Historical anecdotes and breakthroughs of the last two centuries
Today, we will talk about the history of allergies through historical anecdotes, over the centuries and millennia, starting with Egyptian antiquity to end with the great discoveries of the nineteenth and twentieth centuries.
To begin with, the term allergy was only invented recently, at the very beginning of the 20th century. In this episode we will talk about anecdotes and allergies with the hindsight that we have today. Therefore, there will be some terminological anachronisms. I would also like to underline the thesis of Dr. Mathieu Salvidant, which you can find on our website in the sources, which helped me a lot in the writing of this episode. Now let’s get to the point of the subject.
Egyptian and Greco-Roman Antiquity
When mentioning historical anecdotes about allergies, the oldest one probably concerns Pharaoh Menes, who lived around 2,650 years A.D. As we approach such ancient dates, it is often difficult to identify the true from the false. However, many authors agree that Menes died of an anaphylactic shock from a sting of a hornet or a wasp. What is problematic in this case is that the Pharaoh was killed by a kheb, whose hieroglyph could mean either hornet or wasp, or hippopotamus. The hypothesis of the hornet is still the most credible since some authors specify that Menes died during a trip to the current United Kingdom. Why the United Kingdom? Because the Egyptians were looking at the time to perfect their weapons and wanted to replace the copper of their swords with tin, very present in the Cornish region.
Papyrus Ebers, which is also considered one of the first true medical documents, also refers to the treatment of symptoms resembling allergies. This papyrus was discovered by Georg Mortiz Ebers in 1862, and its seniority dates back to the 19th century BCE. In this papyrus, the author provides some tips for treating eczema, asthma and a common cold. Of course, it was difficult to know if it was really about allergies at the time. But some details suggest that it was indeed the case. Indeed, the author of the papyrus refers to conditions that could be related to strong odors, such as those of flowers.
As for the episode devoted to the History of Blood last month, it is nearly impossible to talk about the history of medicine without mentioning Hippocrates. Considered as the father of medicine, he evoked in his ” treatise of airs, waters and places” the term idiosyncrasy, to designate the illnesses that can be related to eczema and asthma today. In this treatise, Hippocrates raises two types of what would be called later allergies. These are occupational asthma, and food allergies. For the first, he noted respiratory problems among blacksmiths and stonemasons. For the second, he mentioned different reactions to dairy products among people living in the same environment and coming from the same background. Food allergies, already present at the time, would even be described a few centuries after Hippocrates by the ancient poet Lucretius, who told us, ‘’food for most, poison for some.”
During the Greco-Roman antiquity, one began to understand that these illnesses could, in certain cases, be healed. It is therefore impossible not to mention the theory that has defined medicine for nearly two millennia, the theory of Humorism. Hippocrates thought that allergic asthma appeared when phlegm, one of the 4 humors, rose in the brain, crossed the pituitary gland (a small gland located at the base of the brain) condensed in the nasal cavity and flowed in the lungs, which became clogged. The cure was therefore a restoration of balance by a bloodletting or a purging. A “Medical” practice, which, remember, would remain the norm for nearly two thousand years.
Throughout history, many great characters have suffered from allergies. This was the case, for example, of Britannicus, son of the Roman Emperor Claudius, who was strongly allergic to the laminae of the epidermis which were detached from the skin of horses. In the most powerful family of the empire at that time, allergies were common. Britannicus’ father, Emperor Claude, suffered from rhino conjunctivitis. Auguste, great-grandfather of Britannicus, and founder of the Empire, was renowned for being fragile. In fact, he was probably suffering from pruritus (itching related to a skin condition or general condition), seasonal rhinitis and breathing problems. I quote Dr. Matthieu Salvidant, who states in his thesis of the history of allergies, “the recurring presence of pathologies of allergic nature in this Julio-Claudian dynasty, […] is one of the first evidence that there was probably already at that time atopic families. ”
In the Middle Ages, nothing new
Much later, in the Middle Ages, progress would come, as often at this time, in the Persian and Arab world. It is they who understood that allergic syndromes are often linked to the season.
