Vol. 22, No. 6
Publication from the World Health Organization
Principles and Methods for Assessing Allergic Hypersensitization
Associated with Exposure to Chemicals, Environmental Health Criteria
No. 212 1999, xxix + 399 pages (English, with summaries in French
and Spanish), ISBN 92-4-157212-4, CHF 84.-/ USD 75.60; In developing
countries: CHF 58.80, Order No. 1160212.
This book summarizes current understanding of the complex interactions
between chemicals, the immune system, and target organs that lead to
manifestations of allergic hypersensitivity and autoimmunity. Noting
that the incidence of allergic disorders has increased significantly
in many countries, the book responds to the urgent need to improve methods
for detecting potential allergens and predicting their effects in both
individuals and populations. The need for better preventive strategies
and therapeutic options is also considered, particularly in view of
the high costs of allergic disorders in terms of health care and time
lost from work.
Addressed to researchers, the book concentrates on what is known about
the mechanisms of sensitization and autoimmunity elicited by numerous
industrial chemicals, adjuvant environmental factors (such as air pollution,
tobacco smoke, and ultraviolet radiation), and food allergens with a
proven involvement of the immune system. Although a large number of
allergies are covered, particular attention is given to asthma and contact
dermatitis as major occupational diseases undergoing intensive investigation.
Throughout, a special effort is made to identify lines of investigation
that will lead to a better understanding of fundamental mechanisms and
thus improve the prospects for treatment and prevention. Over 1 000
references to the literature are included.
The book opens with a detailed explanation of the structure and functional
processes of the immune system, followed by a discussion of the mechanisms
by which chemicals can disrupt these functions. Also discussed are fundamental
concepts of immunosuppression, immunodeficiency, and immunological tolerance
that help explain the mechanistic basis of sensitization, allergic responses,
Chapter 2 provides an overview of mechanisms involved in four major
types of hypersensitivity and in autoimmunity. Mechanisms are illustrated
with examples of diseases-from occupational asthma, through myasthenia
gravis, to chronic beryllium disease-where exposure to environmental
chemicals might play a role. The numerous hypotheses put forward to
explain the mechanisms of autoimmune reactions are also critically assessed.
Factors influencing allergenicity are covered in chapter three, which
concentrates on the many complex endogenous and exogenous factors that
govern the induction of allergic responses.
Against this background, Chapter 4 discusses clinical aspects of the
most important allergic diseases, which include allergic contact dermatitis,
atopic eczema, allergic rhinitis and conjunctivitis, allergic asthma
caused by contact with chemicals, food allergy, and autoimmune diseases
associated with drugs, chemicals, and environmental factors. Each disease
is profiled in terms of its epidemiology, clinical manifestations, etiology,
pathogenesis, diagnosis, and strategies for treatment and prevention.
The remaining chapters review the epidemiology of asthma and allergic
disease (including trends over time in different geographical regions),
describe procedures for hazard identification through the demonstration
of allergenicity, and explain how the principles of risk assessment
can be applied to allergy.
The book concludes with a glossary of terms, followed by 15 precise
recommendations for the protection of human health and a list of priorities
for further research.