Article written: December 2001
Some would describe allergic disease as "the epidemic of the 21st century". The prevalence has doubled over the last 20 years. In New Zealand, like most developed countries, about 40% of the population has the predilection for developing allergies (are atopic). Paralleling the ‘true increase’ in allergy is the increased awareness. Allergy however, is not a new disease.
Perhaps the earliest report of allergic disease is that of King Menses of Egypt, who was killed by the sting of a wasp at some time between 3640 and 3300 BC. Another report from ancient history is that of Britannicus, the son of the Roman Emperor Claudius. He was allergic to horses and "would develop a rash and his eyes swelled to the extent that he could not see where he was going". Accordingly, the honour of riding at the head of the young patricians fell to Nero who was Claudius’s adopted son. Nero allegedly threw Christians to the lions and killed Britannicus. Sir Thomas More gives the next authoritative account of allergy: King Richard III used his allergy to strawberries to good effect in arranging the judicial murder of Lord William Hastings. The King surreptitiously ate some strawberries just prior to giving an audience to Hastings and promptly developed acute urticaria. He then accused Hastings of putting a curse on him, an action that demanded the head of Hastings on a plate.
The Roman philosopher, Lucretius observing exaggerated responses to commonly occurring substances said "what is food for some may be fierce poisons for others". However, the modern era of allergy started in the 1800s with the description of hay fever.
Dr. John Bostock first accurately described hay fever as a disease that affected the upper respiratory tract. Although of unknown origin, oddly enough it had nothing to do with either hay or having a fever. Hay fever, or in medical terms, seasonal allergic rhinitis, is the most widespread form of allergy, affecting more than 15 million Americans. Common symptoms include sneezing, a runny or stuffed nose, red, itchy, swollen or watery eyes and itching in the nose and throat.
To investigate his own hay fever, Charles Blakely performed the first skin test by applying pollen through a small break in his skin. His experiment introduced the concept that pollen sensitivity caused hay fever. Today's skin testing methods vary in the way in which the allergen extract is introduced into the skin; however, the principle remains the same. As Blakely found, a positive reaction to a specific allergen becomes evident in about twenty minutes by the appearance of a hive like response at the tested skin site.
Charles Richet and Paul Portier invented the word 'anaphylaxis' when in the course of other immunization research they discovered this life threatening response to medications and protein substances. Anaphylactic shock occurs within minutes after allergen exposure, causing symptoms from swelling of body tissues, to vomiting, to cramps, to a sudden drop in blood pressure or even a loss of consciousness. It often occurs in people who are particularly sensitive to penicillin, stinging insects, shellfish, peanuts or tree nuts and it must be treated as a medical emergency.
Austrian Pediatrician Clemens von Pirquet first used the word 'allergy' to describe the strange, non-disease related symptoms that some diphtheria patients developed when treated with a horse serum antitoxin. The word comes from the Greek word 'alol', meaning, 'change in the original state.' Indeed an allergic reaction is the result of the body's change when it adversely responds to a harmless substance.
The work of Leonard Noon and John Freeman helped established the basis for immunotherapy or allergy shots. Immunotherapy involves injecting the allergy sufferer with small, gradually increasing amounts of the substance that is causing the reaction. The idea is that over time, the body's immune system will become less sensitive to the substance and the allergy symptoms will be reduced or eliminated.
Daniel Bovet synthesized the first antihistamine drug. He and his colleagues found antihistamines, in blocking the effects of the chemical histamine also protected against some of the symptoms of anaphylaxis. Today's antihistamine drugs are effective in the treatment of the sneezing and runny nose of hay fever and the itching, swelling and redness of hives and some other allergic rashes.
Philip Hench and Edward Kendall discovered and introduced corticosteroids into clinical medicine. These drugs were found to be effective in the treatment of asthma and both immediate and delayed allergic reactions. Corticosteroids have significantly improved the lives of today's allergy sufferers.
Researches James F. Riley and Geoffrey B. West discovered the mast cell granule to be the major source of histamine in the body. In this fundamental contribution to the understanding of inflammatory and allergic reactions, Riley and West depended on a valued partner and experimental subject named Judy. This ten-year-old cocker spaniel earned a place in canine history thanks to her mast cell tumour, which had the highest histamine content ever recorded.
Kimishige and Teruko Ishizaka further explained the allergy process by discovering the role of IgE class antibodies as the principal mediator in the allergic reaction. In response to repeated exposure to an allergen such as pollen, the allergic individual produces IgE antibodies, which then attach to mast cells. This is the first step in sensitizing the affected tissue. Upon repeated exposure, allergens cross-link IgE antibodies on the surface of the mast cells. It is this binding process that triggers the release of histamine and other mediators, thus causing allergy symptoms.
In the early 1980s Professor Bengt I Sameulsson received the Nobel Prize in Medicine/Physiology for identifying leukotrienes as the elusive 'slowing reacting substance of anaphylaxis' which had been implicated in allergic inflammation many years earlier. These are natural chemicals in the body, which contribute asthma attacks. His work greatly expanded the understanding of the important biological role leukotrienes play as mediators in asthma, allergy and inflammation.