The Iranian Rhazes, who lived in the late 9th century and early 10th century AD, describes the symptoms of his philosophy teacher, who suffered from allergic rhinitis: stuffy nose, sneezing, pruritus, etc. Just like in the Papyrus Ebers, Rhazes stresses that symptoms often worsen in the spring. He therefore recommends avoiding strong odors, but also certain plants such as roses or basil.
300 years later, it is Moise Maimonides, doctor and philosopher in the Muslim Spain of the 12th century, who in his “treatise on asthma”, describes a disease that is declared only according to the time of year, while taking into account the weather conditions and the small habits of everyday life. It is possible to think that Maimonides was actually describing allergic asthma.
Shortly after, in England, it was the very unpopular John Lackland who was the victim of an anaphylactic shock following the ingestion of peaches. He became king of England in 1199 after the death of his brother Richard Lionheart. He remarried, by force, with the young Isabelle of Angouleme, thirteen years old, in the year 1200. 16 years later, he was forced to flee after many political problems with the English nobility. Isabelle, who had no affection for her husband, fomented an elaborate plan of assassination. Knowing that John Lackland could not bear the peaches, she made him a compote of these fruits, and concealed the taste by adding a marinade of cider and sweet wine. The result provoked a fatal anaphylactic shock and the fleeing king died.
It was not the only time that allergies were used for political purposes in the highest circles of the English monarchy. In the 15th century, King Richard III, made famous by the eponymous play by Shakespeare, could not eat strawberries without suffering serious attacks of urticaria. Having problems with a fringe of the English nobility, Richard III had the idea of organizing a banquet and to invite some of his most fervent detractors, including Lord William Hastings. The king then decided to put himself at risk by serving strawberries during this sumptuous meal. As expected, a crisis of urticaria hit him, and Richard III jumped on the occasion to accuse his opponents of treason and attempted assassination by poisoning. The poor Lord Hastings was decapitated on the spot.
Around 1530, Jerome Cardan, doctor and Italian philosopher who was extremely famous at the time, was invited by the Primate of Scotland, who was suffering from asthma for already ten years. To put it simply, the Primate was at the time a kind of President of the Bishops. After an analysis of the patient, but especially of the surrounding environment, Cardan recommended activities outdoors, and strongly advised to get rid of the feather bedding. The cure was immediate. It can therefore be concluded that the Primate was either allergic to acarids or feathers. This episode shows that, as early as the 16th century, the brightest minds understood that certain allergies were related to the environment.
A few decades later, two well-known characters, whom we already mentioned last month, also made interesting remarks about potential allergies. Ambroise Paré, royal surgeon, noted that some people started to have breathing difficulties in the presence of cats. At the same time, Leonardo Botallo, royal physician, observed illnesses in some members of the court at the time of flowering roses. He began to work on his idea, and all his work on the subject was compiled in a book in 1564: “De catarrho commentarius” where he explained: ‘’pleasant smells have healing properties for diseases of the heart, brain and liver. Stimulating one of the five senses stimulates the whole being, and the pleasant smells that drive away the discomfort soothe the mind itself. Yet, odors favorable to many are unfavorable to one. I know healthy men who react to the smell of roses with sneezing, headaches and such itchy nose that they cannot help but scratch their noses for two days.” As Dr. Matthieu Salvidant points out, still in his thesis, it is difficult not to remember Lucretius’ verse, “food for most, poison for some.”
Roses were fundamental in understanding what triggered certain allergies. Bernardino Ramazzini, an Italian physician considered by many to be the precursor of occupational medicine, worked in particular on occupational diseases. He noted, for example, in his treatise “De morbis artificium diatribe”, that certain illnesses were more prevalent in certain professions, such as farmers or manufacturers of rosebuds. He also describes widespread asthma among bakers. For the record, Ramazzini believed that the flour dust that bakers breathed daily accumulated in the airways and formed a kind of dough, which prevented them from breathing properly.
Robert William, a British doctor, described cases of food allergies at the end of the 18th century, some mortals, noting sometimes extreme reactions in patients who ate crustaceans.
As you may have noticed in this regard, many allergies and types of allergies have been discovered, suspected, then forgotten, before being rediscovered. It is only in the nineteenth century that these discoveries would lead to real sustainable progress.
