Allergy Frontiers

Allergy Frontiers is a remarkable undertaking by 3 well-known experts in the field of allergy/immunology. This projected 6-volume series (3 volumes of which are currently available) is a comprehensive, state-of-the-art review comprising more than 150 chapters.

Volume 1, Epigenetics, Allergens and Risk Factors, contains 400 pages and is separated into 4 parts: “Evolution of Allergy,” “Epigenetics and Phenotypes,” “Allergens,” and “Risk Factors.” This logical approach for the first book establishes what is known regarding the epidemiology, genetics, and immunology of allergen structure and recognition, as well as risk factors. It contains welcome chapters such as “Indoor Air Pollution and Airway Disease” and “Socioeconomic Status and Asthma in Children.” The latter chapter provides an in-depth look at the complicated interplay of individual, family, neighborhood, and societal factors on the prevalence of childhood asthma.

Volume 2, Classification and Pathomechanisms, contains 600 pages in 3 parts: “Classification and Pathomechanisms,” “Allergy and the Nervous System,” and “Allergy and Mucosal Immunity.” This text brings the reader up to date on the basic science of allergic diseases. It is exhaustive in scope and contains chapters such as “Function of Dendritic Cell Subsets in Allergic Disease” and “Immune Complexes: Normal Physiology and Role in Disease.” The section on neuroregulation of immunity is particularly intriguing and covers topics such as neurotrophins, neuropeptides, and mascarinic receptors in the inflammation of asthma. The role of neuroregulation in allergic disease is likely underestimated, and one can hope that this review will serve as a catalyst for further research.

Volume 3, Clinical Manifestations, contains 500 pages and comprises 30 chapters that summarize the current knowledge of the clinical manifestations of allergic diseases, with many chapters containing sections on differential diagnosis and diagnostic work-up. Its focus is predominantly on disease of the upper and lower airways. One notable chapter reviews the therapeutic implications of airway remodeling in asthma.

There is much to like about Allergy Frontiers. By soliciting chapters from international authors, the editors have succeeded in giving the text a broad and balanced perspective. This type of international collaboration is refreshing and reflects the effort of researchers around the world to advance the clinical care of persons with allergic and immunologic disorders. It likewise reminds the reader that socioeconomic status, culture, lifestyle decisions, and a host of other factors influence the nature and severity of allergic disease.

The basic science review is particularly strong. The reader develops an appreciation for the complexity of the immune system and the multiple redundant cytokine mechanisms that can be vexing to researchers and clinicians. Yet this information is helpful to clinicians, who are often challenged to understand why some patients respond to treatment and others do not. This series is clearly unique in both its scope and its ability to focus on highly specific topics.

One could guess that the first edition of such an ambitious project would likely have a few glitches. A few typographical errors and rough spots with written English could be addressed easily in the next edition. Notably, these problems do not interfere with the reader's comprehension.

The heavy emphasis in volume 3 on upper and lower respiratory tract disease is, on one hand, exceedingly helpful because even topics such as “hormonal rhinitis” are addressed. On the other hand, food allergy is given only 15 pages in the 500-page volume (lactose and fructose intolerance is given another 12 pages). However, aspects of food allergy such as anaphylaxis are reviewed in several areas and relate to the final manifestations of several severe allergic disorders. Within the section on food allergy, it would be helpful to learn more about food-associated, exercise-induced anaphylaxis, which is likely underrecognized owing to its broad spectrum of presentation.

With its comprehensive scope, Allergy Frontiers will serve as an invaluable resource for academicians, allergy/immunology training programs, and curious individuals who require more than a basic understanding of the subject. The editors are to be commended for their hard work on this ambitious project, which adds much to the current understanding of allergic disease.