Immunology in the pediatrician's office.

The development of antibody-mediated immunity is reflected in the maturation of B lymphocytes, in the changing levels of total immunoglobulins, and in the development of specific antibodies first to proteins and then sequentially to different types of polysaccharides. The measurement of anti-pneumococcal antibodies allows us to recognize specific antibody deficiencies, which need to be differentiated from normal developmental phases in the maturation of antibody-mediated immunity. The recognition of the late phase of IgE mediated allergic reactions is important to understanding the chronic manifestations of allergy. Chronic manifestations of allergy are frequently missed because they do not appear to be clearly related to acute triggers of allergic reactions. These conditions can be appropriately diagnosed, prevented, and treated, however, when the mechanisms of the late manifestations of allergy are understood. The integration of knowledge about the development of immunity and of allergic diseases enhances the pediatrician's ability to care for patients with immunologic abnormalities.