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Allergic Diseases. Diagnosis and Treatment.
  1. ROBERT SCOTT-JUPP, Consultant paediatrician

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    Allergic Diseases. Diagnosis and Treatment. Edited by Phil Lieberman and John A Anderson. (Pp 402; $89.50 hardback.) Humana Press, 1997. ISBN 0-896-03367-8.

    This is very much an American book aimed at a home readership, and as such its applicability to UK clinical practice is limited. Neither the editors nor the contributors are likely to be familiar to British paediatricians. Although comprehensive, it does not hang together well as a coordinated textbook: it is more a series of essays on topics related to allergic disease in the widest sense. It declares itself to be aimed at primary care physicians and allergy specialists rather than paediatricians.

    The book is not tightly edited, and as well as some sloppy typographical errors, there is also a great deal of repetition. For example, most of the chapter on diagnostic tests is repeated elsewhere, and the chapters on asthma in children and adults respectively have much in common. There is almost no cross referencing between chapters. With better editing the book could be considerably shorter.

    Good points include liberal use of boxes containing key points, a generally readable style, and a healthy scepticism towards unproved and unscientific tests and treatments. There are helpful explanations of underlying theories of allergic disease, good descriptions of diagnostic tests including skin testing, and a quite comprehensive description of childhood asthma, which goes beyond what one might expect in a book confined to allergic disease.

    There are thorough, although rather repetitive, chapters on allergic disorders of the upper respiratory tract, eyes, and skin.

    Weak points include paucity of illustrations, poor quality black and white photographs and, in the chapters related to drug treatment, there tends to be too much pharmacology and not enough on trials of clinical efficacy. Surprisingly, in spite of the comprehensive account of asthma, there is very little on inhaler devices and nothing on comparisons of nebulised with aerosol treatments.

    However, the main factor limiting the usefulness of this book to British doctors is its North American parochialism. Thus the thorough account of environmental allergens refers only to pollen species found in the USA, and the insect bites that may cause anaphylaxis are inflicted by species unfamiliar to us. The clinical management of asthma suggested differs quite considerably from standard UK practice (for example, chest radiography for every patient, different bronchodilator drugs, and much later use of inhaled steroids), and there is much greater emphasis on the use of immunotherapy and tolerance regimens for all types of allergic disease.

    The best chapter is probably the last, ‘Controversies in Allergy’, which commendably debunks most of the alternative and unproved methods of diagnosis and treatment that seem to be finding increasing favour on both sides of the Atlantic.

    In summary, this book will not find a ready market in the UK, and readers wanting accounts of the various allergic diseases and their treatments would probably not turn to this particular book as their first option. There are better, more internationally orientated texts available. That said, there are some excellent chapters and the subject is covered most comprehensively.