Table Of Content

Normal ranges Serum immunoglobulins (adults) IgG 5.8–15.4g/L IgA 0.64–2.97g/L IgM (males) 0.24–1.90g/L IgM (females) 0.71–2.30g/L IgG subclasses (adults) IgG1 2.2–10.8g/L IgG2 0.5–8.0g/L IgG3 0.05–0.9g/L IgG4 0.0–2.4g/L Antibacterial antibodies Pneumococcal (Pneumovax®) >20U/L Tetanus (protective) >0.1 IU/mL Haemophilus infl uenzae B >1mcg/mL (full protection) Complement C3 0.68–1.80g/L C4 0.18–0.60g/L C1-esterase inhibitor (adult) Immunochemical 0.18–0.54g/L Functional 80–120% of normal plasma Total IgE (>14 years) IgE <100kU/L Specifi c IgE Grade 0 <0.35IU/mL Grade 1 0.35–0.70IU/mL Grade 2 0.70–3.50IU/mL Grade 3 3.50–17.50IU/mL Grade 4 17.5–50.0IU/mL Grade 5 50–100IU/mL Grade 6 >100IU/mL Lymphocyte subsets (adult values) Total T cells (CD3+) 690–2540 cells/mm3 Total B cells (CD19+ or CD20+) 90–660 cells/mm3 T helper cells (CD3+CD4+) 410–1590 cells/mm3 T cytotoxic cells (CD3+CD8+) 190–1140 cells/mm3 NK cells (CD16+CD56+) 90–590 cells/mm3 NB: normal total lymphocyte count for infant <6 months is 3500–7000 cells/mm3. OXFORD MEDICAL PUBLICATIONS Oxford Handbook of Clinical Immunology and Allergy Published and forthcoming Oxford Handbooks Oxford Handbook for the Oxford Handbook of Genetics Foundation Programme 3e Oxford Handbook of Genitourinary Oxford Handbook of Acute Medicine, HIV and AIDS 2e Medicine 3e Oxford Handbook of Geriatric Oxford Handbook of Anaesthesia 3e Medicine Oxford Handbook of Applied Oxford Handbook of Infectious Dental Sciences Diseases and Microbiology Oxford Handbook of Cardiology 2e Oxford Handbook of Key Clinical Oxford Handbook of Clinical and Evidence Laboratory Investigation 3e Oxford Handbook of Medical Oxford Handbook of Clinical Dermatology Dentistry 5e Oxford Handbook of Medical Oxford Handbook of Clinical Imaging Diagnosis 2e Oxford Handbook of Medical Oxford Handbook of Clinical Sciences 2e Examination and Practical Skills Oxford Handbook of Medical Oxford Handbook of Clinical Statistics Haematology 3e Oxford Handbook of Nephrology Oxford Handbook of Clinical and Hypertension Immunology and Allergy 3e Oxford Handbook of Neurology Oxford Handbook of Clinical Oxford Handbook of Nutrition and Medicine - Mini Edition 8e Dietetics 2e Oxford Handbook of Clinical Oxford Handbook of Obstetrics and Medicine 8e Gynaecology 2e Oxford Handbook of Clinical Oxford Handbook of Occupational Pathology Health 2e Oxford Handbook of Clinical Oxford Handbook of Oncology 3e Pharmacy 2e Oxford Handbook of Oxford Handbook of Clinical Ophthalmology 2e Rehabilitation 2e Oxford Handbook of Oral and Oxford Handbook of Clinical Maxillofacial Surgery Specialties 9e Oxford Handbook of Paediatrics 2e Oxford Handbook of Clinical Oxford Handbook of Pain Surgery 4e Management Oxford Handbook of Oxford Handbook of Palliative Complementary Medicine Care 2e Oxford Handbook of Critical Care 3e Oxford Handbook of Practical Drug Oxford Handbook of Dental Patient Therapy 2e Care 2e Oxford Handbook of Pre-Hospital Oxford Handbook of Dialysis 3e Care Oxford Handbook of Emergency Oxford Handbook of Psychiatry 3e Medicine 4e Oxford Handbook of Public Health Oxford Handbook of Endocrinology Practice 2e and Diabetes 2e Oxford Handbook of Reproductive Oxford Handbook of ENT and Head Medicine & Family Planning and Neck Surgery Oxford Handbook of Respiratory Oxford Handbook of Epidemiology Medicine 2e for Clinicians Oxford Handbook of Rheumatology Oxford Handbook of Expedition and 3e Wilderness Medicine Oxford Handbook of Sport and Oxford Handbook of Exercise Medicine Gastroenterology & Hepatology 2e Oxford Handbook of Tropical Oxford Handbook of General Medicine 3e Practice 3e Oxford Handbook of Urology 3e Oxford Handbook of Clinical Immunology and Allergy Third edition Gavin P Spickett Consultant Clinical Immunologist Regional Department of Immunology Royal Victoria Infi rmary Newcastle upon Tyne UK 1 3 Great Clarendon Street, Oxford, OX2 6DP, United Kingdom Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries © Oxford University Press, 2013 The moral rights of the author have been asserted First edition published 1999 Second edition published 2006 Third edition published 2013 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this book in any other binding or cover and you must impose the same condition on any acquirer British Library Cataloguing in Publication Data Data available Library of Congress Cataloging in Publication Data Library of Congress Control Number: 2012946415 ISBN 978–0–19–960324–4 (fl exicover: alk.paper) Printed in China by C&C Offset Printing Co. Ltd. Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding. v Dedication from fi rst edition To the memory of the late Charles Newman, who inspired me to con- tinue with a career in medicine, when I was assailed by doubts about my chosen path. This page intentionally left blank vii Contents Symbols and abbreviations ix Introduction xxv Part I 1 Primary immunodefi ciency 3 2 Secondary immunodefi ciency 81 3 Allergic disease 119 4 Autoimmunity and the endocrine system 167 5 Autoimmunity of the nervous system 187 6 Autoimmunity associated with cardiac, respiratory, and renal disease 201 7 Autoimmunity in gastrointestinal disease 213 8 Autoimmunity in liver disease 223 9 Autoimmune haematological disorders 231 10 Autoimmune skin disorders 241 11 Autoimmune eye disease 251 12 Connective tissue disease 257 13 Vasculitis 301 14 Miscellaneous conditions 335 15 Transplantation 367 16 Immunotherapy 383 viii CONTENTS Part II 17 Immunochemistry 433 18 Autoantibodies 473 19 Allergy tests 533 20 Cellular investigations 555 21 Tissue typing 579 22 Quality and managerial issues 591 Index 615

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The Oxford Handbook of Clinical Immunology and Allergy is a unique, practical and clinically relevant guide for clinicians and laboratory staff to assist with the diagnosis and management of immunological/allergic disease, and the correct selection and interpretation of immunological tests. Now full