Essentials of Allergy

207 Pages·2001·1.16 MB·English

by  M Thirumala Krishna

Essentials of Allergy
M Thirumala Krishna PhDMRCP(UK)DNB
Specialist Registrar in Allergy and Clinical Immunology,
and Honorary Clinical Lecturer, Southampton General
Hospital and University of Southampton, Southampton,
UK
George Mavroleon PhD
Specialist in Allergy, 10–12 Sfakion Street, Chania,
73134 Crete,Greece
Stephen T Holgate MDDScFRCP
MRCClinical Professor of Immunopharmacology,
andHonorary Consultant Physician, University of
Southampton and Southampton General Hospital,
Southampton, UK
with a Foreword by Professor Stephen R Durham MAMDFRCP,
Professor of Allergy and Respiratory Medicine,
National Heart & Lung Institute, London, UK
MARTIN DUNITZ
Although every effort is made to ensure that drug doses and other information are presented
accurately in this publication, the ultimate responsibility rests with the prescribing physician.
Neither the publishers nor the authors can be held responsible for errors or for any consequences
arising from the use of information contained herein.
© 2001 Martin Dunitz Ltd, a member of the Taylor and Francis group
This edition published in the Taylor & Francis e-Library, 2003.
First published in the United Kingdom in 2001 by
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Composition by Wearset, Boldon, Tyne and Wear
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Contents
Foreword v
Preface vii
1 Diagnostic tests in allergy 1
2 Asthma 15
3 Rhinitis 29
4 Urticaria and angioedema 53
5 Anaphylaxis 77
6 Insect venom allergy 85
7 Drug allergy 95
8 Food allergy 107
9 Atopic dermatitis (eczema) 129
10 Immunotherapy 145
11 Latex allergy 161
12 Eosinophilic lung diseases 167
13 Extrinsic allergic alveolitis 181
Index 191

Foreword
Atopy, a predisposition to IgE-mediated allergic
disorders, is defined as the presence of a positive skin
test and/or raised serum allergen-specific IgE to one or
more common inhaled allergens. Atopy affects some
30–40 per cent of the population of westernised
countries. Approximately half these individuals develop
clinically significant allergic disorders, which include
allergic rhinitis, conjunctivitis and bronchial asthma.
Allergic rhinitis is particularly common and, although
often trivialized, may have a major impact on quality of
life with impaired performance at work/school, poor
sleep quality and interference with leisure pursuits. Less
common but potentially life-threatening conditions
include anaphylaxis to certain foods and to the venom of
stinging insects.
Essentials of Allergycovers the diagnosis and clinical
management of the common allergies. The less common
eosinophilic lung diseases and extrinsic allergic alveolitis
are also expertly covered. The text is easy to read and
complemented by the many tables and illustrations. The
diagnostic algorithms and detailed information on drugs
vi Foreword
and doses are particularly helpful. particular interest to general practitioners,
Frequently, allergic disorders coexist. nurses and organ-based specialists and
Whereas the first port of call for patients will be a valuable teaching aid for
with multiple allergies is, quite rightly, the allergists.
general practitioner, such patients may
benefit from the multidisciplinary Professor Stephen R Durham
approach offered by an allergy specialist. Professor of Allergy and Respiratory
In this sense, Essentials of Allergy‘fills Medicine
the gap’ by providing a timely and Upper Respiratory Medicine
comprehensive account of the common National Heart & Lung Institute
allergic disorders. The book should be of London
Preface
Most medical specialties are focused on specific organs,
while others, such as immunology, cover a series of
interdependent events relating to the host and its ability
to protect itself against the environment. The practice of
allergy falls somewhere between the two: strong organ-
based expression (e.g. asthma, atopic eczema) but often
extending to other systems. The definition of ‘allergy’
also leads to confusion – on the one hand, meaning a
group of hypersensitivity disorders with well-defined
immunological mechanisms and, on the other, covering
a range of intolerances to various environmental factors
for which clear mechanisms have not been defined.
Different health systems provide services to allergy
patients through both the primary and secondary care
sectors, with large variations between countries.
Because of the high prevalence of allergic disease, its
rising trend over time and the appearance of new
allergens to which patients react, we felt there was a
need for an easily digestible text on the subject, which
was highly accessible to those wishing to obtain a good
background relatively easily. We have targeted the book
viii Preface
towards both primary and secondary There is a pressing need to improve the
health care. The text is divided into 13 quality of care that patients with allergic
chapters covering different aspects of disease receive. It is with this in mind that
hypersensitivity responses. Thus, the we hope that this text provides a useful
book is clinically oriented and should be and accessible source of practical
valuable to trainees in allergy, respiratory information.
medicine and general (internal) medicine,
as well as to general practitioners and the MThirumala Krishna
professions allied to medicine. George Mavroleon
Stephen T Holgate
1
Diagnostic tests in allergy
1
Introduction
Although there is no substitute for a good history in
clinical medicine, laboratory tests are often required to
strengthen the clinical diagnosis and to provide a means
of, objectively, evaluating the disease, its severity and its
response to treatment. This chapter focuses on various
in vivoand in vitrotests employed in the investigation
and diagnosis of allergic disease. Some of these tests are
used mostly as research tools but, nevertheless, they
provide useful clinical information.
In vivo tests
Skin prick tests
Skin prick tests (SPT) (Figure 1.1) have been, and will
remain, the gold standard in the diagnosis of allergy. The
basic principle of this test is to detect the presence of
specific IgE bound to the surface of mast cells and
basophils. Upon challenge with the allergen, there is
cross-linking between the specific IgE and allergen on