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Geriatric Anesthesia: Principles and Practice

nevertheless practically useful clinical diagnosis. Throughout the book there is a heavy leavening of orthodox immunological theory, with pointers to other mechanisms which may play a role, such as idiosyncratic metabolic defects, toxic additives. The introductory chapters are a collection of well written articles on various aspects of mucosal immunology. The authors have gone to a lot of trouble to exhaust the information banks on their topics, as in the 20 page chapter (with 96 references) on gut-associated macrophages, by Bockman. Despite this wealth ofinformation, the author had to admit in the conclusion to '. . . the paucity of our detailed knowledge about the role which macrophages play in food intolerance . . .'. For those whose physiology is rusty there is an excellent chapter on gut function by Mallinson in this section. Later come interesting chapters on mucins by Clamp and lectins by Freed. Are these the missing links in the mechanisms which so many doctors (particularly among the contributors) believe are causing their patients' food dependent symptoms? Although expounding the theoretical potential, neither author reported evidence supporting abnormalities of either mucin or response to lectins in patients with food allergy or food intolerance. Wright and Robertson do a service in drawing together many of the non-immune mechanisms by which substances in food cause gut damage. The four chapters in the section 'Examples of Foods as Allergens' are illustrative of the varied approach in the book. Jean Monro is short on science and long on advice in her chapter about rotational diets, with appendices which are a food faddists dream. Gerrard presents both orthodox and unorthodox views ofcows' milk allergy, while the chapters on fish and egg white allergy, by Aas, are models of scientific exposition. The third section of the book deals with end organ effects. This covers many of those clinical states in which the connection with food allergy is tenuous, to say the least. In discussing the mechanisms involved, in the first chapter of this section Jonathan Brostoff rightly points out that the cornerstone ofthe diagnosis offood sensitivity is clinical the response of the patient's symptoms to specific dietary manipulation. Beyond the well-known and accepted Gell and Coombs classification ofimmunological hypersensitivity, the abnormalities of metabolic pathways mentioned are all hopeful but as yet unproven explanations of why some patients become clinically ill after ingesting certain foods. The introduction of assorted data about disturbances of immune function in psychological states is presumably to lend credibility to the proposition that food intolerance can lead to behaviour disturbance, and conversely, that patients with psychological problems and stress may more easily develop food sensitivity to compound their symptoms. Among the chapters in this section are a number which cover various neuropsychological disturbances, arthritis and renal diseases, all attributed to food sensitivity. It would be true to say that most ofthe claims in these sections are controversial. This volume must have been a nightmare for the indexer since there is much repetition of ideas. Many authors quote their own or other workers' suggestive but incomplete data in support of these ideas. There is a section on the APICH syndrome (Autoimmune, Polyendocrinopathy Immune dysregulation, Candidiasis, Hypersensitivity) by Saifer and Becker which links occult autoimmunity with allergy in a novel manner. The section on the diagnosis of food allergy is also covered by many authors presenting various ways of detecting this such as by exclusion diets, laboratory tests (including IgG4 antibodies), food challenges intradermal tests. Treatment and prevention are covered in four relatively short chapters, again with a mixture of orthodox methods such as avoidance and symptomatic pharmacotherapy to somewhat unorthodox regimes oftransfer factor administration and hypersensitisation. This is a book in which there is something for everyone which is why it will undoubtedly find its way onto the shelves of many departments with an interest in nutrition, immunology, allergy and much else besides. The editors have interpreted Sir Peter Medawar's dictum about seeking to make the world a better place, by not excluding those with whom they disagree, and recognising that many patients have benefited symptomatically from both orthodox and more controversial approaches to this topic. However for the critical scientist this mixture can be somewhat unpalatable. At £75.00 it is more likely to be a departmental than an individual investment.