Allergens and Allergen Immunotherapy: Subcutaneous, Sublingual and Oral, Sixth Edition, 6th Edition (Hardback) book cover

Allergens and Allergen Immunotherapy

Subcutaneous, Sublingual and Oral, Sixth Edition, 6th Edition

Edited by Richard F. Lockey, Dennis K. Ledford

CRC Press

584 pages | 75 Color Illus. | 161 B/W Illus.

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Hardback: 9780815382218
pub: 2020-03-23
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The Sixth edition of Lockey and Ledford's Allergens and Allergen Immunotherapy continues to provide comprehensive coverage of all types of allergens and allergen vaccines, providing clinicians the essential information they need to accurately diagnose and manage all allergic conditions. With new and updated chapters, the sixth edition is the most up-to-date, single resource on allergy and immunotherapy.

Key Features

  • Completely revised and updated
  • Detailed single source reference on allergy and immunotherapy
  • Reorganized to provide clinicians with essential information to make diagnoses and offer the best treatments

Table of Contents

ALLERGENS AND ALLERGEN IMMUNOTHERAPY – Subcutaneous, Sublingual and Oral

6th edition


Section I Basic Concepts

Chapter 1 Historical Perspectives of Allergen Immunotherapy

David Fitzhugh, Sheldon G. Cohen (deceased) and Richard Evans III (deceased)

Chapter 2 Aeroallergen Sampling

Estelle Levetin and Josh D. McLoud

Chapter 3 Definition of an Allergen (Immunobiology)

Lauren Fine

Chapter 4 Allergen Nomenclature

Heimo Breiteneder, Richard Goodman, Martin D. Chapman, and Anna Pomés

Chapter 5 Immunologic Response to Various Forms of Allergen Immunotherapy

Umit Murat Sahiner, Mohamed H. Shamji, Sakura Sato, Ozge Soyer,

Stephen J Till, Motohiro Ebisawa, Mübeccel Akdis, and Stephen R. Durham

Chapter 6 In Vivo Testing

Richard W. Weber

Chapter 7 Serologic (in vitro) and Component Testing Methods in the Diagnosis of Human Allergic Disease

Robert G. Hamilton

Chapter 8 Nasal, Bronchial, Conjunctival, and Food Challenge Techniques and Epicutaneous Immunotherapy of Food Allergy

Mark W. Tenn, Matthew Rawls, Babak Aberumand, and Anne K. Ellis


Chapter 9 Local Mucosal Allergic Disease

Ibon Eguiluz-Gracia, Paloma Campo, and Carmen Rondón

Section II Allergens: Inhalation, Ingested, and Injected

Chapter 10 Tree Pollen Allergens

Rosa Codina, Fernando Pineda, and Ricardo Palacios

Chapter 11 Grass Pollen Allergens

Robert E. Esch


Chapter 12 Weed Pollen Allergens

Michael Hauser, Gabriele Gadermaier, Sabrina Wildner, Lisa Pointner, Michael Wallner, and Fatima Ferreira

Chapter 13 Fungal Allergens Robert Esch, Jonathan A. Bernstein, and Hari Vijay

Chapter 14 Mite Allergens Enrique Fernández-Caldas, Leonardo Puerta, Luis Caraballo, Victor Iraola, and Richard F. Lockey


Chapter 15 Cockroach and Other Inhalant Insect Allergens

Anna Pomés and Coby Schal


Chapter 16 Mammalian Allergens Tuomas Virtanen and Marja Rytkönen-Nissinen


Chapter 17 Food Allergens

Anusha Penumarti, Mike Kulis, and A. Wesley Burks


Chapter 18 Hymenoptera Allergens

Rafael I. Monsalve, Te Piao King, and Miles Guralnick

Chapter 19 Biting Insect and Tick Allergens Donald R. Hoffman and Jennifer E. Fergeson

Chapter 20 Occupational Allergens

Loida Viera-Hutchins, Andrew M. Smith, and David Bernstein


Section III Immunotherapy Techniques: Production, Preparation and Administration of Allergen Immunotherapy

Chapter 21 Manufacturing Pollen and Fungal Extracts

Robert E. Esch, Rosa Codina, Fernando Pineda, and Ricardo Palacios

Chapter 22 Manufacturing Arthropod and Mammalian Allergen Extracts

Enrique Fernández-Caldas, Eva Abel Fernández, Jonathan Kilimajer, and Seong H. Cho

Chapter 23 Manufacturing Food Extracts

Natalie A. David, Anusha Penumarti, A. Wesley Burks, and Jay E. Slater

Chapter 24 Regulation of Allergen Extracts in the United States

Jennifer Bridgewater, Jay E. Slater, and Ronald L. Rabin

Chapter 25 Manufacturing and Standardizing Allergen Extracts in Europe Jørgen Nedergaard Larsen, Christian Gauguin Houghton, Manuel Lombardero Vega, Hendrik Nolte, and Henning Løwenstein

