T. Kelly, MD MA
Director, Johns Hopkins Dermatology, Allergy and Clinical Instructor and Fellow, Department of Pediatrics
Immunology Reference Laboratory Division of Allergy/Immunology
Johns Hopkins University School of Medicine Medical College of Wisconsin
Baltimore, MD, USA Milwaukee, WI, USA
Elysia M. Hollams, PhD Kevin J. Kelly, MD
Senior Research Officer Professor of Pediatrics
Division of Cell Biology Vice Chair of Clinical Operations
Telethon Kids Institute, University of North Carolina
University of Western Australia, Pediatrician in Chief
Perth, WA, Australia North Carolina Children’s Hospital
Chapel Hill, NC, USA
Steven M. Holland, MD
Chief, Laboratory of Clinical Infectious Diseases Susan Kim, MD MMSc
National Institutes of Allergy and Infectious Diseases, NIH Instructor of Pediatrics
Bethesda, MD, USA Division of Immunology
Rheumatology Program
John W. Holloway, PhD Harvard University
Professor of Respiratory and Allergy Genetics Boston Children’s Hospital
Human Development and Health Boston, MA, USA
University of Southampton
Southampton, UK Donald B. Kohn, MD
Professor
Patrick G. Holt, DSc FAA Departments of Microbiology, Immunology & Molecular
Professor Genetics and Pediatrics
Telethon Kids Institute,University of Western Australia, Perth, David Geffen School of Medicine and Mattel Children’s
Australia, Hospital
Queensland Childrens Medical Research Institute, University of California, Los Angeles
University of Queensland, Brisbane, Australia. Los Angeles, CA, USA
Arne Høst, MD DMSci Howard M. Lederman, MD PhD
Associate Professor Professor of Pediatrics, Medicine and Pathology
Head of Department of Pediatrics Eudowood Division of Pediatric Allergy and Immunology
Hans Christian Andersen Children’s Hospital Johns Hopkins University School of Medicine
Odense University Hospital Baltimore, MD, USA
Odense C, Denmark
List of Contributors xi
Heather K. Lehman, MD Elizabeth C. Matsui, MD MHS
Clinical Associate Professor of Pediatrics Associate Professor
Division of Allergy, Immunology and Rheumatology Division of Pediatric Allergy and Immunology
Department of Pediatrics Johns Hopkins University School of Medicine
Women and Children’s Hospital of Buffalo Baltimore, MD, USA
University of Buffalo School of Medicine and Biomedical
Sciences Bruce D. Mazer, MD
Buffalo, NY, USA Professor of Pediatrics
Head of Child Health Research
Robert F. Lemanske Jr, MD Deputy Executive Director
Professor of Pediatrics and Medicine The Research Institute of the McGill University Health Center
Head, Division of Pediatric Allergy, Immunology and Montreal Children’s Hospital
Rheumatology Montreal, QC, Canada
University of Wisconsin School of Medicine and Public
Health Henry Milgrom, MD
Madison, WI, USA Professor of Pediatrics
National Jewish Health
Donald Y.M. Leung, MD PhD FAAAAI University of Colorado School of Medicine
Professor of Pediatrics Denver, CO, USA
University of Colorado
Edelstein Family Chair of Pediatric Allergy-Clinical Amanda B. Muir, MD
Immunology Instructor of Pediatrics
National Jewish Health Perlman School of Medicine at the University of Pennsylvania
Denver, CO, USA School of Medicine
Division of GI & Nutrition
Chris A. Liacouras, MD The Children’s Hospital of Philadelphia
Professor of Pediatrics Gastroenterology Philadelphia, PA, USA
Perlman School of Medicine at the University of Pennsylvania
School of Medicine Harold S. Nelson, MD
Division of GI & Nutrition Professor of Medicine
