Allergy The History of a Modern Malady Mark Jackson Allergy Allergy The History of a Modern Malady Mark Jackson reaktion books For Siobhán Love, all alike, no season knowes, nor clyme, Nor houres, dayes, moneths, which are the rags of time. John Donne, ‘The Sunne Rising’ Published by reaktion books ltd 33 Great Sutton Street London EC1VODX, UK www.reaktionbooks.co.uk First published 2006 Copyright © Mark Jackson 2006 All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publishers. Printed and bound in Great Britain by Cromwell Press Ltd, Trowbridge, Wiltshire British Library Cataloguing in Publication Data Jackson, Mark, 1959– Allergy: the history of a modern malady 1. Allergy 2. Social medicine I. Title 614.5’993 isbn–10: 1 86189 271 3 contents Preface 7 1 Histories 9 2 Strange Reactions 27 3 Allergy in the Clinic 56 4 The Global Economy of Allergy 103 5 Civilization and Disease 148 6 Resisting Modernity 185 7 Futures 216 Glossary 222 References 224 Bibliography 274 Acknowledgements 278 Photo Acknowledgements 280 Index 281 ‘elixir Anti-Asthmatique’, a French medicine label of 1920. preface This book is fuelled by a close personal, as well as professional, interest in the dramatic emergence and astonishing tenacity of allergies in the modern world. At the turn of the millennium, an English independent commission on the organization of the school year strongly recommended adopting a six- term, rather than the traditional three-term, academic year. Within this frame- work, the new fifth term, stretching from early April until the end of May, was to be devoted largely to assessing and examining pupils. In addition to ‘ratio- nalising the process of assessment’ and making greater space in term six for induction into the following year’s programmes, this innovative educational policy was also intended to ‘create more equitable assessment arrangements for 1.4 million to 1.8 million hay fever sufferers by moving assessment and examinations out of the main pollen season for grass, which is the major cause of hay fever’. Drawing strength from concurrent attempts to reform curricula and modes of assessment throughout the educational system, the commission believed that the rhythm of school life should be determined, at least in part, by the prevalence of a minor, albeit distressing, allergic disease.1 Such an educational strategy was not new. Throughout the 1960s, ’70s and ’80s contributors to the British medical and popular press regularly advo- cated removing examinations from the peak pollen season on the grounds that pupils with hay fever suffered both from the symptoms of their condition and from the sedative effects of medication.2 While such arguments failed to initiate reform 30 or 40 years ago, ongoing efforts to revise the curriculum may well benefit the next generation of school pupils. In part, the greater chances of success at the start of the new millennium can be traced to dramatic shifts in the politics of education since the 1960s and ’70s. More particularly, however, they can also be explained in terms of a remarkable global surge in allergic diseases, such as hay fever, asthma, food allergies and eczema, over the last century. At the start of the twentieth century, when allergy had no name, hay fever was considered to be a rare disease largely confined to the educated classes of the Western world. By the 1930s and ’40s 7 approximately 1 in 30 people in developed countries was suffering from the major manifestations of allergic reactions. In the immediate post-war decades, it was estimated not only that 10 per cent of the population in the modern industrialized world was experiencing the symptoms of allergy but also that the prevalence of allergic diseases was rising rapidly in the developing world. By the turn of the millennium, 1 in 5 British children was thought to exhibit some form of allergy, and allergic diseases had been identified as a significant threat to global health. My own family history bears out this broad temporal trajectory. My paternal grandparents, born in 1898 and 1904, ostensibly exhibited no evidence of allergy, although my grandmother’s older sister did suffer from asthma and eczema. While my father suffered from hay fever as a child (and indeed was treated for the condition by John Freeman, one of the leading British allergists) and devel- oped both asthma and shellfish allergy as a young adult, his sister demonstrates no signs of allergic reactions except the commonly experienced reactions to horse serum. On my mother’s side, not only is there a stronger tradition of allergic reactivity but allergies have also become more prominent over time. My maternal grandparents, born in 1898 and 1899, exhibited mild allergic sensitivity: in later life, my grandfather was allergic to penicillin and my grand- mother had mild hay fever and reacted to certain soaps. Significantly, both children (although interestingly not their cousins) were allergic: my mother has suffered from hay fever since the age of eleven or twelve, and her brother (who died in early adulthood while exploring previously uncharted territory in Canada) had eczema during the hay fever season. Given such a prominent family history of allergy as well as the nascent global configuration of allergies during the twentieth century, there was perhaps no prospect of escape for my own (or indeed the next) generation: my five siblings and I all enjoy some form of allergic sensitivity, whether it is hay fever, asthma, food sensitivity or skin reactions, and our children are beginning to demonstrate the characteristic rashes, wheezes and sneezes of the allergic constitution. Stim- ulated in part by the gradual eruption of allergic diseases within the convergent histories of the Mayhew, Haywood, Griffin, Jackson and Deehan families, this book is about the emergence of allergy in the modern world. It stretches from the first tentative formulations of the concept of allergy at the dawn of the twentieth century through to the exuberant flowering of allergy as a plague of global proportions at the turn of the millennium. 8 1 histories It must first, however, be generally believed with Sydenham, that our chronic maladies are of our own creating. Thomas Beddoes, 18021 Allergy is a modern malady, one with a relatively brief but nevertheless fertile and tenacious history. Although clinical conditions such as asthma and eczema had been known since antiquity and although hay fever had been extensively described in the early nineteenth century, the notion that these chronic afflictions might possess a common cause and a shared pathology, conveniently captured under the rubric of allergy, emerged initially in the early 1900s as a byproduct of rapid developments in biomedical science and clinical practice. Allergy swiftly gained an imperious position in modern culture. During the course of the twentieth century, the term allergy was applied by doctors and their patients throughout the world to an expanding range of bodily and mental symptoms; allergic reactions were thought to determine the quintessential clinical features of hay fever, asthma, eczema, urticaria, food sensitivities and reactions to cosmetics and other synthetic chemicals, as well as a miscellany of diffuse physical and psychological mani- festations. At the same time, allergy gained figurative currency as an expedient and popular metaphor for a variety of personal, professional and political antipathies and aversions; people enthusiastically, and not always ironically, claimed to be allergic to hard work and discipline, to Mondays, to business and sporting competitors, to other nationalities or to their mothers-in-law. The primary purpose of this book is to trace the global history of allergy from its roots in the comparatively limited theatre of late nineteenth- and early twentieth-century laboratory and clinical science to its pervasive pres- ence as an epidemiological and cultural phenomenon in the modern world. In the process, the book charts not only evident continuities in the definition and experience of allergic disorders but also apparent disjunctions in the manifes- tations and meanings of allergy across time and space. Within this ambitious remit, the more focused aims of this introductory chapter are to establish the theoretical, chronological and geographical parameters of the analysis and to outline the principal evidential and structural features of the subsequent narrative. 9 A modern plague In 1906 Clemens von Pirquet (1874–1929), a young Austrian paediatrician, introduced a novel term to the scientific vocabulary. Eager to establish a constructive conceptual framework for understanding and exploring a vari- ety of seemingly disparate clinical and experimental observations within the nascent field of immunology, von Pirquet suggested employing the term ‘allergy’ to denote any form of altered biological reactivity. His notion of changed reactivity encompassed not only the generation of immunity against disease but also situations in which a state of so-called hypersensitivity or supersensitivity resulted in tissue damage. Allergy was thus manifest in cases of serum sickness, hay fever, sensitivities to mosquito bites and bee stings, and various idiosyncratic food reactions as well as in individuals who had been exposed to, or successfully immunized against, common infectious diseases such as diphtheria and