Chapter 26 Indications for and Preparing and Administering Subcutaneous Allergen Vaccines Harold S. Nelson

Chapter 27 Preparing and Administering Sublingual Allergen Vaccines

Miguel Casanovas, Jonathan Kilimajer, and Enrique Fernández-Caldas

Chapter 28 Sublingual and Oral Food Immunotherapy: Indications, Preparation and Administration

Whitney Block, Sayantani B. Sindher, Vanitha Sampath, and Kari Nadeau

Chapter 29 Indications for and Preparing and Administering Hymenoptera Vaccines

David B. K. Golden, Farnaz Tabatabaian, Ulrich Müller-Gierok, and

Richard F. Lockey


Chapter 30 Recombinant and Modified Vaccines and Adjuvants used for Allergen Immunotherapy

Jeffrey Stokes and Thomas B. Casale


Section IV Clinical Application of Allergen Imunotherapy and Biological Therapy for Allergic Diseases

Chapter 31 Adherence and Cost-Effectiveness of SCIT and SLIT

Dana V. Wallace and John Oppenheimer

Chapter 32 Biologics in Allergic Disease

Tara Saco and Farnaz Tabatabaian




Chapter 33 Unproven and Epicutaneous and Other Investigational Forms of Immunotherapy

Haig Tcheurekdjian and Abba I. Terr




Section V Recognition, Management and Prevention of Adverse Effects of Allergen Immunotherapy

Chapter 34 Adverse Effects and Fatalities Associate with Allergen Skin Testing and Subcutaneous Allergen Immunotherapy

Andrew S. Bagg and Richard F. Lockey

Chapter 35 Recognition, Prevention, and Treatment of Adverse Effects Associated with Sublingual Immunotherapy

Giovanni Passalacqua, Diego Bagnasco, and Walter Canonica

Chapter 36 Recognition, Prevention, and Treatment of Adverse Effects Associated with Oral Allergen Immunotherapy

Jennifer A. Dantzer and Robert A. Wood

Chapter 37 Instructions and Consent Forms for Subcutaneous Allergen Immunotherapy

Shiven S. Patel, Linda Cox, and Richard F. Lockey

Chapter 38 Recognition, Treatment, and Prevention of Systemic Allergic Reactions and Anaphylaxis

Emma Westermann-Clark, Stephen F. Kemp, and Richard D. deShazo

About the Editors

Richard F. Lockey, MD, MS, Director of the Division of Allergy and Immunology, Department of Internal Medicine, and Professor of Medicine, Pediatrics and Public Health, was named the Joy McCann Culverhouse Chair in Allergy and Immunology at the University of South Florida Morsani College of Medicine, Tampa, Florida, in 1997. He is a tenured physician and in 2007 was honored to receive the additional title of University of South Florida Distinguished Health Professor. He joined the faculty in 1973 at which time he also became a staff member on the James A. Haley Veterans’ Hospital where he was Chief of the Section of Allergy and Immunology until 2017. He is board certified in both internal medicine and in allergy and immunology.

The Division of Allergy and Immunology, Department of Internal Medicine, is a widely recognized treatment, teaching, and research facility in the field of allergy, asthma, and clinical immunology. For example, at different times in the history of the Division, up to five Division faculty have been named as Òbest doctorsÓ in America. Through the efforts of Dr. Lockey, the Division is now endowed with more than US$14 million dedicated to teaching and research. The faculty in the Division work in the state-of-the-art Joy McCann Culverhouse Airway Disease Research Center, devoted to long-term treatments and even a cure for allergic and immunologic diseases and asthma. In addition, the Division’s Joy McCann Culverhouse Airway Disease Research Center’s Clinical Research Unit has participated in many of the major drug innovations for the treatment of allergic and immunologic diseases and asthma over the past 40 or more years. The Division has approximately 50 members consisting of nine physicians, some of whom are also basic scientists, and four PhDs, devoted to basic research. Four clinician scientists are in the Division of Allergy and Immunology, Department of Pediatrics, at the University of South Florida Morsani College of Medicine, Tampa, Florida and the Johns Hopkins/All Children’s Hospital, St. Petersburg, Florida. The Division is supported by 11 affiliated physicians who interact with the Division regularly and help with the teaching and research programs.