The Children’s Hospital of Philadelphia National Jewish Health and
Philadelphia, PA, USA University of Colorado Denver School of Medicine
Denver, CO, USA
Andrew H. Liu, MD
Professor of Pediatrics David P. Nichols, MD
Allergy and Clinical Immunology Division Head, Pediatric Pulmonology
National Jewish Health National Jewish Health
Children’s Hospital Colorado Associate Professor of Pediatrics
University of Colorado School of Medicine University of Colorado School of Medicine
Denver, CO, USA Denver, CO, USA
Gabrielle A. Lockett, PhD Luigi D. Notarangelo, MD
Post-doctoral Research Fellow Prince Turki Bin Abdul-AzizAl-Saud Professor of Pediatrics
Human Development and Health Harvard Medical School
University of Southampton Division of Immunology
Southampton, UK Boston Children’s Hospital
Boston, MA, USA
Jonathan E. Markowitz, MD MSCE
Medical Director, Pediatric Gastroenterology Natalija Novak, MD
Greenville Health System Professor of Dermatology
Professor of Clinical Pediatrics Department of Dermatology and Allergy
University of South Carolina School of Medicine – Greenville University of Bonn
Greenville, SC, USA Bonn, Germany
Fernando D. Martinez, MD Anna Nowak-We˛grzyn, MD
Regents’ Professor Associate Professor of Pediatrics
Director, Arizona Respiratory Center Jaffe Food Allergy Institute
Director, BIO5 Institute Kravis Children’s Hospital
Swift-McNear Professor of Pediatrics Icahn School of Medicine at Mount Sinai
University of Arizona New York, NY, USA
Tucson, AZ, USA
xii List of Contributors
Hans C. Oettgen, MD PhD Marc E. Rothenberg, MD PhD
Professor of Pediatrics Professor of Pediatrics
Boston Children’s Hospital Director, Division of Allergy and Immunology
Harvard Medical School Director, Cincinnati Center for Eosinophilic Disorders
Boston, MA, USA Cincinnati Children’s Hospital Medical Center
Cincinnati, OH, USA
J. Tod Olin, MD MSCS
Assistant Professor Hugh A. Sampson, MD
Department of Pediatrics, Division of Pulmonology Kurt Hirschhorn Professor of Pediatrics
Director, Pediatric Exercise Tolerance Center Dean for Translational Biomedical Sciences
National Jewish Health Director, Conduits (Mount Sinai’s CTSA Program)
Denver, CO, USA Director, Jaffe Food Allergy Institute
Department of Pediatrics
Joao Bosco Oliveira, MD PhD Icahn School of Medicine at Mount Sinai
Staff Clinician/Assistant Director New York, NY, USA
Department of Laboratory Medicine
NIH Clinical Center William J. Sheehan, MD
National Institutes of Health Instructor of Pediatrics
Bethesda, MD, USA Harvard Medical School
Division of Immunology
Hanneke (Joanne) N.G. Oude Elberink, MD PhD Boston Children’s Hospital
Associate Professor of Medicine Boston, MA, USA
Director Dutch Mastocytosis Center Groningen
Department of Allergology and Internal Medicine Scott H. Sicherer, MD
Groningen Research Institute of Asthma and COPD Elliot and Roslyn Jaffe Professor of Pediatrics, Allergy and
University Medical Center Groningen Immunology
University of Groningen Division Chief, Pediatric Allergy and Immunology
Groningen, The Netherlands Jaffe Food Allergy Institute
Kravis Children’s Hospital
Oscar Palomares, PhD Icahn School of Medicine at Mount Sinai
Ramón y Cajal (RyC) Research Associated New York, NY, USA
Department of Biochemistry and Molecular Biology
School of Chemistry F. Estelle R. Simons, MD FRCPC FAAP FACAAI
Complutense University of Madrid FAAAAI FCAHS
Madrid, Spain Professor
Department of Pediatrics & Child Health
