Table Of ContentP
ediatric
Allergy
Commissioning Editor: Claire Bonnett
Development Editor: Joanne Scott
Editorial Assistant: Kirsten Lowson
Project Manager: Joannah Duncan
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Illustration Manager: Bruce Hogarth
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P Second Edition
ediatric
Allergy
Principles and Practice
Donald Y. M. Leung, MD PhD FAAAAI
Edelstein Family Chair of Pediatric Allergy-Clinical Immunology
National Jewish Health
Professor of Pediatrics
University of Colorado Denver School of Medicine
Denver, CO, USA
Hugh A. Sampson, MD
Kurt Hirschhorn Professor of Pediatrics
Dean for Clinical and Translational Biomedical Sciences
Mount Sinai School of Medicine
New York, NY, USA
Raif Geha, MD
Chief, Division of Immunology
Children’s Hospital
James L. Gamble Professor of Pediatrics
Harvard Medical School
Boston, MA, USA
Stanley J. Szefler, MD
Helen Wohlberg and Herman Lambert Chair in Pharmacokinetics
Head, Pediatric Clinical Pharmacology
Department of Pediatrics
National Jewish Health
Professor of Pediatrics and Pharmacology
University of Colorado Denver School of Medicine
Denver, CO, USA
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British Library Cataloguing in Publication Data
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Saunders
Pediatric allergy: principles and practice. – 2nd ed.
1. Allergy in children. 2. Immunologic diseases in children.
I. Leung, Donald Y M, 1949-
618.9’297–dc22
ISBN-13: 9781437702712
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Preface
These are exciting times for physicians who treat children and who are acknowledged leaders in their fields has been assembled
investigators interested in mechanisms underlying diseases in because of their personal knowledge, expertise, and involvement
the area of pediatric allergy, asthma and clinical immunology. with their subject matter in children. Every effort has been made
There has been a well-documented rise in prevalence of this to achieve prompt publication of this book, thus ensuring that
group of diseases during the past three decades. Protection the content of each chapter is ‘state of the art.’
against microbial infection and treatment of hypersensitivity Section A presents general concepts critical to an understand-
reactions to environmental triggers have become primary goals ing of the impact and causes of allergic diseases. These include
for the practicing pediatrician. As a result, investigators at aca- reviews of the epidemiology and natural history of allergic
demic centers and in the pharmaceutical industry have part- disease, genetics of allergic disease and asthma, biology of
nered to understand mechanisms underlying these diseases and inflammatory-effector cells, regulation of IgE synthesis, and the
have developed evidence- and mechanism-based approaches for developing immune system and allergy. Section B reviews an
management and treatment of these illnesses. In addition, the approach to the child with recurrent infection and specific immu-
National Institutes of Health through the National Institutes of nodeficiency and autoimmune diseases that pediatricians fre-
Allergy and Infectious diseases and the National Heart, Lung quently encounter. Section C updates the reader on a number of
and Blood Institute have formed networks and collaborative important and emerging immune-directed therapies including
studies to study allergic/immunologic diseases, such as food immunoglobulin therapy, bone marrow transplantation, immu-
allergy and asthma. The need to document and summarize this nizations, gene therapy, and stem cell therapy. Section D exam-
recent remarkable increase in information justifies this new text- ines the diagnosis and treatment of allergic disease. The
book in the field of pediatric allergy and clinical immunology for remainder of the book is devoted to the management and treat-
practicing physicians and investigators interested in this area. ment of asthma and a number of specific allergic diseases such
It is often said, ‘Children are not simply small adults.’ In no as upper airway disease, food allergy, allergic skin and eye dis-
other subspecialty is this more true than in pediatric allergy and eases, drug allergy, latex allergy, insect hypersensitivity, and
immunology, where the immune system and allergic responses anaphylaxis. In each chapter, the disease is discussed in the
are developing in different host organs. This early age of onset context of its differential diagnoses, key concepts, evaluations,
of disease offers special opportunities for prevention and inter- environmental triggers, and concepts of emerging and estab-
vention, which cannot be carried out once disease processes have lished treatments.
been established in the older child and adult. Indeed, many dis- Major advances in this second edition include updates on new
eases that pediatricians see in clinical practice are complex dis- genetic advances in allergic diseases, inflammatory conditions
eases thought to result from a multigene predisposition in and immunodeficiencies, new biomarkers to monitor allergic
combination with exposure to an unknown environmental agent. diseases, recent revisions in asthma guidelines emphasizing a
However, the age at which the host is exposed to a particular step-care approach to control asthma, appropriate evaluation of
environmental agent and the resultant immune response are drug allergy and a better understanding of drug cross-reactivity
increasingly being recognized as important factors. Furthermore, to eliminate the difficulty prescribing antibiotics in the pediatric
determining the appropriate time for intervention will be impor- population, the role of new biologics and immunomodulatory
tant in defining a window of opportunity to induce disease therapy in the treatment of inflammatory diseases and emerging
remission. For example, endotoxin is a known trigger of estab- evidence that barrier dysfunction can drive allergic disease.
lished asthma in adults but the ‘hygiene hypothesis’ in children We would like to thank each of the contributors for their time
suggests that early exposure to endotoxin prior to the onset of and invaluable expertise, which were vital to the success of this
allergies may actually prevent allergic responses and thus book. The editors are also grateful to Joanne Scott (Deputy Head
account for the low prevalence of allergic disease in children of Development), Claire Bonnett (Acquisitions Editor), Joannah
living on farms. New information is available on controlling Duncan (Project Manager) and Kirsten Lowson (Senior Editorial
asthma in early childhood but our current treatment does not Assistant), who have played a major role in editing and organ-
alter the natural history of the disease. izing this textbook, as well as the production staff at Elsevier Ltd
Pediatric Allergy: Principles and Practice is aimed at updating for their help in the preparation of this book.
the reader on the pathophysiology of allergic responses and the
atopic triad (asthma, allergic rhinitis, and atopic dermatitis), the Donald Y. M. Leung, MD PhD FAAAAI
mechanisms underlying specific allergic and immunologic dis- Hugh A. Sampson, MD
eases, and their socioeconomic impact and new treatment Raif Geha, MD
approaches that take advantage of emerging concepts of the Stanley J. Szefler, MD
pathobiology of these diseases. An outstanding group of authors 2010
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