Manual of Allergy and Clinical Immunology for Otolaryngologists

Review by L Flood
Middlesborough, UK

This is a potentially daunting textbook, but it is certainly comprehensive and tackles a subject largely overlooked in the ENT literature. We all recognise that Immunology is either a good thing or sometimes a bad thing, in that it can salvage conditions surgeons cannot treat, but can equally challenge our diagnostic skills. We must recognise when there is too much of it, or, equally, too little. We all know that Polyangiitis with granulomatosis (or is the other way around?) is preferred to the eponym of He Who Must Not Be Named (nothing to with Harry Potter). I congratulate myself on picking up two in one clinic last week, which oddly was meant to be only Two Week Wait cancer referrals! We can safely mutter about Churg Strauss or Cogan with no idea who they were. I have long taught the mnemonic LIAM for factors in rhinosinusitis (Lifestyle, Immunity, Anatomy and Mucociliary clearance). That is probably the limit of my understanding.

Multiple Choice Questions for FRCS candidates always ask about Type I-IV hypersensitivity and, having been involved as an examiner for over a decade, I think it is only now, after reading some bullet points here, that I understand it. Table 2.1………… I simply know I must learn it. It is not too late, even aged 62 and working part time.

This is a multi-author work but largely based on input from New York and the Netherlands. Of course it starts with the Basic Sciences and diagnostics, but then covers the obvious topics such as Rhinosinusitis, Asthma, Angioedema and Anaphylaxis etc. Immune deficiency and the converse, autoimmune disorders are particularly interesting to read. Those vasculitides are still fascinating and there is clearly the opportunity still to be famous. There is far more out there, unrecognised, than “WG” to which to attach one’s name. I would not have thought of Sarcoidosis fitting in here, but of course. Mind you, to prove I did read this (if not cover to cover), I was puzzled to see Fig 13.7 which is meant to be laryngeal amyloid, but proves to be a gouty tophus of the ear. A minor error we will soon forgive.

This is very much updated, with chapters relevant to many subspecialities in ENT practice eg Tumour Immunology, Allergic Skin Diseases (that otitis externa that will not respond to these Neomycin drops we keep giving her), Food Allergens (I am suddenly an authority on Eosinophilic Oesophagitis. I must be, as there is a JLO paper shorty to be published), Immunotherapy. This is an imaginative topic that delivers “something different”. One feels one should read every word of it frankly, but, if it just makes us all think about the role of Immunology, it will have achieved much.

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