Dr. Lockey received his undergraduate degree from Haverford College, Haverford, Pennsylvania, in 1961 and a medical degree from Temple University School of Medicine, Philadelphia, Pennsylvania, in 1965 where he was a member of the Alpha Omega Alpha National Medical Honor Society. After completing his internship in medicine at Temple University School of Medicine in 1966, he finished his residency in internal medicine in December 1968 and fellowship in allergy and immunology at the University of Michigan, Ann Arbor, Michigan in December 1970, where he also attended the University of Michigan Rackham Graduate School and received a Master’s degree in Internal Medicine this same year. He was a Major, U.S. Air Force, during the Vietnam War and served as Chief of Allergy and Immunology at Carswell Air Force Base, Fort Worth, Texas, from 1970 to 1972.

Widely published, Dr. Lockey has authored, co-authored, or edited over 750 scientific and review articles and book chapters, 17 books and 20 monographs. He has published and co-authored articles in Nature, JAMA, and the New England Journal of Medicine. He has been an invited speaker on more than 450 occasions for both national and international scientific conferences and has served on the editorial boards of many peer-reviewed journals. In 1987, he edited a special edition for the Journal of the American Medical Association, Primer on Allergic and Immunologic Diseases. He was a co-editor of the first American College of Physicians and American Academy of Allergy Asthma & Immunology Medical Knowledge Self-Assessment Program (MKSAP) in Allergy and Immunology, published in 1992. He is a fellow of the American Academy of Allergy Asthma & Immunology and a past-fellow of the American College of Chest Physicians and the American College of Physicians. He also is a past-member of the American Thoracic Society, European Academy of Allergy and Clinical Immunology, Clinical Immunology Society, American College of Occupational and Environmental Medicine, European Thoracic Society, and the American Medical Association. He is a current member of the Florida Allergy, Asthma and Clinical Immunology Society of which he is a past-president. In 1992, Dr. Lockey received a ÒCertificate of AppreciationÓ from the Florida Medical Association in addition to being featured with Drs. Samuel C. Bukantz and Robert A. Good, mentors and colleagues, on the cover of the June/July 1996 special issue of The Journal of the Florida Medical Association.

Professional honors include serving as President of the American Academy of Allergy Asthma & Immunology (1992–1993); Director of the American Board of Allergy and Immunology from 1993 to 1998, the organization which oversees and examines physician candidates for certification as specialists in allergy/immunology; and the Board of the World Allergy Organization (WAO) from 1995 to 2016. He served as the WAO President from January 2010 until December 2012. The organization represents approximately 35,000 allergists/immunologists from over 100 countries throughout the world. He has also served as an associate on two World Health Organization committees, one on the Prevention of Allergies and Asthma and the other, Allergic Rhinitis and Its Impact on Asthma. He was also a co-editor of a third project, the WHO Position Paper, Allergen Immunotherapy: TherapeuticVaccines for Allergic Diseases, published in 1998. He was the editor of the World Allergy Organization WEB-Page and the World Allergy Organization E-MAIL News and Notes from 2004 to 2009, which served all physicians, in particular, allergists/immunologists throughout the world.

Included among the numerous distinctions Dr. Lockey has received are the Alumni Achievement Award, Temple University School of Medicine, Philadelphia, PA, and McCaskey High School, Lancaster, PA, and listings in many Who’s Who in the World and as an outstanding medical specialist in Town and Country magazine. He has also received an award for Outstanding Leadership in Chapter Development and Patient Support from the National Asthma and Allergy Foundation of America, an appreciation award from the Asthma and Allergy Foundation of America, Florida Chapter, and the Team Physician Award for his services as a volunteer physician for the University of South Florida Athletic Department. He received a Special Recognition Award in 1993 and Distinguished Service Award in 1999 from the American Academy of Allergy Asthma & Immunology.

In 2008, he was awarded the Distinguished Clinician’s Award from this same organization. He was awarded the Florida Academy of Sciences Medal for the year 2000 presented for outstanding work in scientific research, activities in the dissemination of scientific knowledge and service to the community. He received the University of South Florida Distinguished Service Award in 2001. In the year 2006, Dr. Lockey received the Distinguished Visiting Professor Award from the Faculty of Medicine at the Catholic University of Cordoba, Argentina and

was also made an Honorable Member of the Latin-American Society of Allergy Asthma and Immunology. He is an honorary member of other societies. He was awarded the Southern Medical Society Dr. Robert D. and Alma W. Moreton Original Research Award, in 2012. In 2018, he received the Distinguished Eagle Scout Award from the Boy Scouts of America, the highest honor bestowed by this organization. He was also inducted into the University of South Florida Robert A. Good Honor Society this same year. In 2019, he was honored by the American Academy of Allergy Asthma & Immunology (AAAAI) which established the AAAAI Foundation and Richard F. Lockey, MD, MS, FAAAAI University of South Florida Lectureship and Faculty Development Award. The $250,000 generated for this award were donated by colleagues, both present and past, for which he is extremely grateful.

