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Excerpts from classics in allergy. second edition. Second edition. Edited by Sheldon G. Cohen and Max Samter. Carlsbad CA Symposia Foundation 1992. 211 pp. Illustrated. Indexed

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drugs. Compliance is next addressed. The succeeding two
chapters seem misplaced at this juncture; they deal with
poisoning by NSAIDs, including acetaminophen and salicylates, but they do explain the rather late recognition of
overdosage in the elderly that resulted from the benoxaprofen disaster (Has it only been ten years since this basic
principle of therapeutics was recognized?). Packaging and
storing comes next, followed by a three-chapter section on
pregnancy, neonates, and children. Nurselings do imbibe
some small quantity of NSAID metabolites in the mother’s
milk, but it is usually insufficient to harm (but could it
sensitize and lead to later anaphylactic response?).
The succeeding section of seven chapters deals with
subpopulations: the “healthy” elderly (generally so; they
must have something wrong to be taking NSAIDs!), in renal
impairment and dialysis, and the problems resulting in the
liver, in the upper gastrointestinal tract (“gastropathy”).
Also addressed are the use in dysmenorrhea, athletic injuries, and for pain, and the new ocular preparations of
NSAIDs. The next section discusses variations in formulation in eight chapters: serum half-life, controlled-release and
enteric coating, nonclassical oral formulations, intramuscular and intravenous administration, suppositories, and topical (still a good method of giving NSAIDs, but the benefit
hard to prove by standard scientific means). Finally, a
chapter on NSAIDs as accompaniment to physical therapy.
An international panel of experts has been assembled
by the respected editors, and despite that, the chapters read
coherently, in most acceptable expository prose. However,
some variability is inevitable. For example, in a table on
page 98 are recommended maximum doses for adults, often
below those that are now in use or are recommended in the
United States, especially for ibuprofen and naproxen.
No other current book goes into as much detail on
NSAIDs, nor can even a dedicated reader find all the
information in the journals. Individual studies and case
reports abound, but only considerable effort could bring
together all the disciplines and viewpoints represented here.
Moreover, not only are the currently available NSAIDs
covered, but also some awaiting approval and others sold
elsewhere, which many patients may well bring back from
trips abroad and whose benefits and adverse effects will be
unknown to many practicing physicians in the United States.
That Latin America and Japan and some Pacific and Indian
Ocean rim countries treat fever preferentially with NSAIDs,
an indication eschewed here, is important information, and
in the future, we are likely to see NSAIDs supplanting
narcotics for acute colics and other severe pains.
The book is amazingly up-to-date, given the pace of
introduction of medications, and the references voluminous,
although some prior discussions relevant to the topics seem
to have been missed or otherwise omitted by some of the
authors. But these minor shortcomings, and a rather steep
price, fail to detract from the excellence and value of the
work. It should be consulted by all who treat inflammation,
and can be read with profit-even with pleasure-by those in
George E. Ehrlich, MD, FACR
Philadelphia, P A
Excerpts from Classics in Allergy. Second edition. Edited by
Sheldon G . Cohen and Max Samter. Carlsbad, CA, Symposia Foundation, 1992. 211 p p . Illustrated. Indexed.
Drs. Cohen and Samter present brief biographies of
many of the contributors to the ever-evolving field of allergy.
Rheumatologists, immunologists, and those interested in the
history of medicine and science will recognize some of the
pioneers in the field, but many names will not be familiar.
However, when reading of their contributions, one senses
the development of an increasingly complex bank of knowledge as we have dissected the immune system of Homo
sapiens and related species.
From Shen-Nung (Muteria Medica [2838-2698 BC])
who first recognized the stimulant properties of Ephedrine,
to Lucretius who noted that “Food to one is poison to
another,” to Aretaeus the Cappadocian (12&180 AD) who
described the causes of acute and chronic diseases, to Willis
(1621-1675) who prescribed Colchicum for gout (and was
also known for his description of “the circle”), to Bernardino Ramazzini (1633-1714) who described occupational
diseases, the reader then encounters such familiar names as
Schonlein and Henoch, Ehrlich, Osler, Heidelberger,
Coons, Hargraves, and Kunkel, to name but a few. A
depiction, illustration, or photograph of each is included,
accompanying quotes from original works. For those interested in the history of medicine, especially allergy and
immunology, this labor of love is a delight to read.
Peter H. Schur, MD
Arthritis and Rheumatism
Boston, MA
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second, symposia, illustrated, 1992, max, cohen, allergy, carlsbader, edition, classic, sheldon, samter, edited, indexes, 211, foundations, excerpts
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