All About Allergies: Everything You Need to Know About Asthma, Food Allergies, Hay Fever, and More

The Russian immunologist Elie Metchnikoff (1845-1916) won the Nobel Prize for his work in immunology. He is considered the father of cell-mediated immunity. This is the arm of the immune system involving immune cells that do not use antibodies. In 1883, he published his first paper on our understanding of phagocytosis, which is the process in which cells ingest foreign substances and other cells. He noticed that foreign materials were being engulfed by the cells of a transparent starfish larva. These cells were called phagocytes, a term derived from the Greek 'phagein', meaning "to eat," and 'cyte', meaning "cell." Metchnikoff also coined the term 'gerontology' and is widely recognized as a pioneer in the study of aging. He even theorized that probiotics could improve health and delay aging.

ALLERGY AT THE START OF THE TWENTIETH CENTURY

The major breakthroughs in the field of allergy came at the beginning of the twentieth century. In 1902, Charles Richet (1850-1935) and Paul Portier (1866-1962) used a lab on the yacht Princesse Alice II, which belonged to the prince of Monaco, Albert I, to study Physalia (Portuguese man of war). If you are not familiar with these animals, they are hydrozoans that look like jellyfish. One of their extracts contains a substance called hypnotoxin, which causes painful hives when skin comes into contact with it. Sailors were accustomed to these uncomfortable stings. While on the voyage, Richet and Portier tried to immunize dogs against this toxin by administering small doses on multiple occasions. However, the opposite occurred. One dog in the experiment, named Neptune, had received two doses of the toxin three days apart that were well tolerated. After twenty-two days, he received the same dose for a third time, but within seconds after the injection, Neptune began to gasp and wheeze, vomited blood, and passed away within twenty-five minutes. Richet initially called this phenomenon aphylaxis because of the "lack of protection" from this reaction, but the name was quickly changed to anaphylaxis because it was more appealing. Anaphylaxis is the term describing a severe, potentially life-threatening allergic reaction. Richet ended up winning the Nobel Prize in 1913 for this discovery.

The word allergy was coined in 1906 by Clemens von Pirquet (1874-1929), an Austrian pediatrician. He wrote in the journal Münchener Medizinische Wochenschrift that "we need a new...word for the altered state which the organism finds out by the acquaintance with any organic, living or lifeless poison...For this general concept of altered responsiveness, I suggest the term allergy." The older term, idiosyncrasy, was replaced very quickly from this point by allergy, from the Greek word allos (other) and ergos (activity). Pirquet also coined the term allergen to describe substances that—upon repeated exposure—lead to a reaction. His initial observations came around 1902 when he took care of children who developed side effects when given horse serum antitoxin to treat diphtheria. He was also a pioneer in medical education. He placed a high value on teamwork between doctors and patients and insisted that his trainees finish a nursing training period to understand problems and take care of patients better.

The word atopy was coined by Arthur Fernandez Coca (1875-1959) and Robert Anderson Cooke (1880-1960) in the 1920s. This concept describes how there is a genetic tendency to develop allergic diseases such as asthma, eczema, and allergic rhinitis. Sometimes, atopy refers generally to any allergic reaction caused by the antibody called immunoglobulin E (IgE).

FINDING THE SOURCE OF ALLERGIC REACTIONS

Throughout the early twentieth century, many steps were taken to try and find the source of reactions that were observed. This substance was often referred to as the reagin. In 1919, a thirty-five-year-old waiter with no significant medical history developed anemia and received a blood transfusion. Two weeks later, he entered a horse carriage at Central Park in New York City and developed an asthma attack five minutes later. He was given epinephrine and his symptoms resolved. However, the next day he entered the park and developed a similar asthma attack. He was then seen by Dr. Maximilian Ramirez, who did a battery of allergy tests and found that the young man was allergic to horses. It turned out that the blood donor for this patient was an asthmatic who was also allergic to horses. This showed that the allergy had been transferred to the patient by the blood donation.

The transfer of allergies is a phenomenon that still exists today. I once saw an elderly patient named Gerald, who had a history of leukemia that had required a stem cell transplant several years prior to seeing me. The good news was that his cancer went into remission. The bad news was that the donor had a history of allergies to milk and eggs. Gerald developed a condition called transplant-acquired food allergies. He came to me to determine whether his food allergies had been resolved. Unfortunately, the testing determined that he was still allergic to these foods. While this phenomenon is not common, it is important for people to be aware that this can potentially happen.

In 1922, Carl Prausnitz (18761963) and his assistant Heinz Küstner (1897-1963) published that allergies can be transferred using serum, which is the component of blood that does not have cells or play a role in clotting. Küstner was allergic to fish, and Prausnitz was allergic to pollen but not allergic to fish. They decided to draw Küstner's blood and inject his serum into Prausnitz's skin. The next day, fish extract was injected near the injection sites of Küstner's serum and around other areas. Only the areas near Küstner's serum reacted quickly with a hive. Clearly, there was a substance being transferred that led to allergic reactions. This method became known as the Prausnitz-Küstner test, which was the classic method for quantifying specific allergen antibodies for many decades.