As Director of the Division of Allergy and Immunology, Dr. Lockey has helped train over 100 MDs in the specialty program of allergy and immunology and approximately 40 postgraduate PhDs or MDs from various parts of the world in clinical and basic research. Most of them have assumed leadership positions in science and medicine in their respective communities or countries. He continues to spend equal amounts of time caring for patients, in basic and clinical research, and teaching at the University of South Florida Morsani College of Medicine and its affiliated hospitals. Dr. Lockey is married to Carol Lockey and has two children, Brian Christopher Lockey and Keith Edward Lockey, and is blessed with five grandchildren, Olivia, Benjamin, William, Nicholas, and Matthew.

Dennis K. Ledford, MD was born and grew up in East Tennessee and was valedictorian of his high school class.

He attended college at the Georgia Institute of Technology, Atlanta, Georgia. He graduated magna cum laude with a

degree in chemical engineering and was selected for membership in Tau Beta Pi, the engineering honor society. He

received his medical degree from the University of Tennessee Center for Health Sciences. Dr. Ledford is a member of Alpha Omega Alpha Medical Honor Society (AOA), being selected as a 3rd year student at the University of Tennessee, and he received the outstanding student of medicine award, graduating first in his class. He remained in Memphis for the completion of his internal medicine residency and served as chief medical resident for Dr. Gene Stollerman at the City of Memphis Hospitals. A fellowship in rheumatology and immunology followed at New York University and Bellevue Hospital in New York. A fellowship in allergy and immunology at the University of South Florida completed his education. Dr. Ledford remained in Tampa at the University of South Florida (USF), joining the faculty and achieving the rank of professor of medicine in 2000. Dr. Ledford received the honor of being named the USF Morsani College of Medicine Mabel and Ellsworth Simmons Professor of Allergy in 2012. He is actively involved in the pediatric and internal medicine allergy/immunology training programs and established and was the prior program director of the program in Clinical and Laboratory Immunology at the University of South Florida.

Dr. Ledford has contributed in a variety of areas to the USF Morsani College of Medicine. He is the

Past-President of the Medical Faculty, serving from 2012–2013. He has served on the medical student selection committee and was chair of the committee for two separate terms. He was honored with the Distinguished Service Award by the University in 2018.

Dr. Ledford received the outstanding teacher award from the USF medical house staff, the outstanding medical volunteer of the year in Hillsborough County and the Governors Community Service Award from the American College of Chest Physicians. He has served on the American Board of Allergy and Immunology as Secretary/Treasurer and leader of the maintenance of certification initiative. He is a past president

of the Florida Allergy Asthma and Immunology Society. Dr. Ledford was a member and vice-chair of the

Residency Review Committee for Allergy/Immunology of the American Council of Graduate Medical Education. He has previously served as an associate editor of the Journal of Allergy and Clinical Immunology, editorial board member for the Annals of Allergy Asthma and Immunology and Journal of Allergy and Clinical Immunology: In Practice,and is a past contributing editor for Allergy Watch. He is a contributor to UpToDate.

Dr. Ledford has served the American Academy of Allergy Asthma and Immunology (AAAAI) in a number of capacities. He was a prior governor of the Southeast Region of the State Local and Regional Allergy Societies of the AAAAI and chair and member of several committees. He has been a member of the Board of Directors and was President of the AAAAI from 2011–2012. He served on numerous task forces for the AAAAI and as chair of the International Collaboration in Asthma Allergy and Immunology. Dr. Ledford is the past chair of the Steering Committee for the Allergy Asthma and Immunology Education and Research Trust, currently known as the AAAAI Foundation. He received the Outstanding Clinician Award from both the American Academy of Allergy Asthma and Immunology and the World Allergy Organization.

Dr. Ledford works with the Division’s faculty in managing Academic Associates in Allergy Asthma and Immunology, is chief of the section of allergy and immunology at the James A. Haley VA Hospital, and has been selected as one of America’s Best Doctors consecutively for more than 25 years. Clinical responsibilities occupy the majority of his time, but he has developed research interests in severe, steroid dependent asthma, allergen characterization, the association of gastroesophageal reflux disease and upper airway disease and eosinophilicesophagitis. Dr. Ledford has been the principal investigator in more than 25 and co- investigator in more than 180 clinical trials, authoring or co-authoring more than 150 publications. He has been married to Jennifer S. Ledford for 45 years and is blessed with three children, Keith, Michael and Robert, and 11 grandchildren, Madelyn, Andrew, Isaiah, Ian, Lukas, Kaila, Annika, Grant, Ethan, Miles and Parker.

Subject Categories

BISAC Subject Codes/Headings:
MEDICAL / General
MEDICAL / Clinical Medicine
MEDICAL / Dermatology