I II III MIDDLETON'S ALLERGY Principles & Practice Sixth edition With more than 683 illustrations and 35 color plates Edited by N. Franklin Adkinson Jr. MD Professor of Medicine and Training Program Director, Division of Allergy and Clinical Immunology, The Johns Hopkins Asthma and Allergy Center, The Hopkins Bayview Medical Campus, Baltimore, Maryland John W. Yunginger MD Emeritus Consultant in Pediatrics and Internal Medicine (Allergy), Mayo Clinic and Foundation, Emeritus Professor of Pediatrics, Mayo Medical School, Rochester, Minnesota William W. Busse MD Charles E. Reed Professor of Medicine, University of Wisconsin, Hospital and Clinics, Head, Allergy and Clinical Immunology, Department of Medicine, University of Wisconsin School of Medicine, Madison, Wisconsin Bruce S. Bochner MD Professor of Medicine and Director, Division of Allergy and Clinical Immunology, The Johns Hopkins Asthma and Allergy Center, The Hopkins Bayview Medical Campus, Baltimore, Maryland Stephen T. Holgate MD, DSc, FRCP, FMed Sci MRC Clinical Professor of Immunopharmacology, Southampton General Hospital School of Medicine, University of Southampton, Southampton, United Kingdom F. Estelle R. Simons MD, FRCPC Professor and Head, Section of Allergy and Clinical Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada http://avaxho.me/blogs/ChrisRedfield IV The Curtis Center Independence Square West Philadelphia, Pennsylvania 19106 MIDDLETON'S ALLERGY PRINCIPLES & PRACTICE, 6th EDITION 0-323-01425-9 Copyright © 2003, Mosby, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Permissions may be sought directly from Elsevier's Health Sciences Rights Department in Philadelphia, PA, USA: phone: (+1) 215 238 7869, fax: (+1) 215 238 2239, e-mail: [email protected]. You may also complete your request on-line via the Elsevier Science homepage (http://www.elsevier.com), by selecting ‘Customer Support’ and then ‘Obtaining Permissions’. NOTICE Medicine is an ever-changing field. Standard safety precautions must be followed, but as new research and clinical experience broaden our knowledge, changes in treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current product information provided by the manufacturer of each drug to be administered to verify the recommended dose, the method and duration of administration, and contraindications. It is the responsibility of the treating physician, relying on experience and knowledge of the patient, to determine dosages and the best treatment for each individual patient. Neither the publisher nor the editors assume any liability for any injury and/or damage to persons or property arising from this publication. Previous editions copyrighted 1978, 1983, 1988, 1993, 1998 International Standard Book Number 0-323-01425-9 Acquisitions Editor: Catherine Carroll Developmental Editor: Jennifer Shreiner Publishing Services Manager: Patricia Tannian Senior Project Manager: Anne Altepeter Book Design Manager: Gail Morey Hudson Cover Design: Jen Brockett Printed in the United States of America Last digit is the print number: 9 8 7 6 5 4 3 2 1 V Contributors N. Franklin Adkinson Jr. MD Professor of Medicine and Training Program Director, Division of Allergy and Clinical Immunology, The Johns Hopkins Asthma and Allergy Center, The Hopkins Bayview Medical Campus, Baltimore, Maryland, USA Cheryl Adolphson MS Senior Science Writer, Department of Immunology, Mayo Clinic and Foundation, Rochester, Minnesota, USA Rafeul Alam MD, PhD Veda and Chauncey Ritter Chair in Immunology, Professor and Director, Division of Allergy and Immunology, National Jewish Medical and Research Center, Denver, Colorado, USA Philip W. Askenase MD Chief, Section of Allergy and Clinical Immunology, Internal Medicine, Yale University School of Medicine, Attending Physician, Yale–New Haven Medical Center, New Haven, Connecticut, USA Bharat Awsare MD Fellow, Division of Critical Care, Pulmonary, Allergic, and Immunologic Diseases, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA Claus Bachert MD, PhD Professor of Surgery, Ear, Nose, and Throat Department, University Hospital Ghent, Ghent, Belgium Mark Ballow MD Professor of Pediatrics, State University of New York, Buffalo School of Medicine and Biomedical Sciences, Director, Allergy/Clinical Immunology Fellowship Training Program Chief, Allergy, Clinical Immunology, and Pediatric Rheumatology Division, Children's Hospital of Buffalo, Buffalo, New York, USA Peter J. Barnes DM, DSc, FRCP Professor of Thoracic Medicine, National Heart and Lung Institute, Imperial College, London, United Kingdom Neal P. Barney MD Associate Professor of Ophthalmology, Ophthalmology Department, University of Wisconsin, Associate Professor of Medicine and Visual Sciences, Ophthalmology and Visual Sciences Department, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA Vikas Batra MD Fellow, Division of Critical Care, Pulmonary, Allergic, and Immunologic Diseases, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA Bruce S. Bochner MD Professor of Medicine and Director, Division of Allergy and Clinical Immunology, Department of Medicine, Division of Allergy and Clinical Immunology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Mark Boguniewicz MD Senior Faculty Member, Department of Pediatrics, National Jewish Medical and Research Center, Denver, Colorado, USA Larry Borish MD Associate Professor of Medicine, Asthma and Allergic Disease Center, University of Virginia School of Medicine, Charlottesville, Virginia, USA Louis-Philipe Boulet MD, FRCPC, FCCP Professor of Medicine, Université Laval, Respirologist, Centre de Pneumologie, Institut de Cardiologie et de Pneumologie de L'Université Laval, Sainte-Foy, Quebec, Canada Jean Bousquet MD, PhD Professor of Respiratory Medicine, Université Montpellier, Professor, CHU Montpellier, Montpellier, France William M.L. Bowerfind MD Research Fellow, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA VI David H. Broide MD, ChB Professor of Medicine, Department of Medicine, University of California—San Diego, La Jolla, California, USA Rebecca Hatcher Buckley MD J. Buren Sidbury Professor of Pediatrics, Department of Pediatrics and Immunology, Duke University Medical Center, Chief, Division of Allergy and Immunology, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA Robert K. Bush MD Professor of Medicine, University of Wisconsin—Madison, Chief of Allergy, William S. Middleton VA Hospital, Madison, Wisconsin, USA William W. Busse MD Professor of Medicine, University of Wisconsin Hospital and Clinics, Head, Allergy and Clinical Immunology, Department of Medicine, University of Wisconsin School of Medicine, Madison, Wisconsin William J. Calhoun MD Associate Professor of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA Lisa Cameron PhD Postdoctoral Fellow, Arizona Respiratory Center, Functional Genomic Lab, University of Arizona, Tucson, Arizona, USA Brendan J. Canning PhD Associate Professor of Medicine, Department of Medicine, Division of Allergy and Clinical Immunology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Margaretha L. Casselbrant MD, PhD Professor of Otolaryngology, University of Pittsburgh School of Medicine, Director of Clinical Research and Education, Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA Pota Christodoulopoulos MSc Postdoctoral Fellow, Meakins Christie Laboratories, McGill University, Montreal, Quebec, Canada Martin K. Church M PHARM, PhD, DSc Professor of Experimental Immunopharmacology, Dermatopharmacology Unit, University of Southampton, Southampton, Hampshire, United Kingdom Lauren Cohn MD Assistant Professor, Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, Yale University School of Medicine, Attending Physician,
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