Preface
These are exciting times for physicians who treat children with
allergic and immune-mediated diseases. Recent studies have pro-
vided new insights into mechanisms underlying diseases in the
areas of pediatric allergy, asthma, and clinical immunology. Many
novel research tools such as multiple omics and bioinformatics
that enable in-depth and precision research and the development
of new treatments are now available. As a result, we are now incor-
porating into clinical practice novel treatments that have resulted
from our improved understanding of the biology and patho-
physiology of allergic and immunologic diseases. New manage-
ment guidelines for various diseases, including food allergy, atopic
dermatitis, asthma, and immunodeficiency, have been developed
according to evidence-based approaches. The need to document
and summarize this remarkable increase in information has neces-
sitated the fourth edition of our textbook in the field of ­pediatric
allergy and clinical immunology for practicing physicians and
investigators interested in this clinical and scientific area.
It is often said that children are not simply small adults. In no
other subspecialty is this more true than in pediatric allergy and
immunology, at the time when the immune system is maturing
during the first few years of life. Earlier identification of disease
onset offers increased opportunities for prevention and interven-
tion, which are difficult to reverse once disease processes have
been established in the older child and adult. Furthermore, many
allergic or immunologic diseases encountered in pediatric clinical
practice are complex and are thought to result from a multigenic
predisposition in combination with exposure to environmental
triggers in an evolving immune response. However, the age at
which the host is exposed to a particular environmental agent and
the resultant immune response are increasingly being recognized
as important factors. Furthermore, early intervention is critical to
induce tolerance and prevent disease. New disease endotypes and
phenotypes are emerging. Increasingly, we are appreciating the
complex interaction of genetics, immune response, the microbi-
ome, and various environmental factors, such as diet and stress,
in the diseases we see as pediatricians. These concepts have now
reached clinical care as we draw attention to population health
and prevention.
Pediatric Allergy: Principles and Practice is intended to update
the reader on the pathophysiology of allergic responses and
allergic diseases, including asthma, food allergy, allergic rhinitis,
atopic dermatitis, and immunologic diseases; their socioeconomic
impact; and new treatment approaches that take advantage of
emerging concepts in the pathobiology of these diseases. An out-
standing group of authors who are key opinion leaders in their
fields have been assembled because of their personal knowledge,
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expertise, and involvement with their subject matter in children.
Every effort has been made to achieve prompt publication of this
book, thus ensuring the content of each chapter is current.
Section A presents general concepts critical to understanding
the causes and impact of allergic diseases. These include reviews of
the epidemiology and natural history of allergic disease, genetics
of allergic disease and asthma, biology of inflammatory effector
cells, regulation of immunoglobulin E synthesis, and the develop-
ing immune system and allergy. Section B reviews an approach to
the child with recurrent infection and specific immunodeficiency
and autoimmune diseases frequently encountered by pediatricians.
This section discusses emerging important immune-directed ther-
apies, including immunizations, immunoglobulin therapy, stem
cell therapy, and gene therapy. Section C examines the diagnosis
and treatment of allergic disease. The remainder of the book is
devoted to the management and treatment of asthma and specific
allergic diseases, such as upper airway disease, food allergy, allergic
skin and eye diseases, drug allergy, latex allergy, insect hypersensi-
tivity, and anaphylaxis. In each chapter, the disease is discussed in
the context of its differential diagnoses, key concepts, evaluation,
environmental triggers, and concepts of established and emerging
treatments.
Major advances in this fourth edition include updates on
genetics and biomarkers of allergy, inflammatory conditions,
and immunodeficiencies; recent guidelines in the treatment of
asthma, food allergy, atopic dermatitis, urticaria and angioedema,
and immunodeficiencies; prevention strategies; appropriate evalu-
ation of drug allergy; the role of new biologic agents and immu-
nomodulatory therapy in the treatment of inflammatory diseases;
and emerging evidence that epithelial barrier dysfunction drives
allergic disease.
We would like to thank each of the contributors for their
time and invaluable expertise, which are vital to the success of
this book. The editors are also grateful to Nani Clansey (Senior
Content Development Specialist) and Robin Carter (Executive
Content Strategist), who have played a major role in editing and
organizing this textbook, and the Elsevier production staff for
their expertise in the preparation of this book.
Donald Y.M. Leung, MD, PhD, FAAAAI
Cezmi A. Akdis, MD
Leonard B. Bacharier, MD
Charlotte Cunningham-Rundles, MD, PhD
Scott H. Sicherer, MD
Hugh A. Sampson, MD
2020