Pediatric Allergy, Asthma, and Immunology

Pediatric Allergy, Asthma, and Immunology
By Arnaldo Cantani. 1619 pp., illustrated. Berlin, Springer, 2008. $779. ISBN: 978-3-540-20768-9

Millions of children worldwide suffer from allergic diseases such as asthma, atopic dermatitis, allergic rhinitis, or food allergy. The diagnosis and treatment of these children require special attention to the complexities not only of childhood but also of developmental and disease processes. As a specialty, pediatric allergy and immunology is not consistently recognized throughout the world. Physicians and researchers recently have brought attention to this area through outstanding clinical care and groundbreaking clinical investigation.

Arnaldo Cantani has undertaken by himself the daunting task of compiling a comprehensive book on pediatric allergy, asthma, and immunology. As Cantani writes in the book's preface, he discovered “this world, where I had the chance to revive the significance of the three S's: science, safety and sympathy.” Cantani understands the significance and complexities of taking care of children of all ages and with many illnesses. The physician must “deal with cases of extreme severity, such as anaphylactic shock, or perform ordinary jobs, such as giving suggestions on the diets or the furnishings of the home.” The earliest beginnings of this book come from numerous classes and lectures that Cantani has given to medical students and postgraduates throughout his career.

The book is complex and detailed, spanning more than 1600 pages, divided into 24 chapters, and including nearly 1400 tables and figures. Cantani covers a wide range of diseases, from food allergy to pediatric AIDS. Each chapter contains scientific information as well as practical knowledge and advice.

Such a book is much needed, but this particular book, written by only one author, leaves much to be desired. The information on allergic diseases has expanded greatly in the past 20 years. The ability of one author to synthesize information from this vast field is limited. For example, in the chapter on food allergy, the recommendations for diagnosis and the discussion of food challenges (introducing a food to see if it provokes an allergic reaction) appear to have been written by a less-than-experienced clinician, with conclusions based on some of the published literature instead of on practical, firsthand knowledge. Additionally, the sections in which insomnia and recurrent stomatitis are described as being caused by foods are neither evidence-based nor in line with current thinking. Similar examples are found in each chapter.

Other comparable books are often written by multiple authors, and although they sometimes suffer from conflicting thoughts and advice, these differences are part of the beauty of the art of clinical medicine — one learns by understanding different opinions as well as the distinctions between established, evidence-based facts and recommendations that are made on the basis of supposedly expert advice.

Part of Cantani's impetus for writing the book was to legitimatize the field of pediatric allergy and immunology, particularly in Europe. The training and accreditation for pediatric allergy and immunology, however, differ throughout Europe and the United States, as well as in other regions worldwide. Although this field does need appropriate recognition of the truly important medical research and breakthroughs that have been made in the past 25 years, the publication of a book that does not include input from the best and brightest clinicians and researchers is not the ideal way to gain acknowledgment of pediatric allergy and immunology as a specialty or to educate readers.

A. Wesley Burks, M.D.
Duke University Medical Center, Durham, NC 27710
wesley.burks@duke.edu

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