Wanda Phipatanakul, MD MS Professor, Department of Immunology
Associate Professor of Pediatrics The University of Manitoba
Division of Immunology Winnipeg, MB, Canada
Boston Children’s Hospital
Harvard Medical School David P. Skoner, MD
Boston, MA, USA Professor of Medicine
Temple University School of Medicine
Nicole Pleskovic, BS Philadelphia, PA, USA
Research Assistant Clinical Professor of Pediatrics
Division of Allergy, Asthma, and Immunology Allegheny West Virginia University School of Medicine Morgantown,
General Hospital WV, USA
Pittsburgh, PA, USA Director, Division of Allergy, Asthma, and Immunology
Department of Medicine Allegheny General Hospital
Susan Prescott, BMedSc FRACP PhD MD Pittsburgh, PA, USA
Winthrop Professor
School of Paediatrics and Child Health Joseph D. Spahn, MD
University of Western Australia Associate Professor of Pediatrics
Paediatric Allergist, Perth Children’s Hospital Division of Allergy/Clinical Immunology
Research Strategy Leader, Telethon KIDS Institute National Jewish Health
Perth, WA, Australia Denver, CO, USA
Sergio D. Rosenzweig, MD PhD Robert C. Strunk, MD
Director, Primary Immunodeficiency Clinic, NIAID; Strominger Professor of Pediatrics
Deputy Chief, Immunology Service, DLM, Clinical Center, Washington University School of Medicine
NIH, Bethesda, MD, USA St. Louis Children’s Hospital
St. Louis, MO, USA
List of Contributors xiii
Kathleen E. Sullivan, MD PhD Rudolph S. Wagner, MD
Professor of Pediatrics Clinical Professor of Ophthalmology
The Children’s Hospital of Philadelphia Director of Pediatric Ophthalmology
University of Pennsylvania Perelman School of Medicine Institute of Ophthalmology and Visual Science
Philadelphia, PA, USA Rutgers – New Jersey Medical School
Newark, NJ, USA
Robert P. Sundel, MD
Director of Rheumatology Julie Wang, MD
Boston Children’s Hospital Associate Professor of Pediatrics
Associate Professor of Pediatrics Jaffe Food Allergy Institute
Harvard Medical School Kravis Children’s Hospital
Boston, MA, USA Icahn School of Medicine at Mount Sinai
New York, NY, USA
Stanley J. Szefler, MD
Director, Pediatric Asthma Research Program Richard W. Weber, MD
Breathing Institute Professor of Medicine
Section of Pediatric Pulmonary Medicine National Jewish Health
Children’s Hospital Colorado University of Colorado School of Medicine
Professor of Pediatrics Denver, CO, USA
University of Colorado Denver School of Medicine
Aurora, CO, USA Robert A. Wood, MD
Professor of Pediatrics
Troy R. Torgerson, MD PhD Director, Pediatric Allergy and Immunology
Associate Professor Johns Hopkins University School of Medicine
Pediatrics, Immunology/Rheumatology Baltimore, MD, USA
University of Washington
Seattle Children’s Hospital Bruce L. Zuraw, MD
Seattle, WA, USA Professor of Medicine
Chief, Division of Rheumatology, Allergy and Immunology
Erika von Mutius, MD MSc Department of Medicine
Professor of Pediatric Allergology University of California San Diego
Dr. von Hauner Children’s Hospital La Jolla, CA, USA
Ludwig Maximilian-University of Munich San Diego VA Healthcare
Munich, Germany San Diego, CA, USA
PREFACE
These are exciting times for physicians who treat children with involvement with their subject matter in children. Every effort
allergic and immunologically-mediated diseases. Microbial has been made to achieve prompt publication of this book, thus
infection and treatment of allergic reactions are common prob- ensuring that the content of each chapter is ‘state of the art.’
