Journal of Clinical Immunology, Vol. 10, No. 3, 1990

Book Review

types and mechanisms of adverse reactions that could occur, they devote the next two parts to (1) adverse effects that occur on a nonallergic basis and (2) those that occur on an allergic or pseudoallergic basis. In each part they consider the reactions to the same five classes of excipients, namely, bulk materials, coatings, flavoring agents, coloring agents, and other additives. The fourth part expands the scope from drugs to mechanical devices and includes such things as dialyzers, needles, sutures, pacemakers, hearing devices, and eye appliances. In addition, an appendix of some 90 pages tabulates the current list of inactive ingredients in United States-marketed drug products. The list is classified by route of administration and includes the number of products incorporating each ingredient. The references are appropriate and an effort is made to maintain timeliness. A 1989 reference was even added while in proofreading. The only major typographical error found was in the title of Part III, page 199. This work should serve as the standard reference for the role so-called inactive ingredients or excipients may play in adverse reactions from the administration of drugs and many medical devices.

Adverse Reactions to Drug Formulation Agents: A Handbook of Excipients (Volume 14. Clinical Pharmacology, M. Weiner, Series Editor). Edited by M. Weiner and I. L. Bernstein. Marcel Dekker, New York, 1989, 480 pp., $125.00 (U.S. and Canada), $150.00 (all other countries).

A physician encountering the problem of a suspected reaction to a drug usually focuses on the principle active ingredient as the most likely agent. However, there is often a nagging doubt. This doubt is generated by the frequent long list of other ingredients such as coloring and flavoring agents, preservatives, antioxidants, fillers, buffers, stabilizers, and more. The authors of this book attempt to fill the gap in information concerning the effects and biological mechanisms by which the excipients of drugs may cause undesired effects. They generally succeed in their goal despite facing a formidable task. The complexity of the ingredients in drugs can be grasped by the example of one flavor, natural cocoa aroma. This single excipient required nearly four pages of two columns each in one publication to name its components and give their reference numbers. To accomplish their task, the authors, both M.D.'s, the first author also a clinical pharmacologist and the second an allergist-immunologist, have divided their book into four main parts. After discussing the classification of drug additives and the

HAROLD S. NOVEY

Basic & Clinical Immunology University of California, Irvine Irvine, California 92664

182 0271-9142/90/0500-0182506.00/0 © 1990 Plenum Publishing Corporation