Journal of the New Zealand Medical Association, 27-February-2009, Vol 122 No 1290
Edited by Werner J Pichler. Published by S Karger AG, Basel, Switzerland, 2007. ISBN 9783805582698. Contains 438 pages. Price CHF 274
This is one of the first texts on the subject of drug hypersensitivity that covers such an extensive range of topics. Other textbooks on the subject focus on a single or limited number of areas or are specific to a particular organ of involvement or drug class. The book therefore has broad appeal with interest to those practising and/or researching in allergy, clinical immunology, dermatology, pharmacology, HIV medicine, microbiology, haematology, anaesthetics, nephrology, or hepatology.
The book is organised into 5 sections comprised of 33 consistently structured chapters that contain useful tables, figures, coloured photos, and up-to-date references.
The second section (12 chapters) examines the pathomechanisms, genetics and animal models of drug hypersensitivity. The initial 5 chapters focus on immunopathogenesis. Both well established mechanisms such as haptenisation and novel theories such as the “p-i or pharmacological interaction with immune receptors” are discussed. A chapter is devoted to the exciting area of pharamocogenetics with emphasis on the strong influence of genetic susceptibility to SJS in Han Chinese in relation to allopurinol and carbamazepine use. One chapter deals with the adverse side effects to biological agents, which are being exponentially developed and increasingly used in clinical practice. There are three chapters that each describes hypersensitivity to an antiretroviral drug, which may have been better condensed to a single chapter. Another chapter advocates for better animal models in drug development that predict for and thereby reduces the risk of SCAR.
The third section (13 chapters) dedicates chapters to various generalised and organ-specific hypersensitivity diseases with an informative initial chapter on the current classification, causes and manifestations of various drug hypersensitivity reactions. A proportion of chapters are drug-specific (betalactam antibiotics, non-betalactam antibiotics, contrast media, and aspirin/NSAIDS). Other more specific topics include perioperative anaphylaxis and paediatric drug and vaccine allergy. These clinical chapters are detailed and comprehensive and do not provide information in a bulleted or boxed format for clinicians seeking swift and succinct direction.
The fourth section (2 chapters) is dedicated to in vivo and in vitro diagnosis and the fifth section (2 chapters) on desensitisation to antibiotics, chemotherapy agents and monoclonal antibodies. These sections do provide concise advice and protocols for physicians. However, the section on desensitisation should have been broadened to include protocols on cephalosporins, sulphonamides, aspirin and insulin.
I can recommend this textbook as a very useful reference for the clinician, pharmacologist, epidemiologist and researcher. The editor and authors have successfully negotiated the challenging task of describing and crystallising the protean and nebulous aspects entailed in the dynamic field of drug hypersensitivity.
Staff Specialist, Clinical Immunology and Allergy
Royal North Shore Hospital, Sydney, Australia
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