lems seen by the practicing pediatrician. Recent studies have Section A presents general concepts critical to an under-
provided new insights into mechanisms underlying diseases in standing of the impact and causes of allergic diseases. These
the area of pediatric allergy, asthma and clinical immunology. include reviews of the epidemiology and natural history of
As a result, new therapies are targeting key immune pathways. allergic disease, genetics of allergic disease and asthma, biology
Management guidelines for various diseases have also been of inflammatory-effector cells, regulation of IgE synthesis, and
developed based on evidence-based approaches. In addition, the developing immune system and allergy. Section B reviews
the National Institutes of Health have formed networks and an approach to the child with recurrent infection and specific
collaborative studies to investigate allergic/immunologic dis- immunodeficiency and autoimmune diseases that pediatricians
eases, such as food allergy, atopic dermatitis, asthma and immu- frequently encounter. Section C updates the reader on a number
nodeficiency. We are now witnessing the introduction of new of important and emerging immune-directed therapies includ-
medications that resulted from improved understanding of the ing immunizations, immunoglobulin therapy, stem cell therapy,
biology of allergic and immunologic diseases. The need to doc- and gene therapy. Section D examines the diagnosis and treat-
ument and summarize this recent remarkable increase in infor- ment of allergic disease. The remainder of the book is devoted
mation justifies the third edition of our textbook in the field of to the management and treatment of asthma and a number of
pediatric allergy and clinical immunology for practicing physi- specific allergic diseases such as upper airway disease, food
cians and investigators interested in this area. allergy, allergic skin and eye diseases, drug allergy, latex allergy,
It is often said, ‘Children are not simply small adults.’ In no insect hypersensitivity, and anaphylaxis. In each chapter, the
other subspecialty is this truer than in pediatric allergy and disease is discussed in the context of its differential diagnoses,
immunology, where the immune system and allergic responses key concepts, evaluations, environmental triggers, and concepts
are developing in different organs of the child. Earlier identifi- of emerging and established treatments.
cation of disease onset offers special opportunities for preven- Major advances in this third edition include updates on
tion and intervention, which cannot be carried out once disease genetics and biomarkers of allergy, inflammatory conditions
processes have been established in the older child and adult. and immunodeficiencies, recent guidelines in the treatment of
Indeed, many diseases that pediatricians see in clinical practice asthma, food allergy, atopic dermatitis, urticaria-angioedema,
are complex and are thought to result from a multigenic pre- and immunodeficiencies, population health, school-centered
disposition in combination with exposure to environmental asthma programs, prevention strategies, appropriate evaluation
triggers. However, the age at which the host is exposed to a of drug allergy and a better understanding of drug cross-reac-
particular environmental agent and the resultant immune tivity to eliminate the difficulty prescribing antibiotics in the
response are increasingly being recognized as important factors. pediatric population, the role of new biologics and immuno-
Furthermore, determining the appropriate time for interven- modulatory therapy in the treatment of inflammatory diseases
tion will be critical for defining a window of opportunity to and emerging evidence that epithelial barrier dysfunction can
induce disease remission. For example, microbes are a known drive allergic disease.
trigger of established asthma in adults but the ‘hygiene hypoth- We would like to thank each of the contributors for their
esis’ in children suggests that early exposure to certain microbes time and invaluable expertise, which were vital to the success of
prior to the onset of allergies may actually prevent allergic this book. The editors are also grateful to Belinda Kuhn (Senior
responses and thus account for the low prevalence of allergic Content Strategist), Joanna Souch (Project Manager) and Nani
disease in children living on farms. New information is available Clansey (Senior Content Development Specialist), who have
on controlling asthma in early childhood, however our current played a major role in editing and organizing this textbook, as
treatment does not alter the natural history of the disease. This well as the production staff at Elsevier Ltd for their help in the
concept will now reach clinical care as we draw attention to preparation of this book.
population health and prevention.
Pediatric Allergy: Principles and Practice is aimed at updating Donald Y. M. Leung, MD, PhD
the reader on the pathophysiology of allergic responses, and
Hugh A. Sampson, MD
allergic diseases including asthma, food allergy, allergic rhinitis,
and atopic dermatitis; their socioeconomic impact and new Francisco A. Bonilla, MD, PhD
treatment approaches that take advantage of emerging concepts Cezmi A. Akdis, MD
of the pathobiology of these diseases. An outstanding group of
Stanley J. Szefler, MD
authors who are acknowledged leaders in their fields has been
assembled because of their personal knowledge, expertise, and 2015
xiv