Richard F. Lockey - Allergens and allergen immunotherapy

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title	:	Allergens and Allergen Immunotherapy Clinical Allergy and Immunology ; 12
author	:	Lockey, Richard F.
publisher	:	CRC Press
isbn10 | asin	:	0824701887
print isbn13	:	9780824701888
ebook isbn13	:	9780585138718
language	:	English
subject	Allergy--Immunotherapy, Allergens--Therapeutic use.
publication date	:	1999
lcc	:	RC588.I45A43 1999eb
ddc	:	616.97/06
subject	:	Allergy--Immunotherapy, Allergens--Therapeutic use.

Allergens and Allergen Immunotherapy

CLINICAL ALLERGY AND IMMUNOLOGY Series Editor MICHAEL A. KALINER, M.D. Medical Director Institute for Asthma and Allergy Washington, D.C. 1. Sinusitis: Pathophysiology and Treatment, edited by Howard M. Druce 2. Eosinophils in Allergy and Inflammation, edited by Gerald J. Gleich and A. Barry Kay 3. Molecular and Cellular Biology of the Allergic Response, edited by Arnold I. Levinson and Yvonne Paterson 4. Neuropeptides in Respiratory Medicine, edited by Michael A. Kaliner, Peter J. Barnes, Gert H. H. Kunkel, and James N. Baraniuk 5. Provocation Testing in Clinical Practice, edited by Sheldon L. Spector 6. Mast Cell Proteases in Immunology and Biology, edited by George H. Caughey 7. Histamine and H1-Receptor Antagonists in Allergic Disease, edited by F. Estelle R. Simons 8. Immunopharmacology of Allergic Diseases, edited by Robert G. Townley and Devendra K. Agrawal 9. Indoor Air Pollution and Health, edited by Emil J. Bardana, Jr., and Anthony Montanaro 10. Genetics of Allergy and Asthma: Methods for Investigative Studies, edited by Malcolm N. Blumenthal and Bengt Bjrkstn 11. Allergic and Respiratory Disease in Sports Medicine, edited by John M. Weiler 12. Allergens and Allergen Immunotherapy: Second Edition, Revised and Expanded, edited by Richard F. Lockey and Samuel C. Bukantz ADDITIONAL VOLUMES IN PREPARATION Emergency Asthma, edited by Barry Brenner Food Hypersensitivity and Adverse Reactions, edited by Marianne Frieri and Brett Kettelhut

Page i Allergens and Allergen Immunotherapy Second 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 MARCEL DEKKER, INC. NEW YORK BASEL HONG KONG

Page ii The first edition was published under the title Allergen Immunotherapy. ISBN: 0-8247-0188-7 This book is printed on acid-free paper. Headquarters Marcel Dekker, Inc. 270 Madison Avenue, New York, NY 10016 tel: 212-696-9000; fax: 212-685-4540 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 1999 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 PRINTED IN THE UNITED STATES OF AMERICA

Page iii We dedicate this book to our families and to Joy McCann Culverhouse for her friendship and support

Page v Introduction Allergic diseases and asthma are becoming more prevalent and costly. Treatments that are currently available are both effective and widely accepted. In general, treatments include allergen avoidance, pharmacotherapy, and allergen immunotherapy. Of these three approaches to a life-long disease, pharmacotherapy has no long-term or lasting value and recent studies with nasal corticosteroids suggest that there may be more potential for systemic side effects than has previously been appreciated. The same potential for subtle untoward effects may apply to other medications as well. Thus, in allergic patients who suffer from diseases that last for months to years at a time, it becomes increasingly important to approach these diseases from the immunological perspective. The underlying allergic mechanisms that cause these diseases are being carefully dissected and better understood. If one avoids the allergens to which one is sensitive, the allergic reaction is reduced. Thus, knowledge of allergens is essential for the physician to advise patients about avoidance techniques. If avoidance is ineffective or impossible, modulation of the production of the allergic reaction is the next appropriate step. As we await immunological approaches that will turn off or convert the type 1 allergic reaction, immunotherapy warrants careful consideration. Immunotherapy has been employed in treatment for nearly a century, with no recognized untoward effects other than induction of immediate allergic reactions. We have examined all aspects of this treatment modality, modified the reagents employed, examined its effectiveness, and concluded that it plays an important role in the management of carefully selected patients with allergic diseases. One would think that this well-established treatment plan should need no review; however, the truth is that the use of immunotherapy has evolved enormously over time. Thus, both older and less experienced practitioners need to read this text and review their approach to this modality in order to make certain that they are using techniques that could stand outside reviews in the next millenium. For example, are allergen vaccines being prepared with mixtures of allergens that contain enzymes capable of destroying each other? Is a preservative being added to extracts? What is the final allergen concentration in the most concentrated vials; is it adequate to induce the immune response desired? Are patients signing appropriate informed consents? These are only a few of the issues in modern immunotherapy which require periodic consideration and possible revision of techniques by practitioners.

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