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WAO Medical Book Review

Parasites & Allergy
Editors: Capron, M; Trottein, F

List price: $162.00 USD
Available from: Karger

Peter DeBuse FRACP, FRCP (LOND.)
Royal Children's Hospital, Brisbane, Australia

Since the 1980's, the "hygiene hypothesis" has held sway in explaining the increase in allergic disease in affluent countries and the lack of increase in underdeveloped communities. The basic concept is that T helper cells are stimulated by infections in childhood and that if they are not, a default mode stimulates the T2 helper cells concerned with the allergic process. The allergic process is often considered to have evolved largely as a measure to counter the gut infestation by protozoan parasites. Where community parasite infestation is high, epidemiologic studies show that the incidence of allergic diseases is lower than in communities with low parasite infestation.

The editors have assembled twelve reviews which address the complicated cellular signaling mechanisms that are involved in the phenomenon, allowing the authors to discuss the anomalies in the basic "hygiene hypothesis" and speculate on the implications for associated T1 disease states such as inflammatory bowel disease and diabetes Type 1. Nearly all the reviews use the example of schistosomiasis in their discussion, probably because of the massive and widespread prevalence in the developing world. The biology of intestinal Helminths is dealt with not only in terms of the life cycle but also in evolutionary significance.

These reviews provide an up-to-date and informative discussion on signaling, proteases, and glycans as promoting molecules, the nature of white cells (natural killer, mast cells, and basophils) and importantly on Regulatory T cells.

I found this a fascinating book and anyone interested in biology will enjoy it. Naturally immunologists and allergists are a target audience, but general physicians – both adult and paediatric – will be interested in the speculations on novel methods of controlling inflammatory/allergic diseases.

The multifaceted approach to unraveling the molecular basis is well organized by the Editors so that there is a layered wealth of detail and a good deal of consensus. The tables and figures are clear and the references numerous.

An excellent book which deals with the very basis of the allergic state. Interestingly, laboratory rodents feature in the experimental data; large domestic animals that are regularly wormed to rid them of intestinal parasites are not mentioned – just wondering?