The progress of the nineteenth and early twentieth centuries
John Bostock, an English doctor from Liverpool, was the first to ‘’discover’’ hay fever. In 1819, he presented to the Society of Medicine and Surgery a work entitled “Case of a periodical affection of the eyes and the chest’’. This study describes a patient named JB, who was in fact John Bostock himself. So exactly two hundred years ago, Bostock exposed the symptoms that still affect people suffering from hay fever nowadays, and mentions his attempts at treatments to counter it, such as bloodletting, cold baths, or taking opium. But all these treatments were fruitless.
The nineteenth century was therefore the century of the first progress that would lay the foundations of modern medicine. We were slowly starting to abandon old beliefs and practices. With regards to allergies, the popular belief was that hay fever was a consequence of the first heat of the year. John Bostock thought so, and a certain Charles Harrison Blackley thought so too. But in 1859, he changed his point of view by noticing small traces of pollen on blades of grass that his children had collected, and which caused him an allergy. He then identified pollen as the allergen causing hay fever. Thanks to this discovery, Blackley then studied as much type of pollen as he could, and even tested his hypotheses on himself, rubbing his eyes with pollen, or spreading it on his skin. It is therefore possible to say that he was, in a way, the precursor of allergy skin tests.
At the end of the 19th century, Louis Pasteur and other great scientists such as Paul Erhlich, Elie Metchnikoff, Jules Bordet and Emil Von Behring managed to describe a new system whose role was to defend the body against the attacks of micro-organisms. They called it the immune system. The immunity provided by this system implied absolute protection against a harmful agent. But nobody could imagine that this could, sometimes, harm the person he protects.
However, a few years later, in 1903, Clemens von Pirquet, an Austrian scientist, wrote in collaboration with the Hungarian Bela Schick: “On the theory of infectious diseases“. This report contained a revolutionary idea, which implied that the immune system, an essentially protective system, could harm the host who hosted it. It was the discovery of hypersensitivity.
At this point, it became clear to von Pirquet that the existing terminology was inadequate. The concept of immunity was created at a time when nothing was known about hypersensitivity and the immune system was considered purely protective. It was therefore von Pirquet who created the word “allergy” with Bela Schick. The word has its roots in ancient Greek, where ‘allos’ means ‘other’ and ‘ergon’ means ‘reaction’.
In 1911, in his latest book on allergies, von Pirquet wrote a comprehensive study devoted to the development of his theory and accumulated a considerable amount of experimental data and clinical results concerning changes in responsiveness. With this information, he showed that the “allergic response” can change over time. In addition, von Pirquet stated that he wanted the term “allergy” to be applied only to immunological reactions, which was not explicitly mentioned in his initial definition.
A few years before von Pirquet published his new idea of allergy, the French physiologist Charles Richet and his colleague Portier studied the pathological effects of marine animal toxins in dogs. In order to reduce costs, they re-administered the toxin to dogs that had survived the first injection and observed sudden and impressive deaths. They then found that they were not exceptional reactions, but that they followed an established pattern. They called these reactions “anaphylaxis” (“phylaxis” means protection). In the beginning, Richet had linked this phenomenon to the immune system, but quickly sought other explanations. Finally, he considered anaphylaxis as a process that protects the chemical integrity of a species against potential corruption of exogenous agents.
Paradoxically, in 1913, when Richet received the Nobel Prize for his work on anaphylaxis, the term “allergy” began to have an impact. From the beginning of the 1930s, this new word, invented by von Pirquet, was completely introduced in medical terminology. It was a long process of almost thirty years to democratize this term which seems, today, so familiar to us.
Meanwhile, in 1921, Otto Carl Prausnitz, a German physicist and bacteriologist, discovered immunoglobulin E (IgE). This antibody, which Yannick spoke to you about last month, is strongly present in allergic individuals.
To conclude, from the 1930s, the definitive solution of the idea of allergy in medicine resulted in the formation of professional organizations. A new medical specialty called allergology dermatitis was established. It is composed of doctors diagnosing and treating hay fever, asthma, drug reactions, adverse reactions to food, serum sickness and many other emerging conditions. So, for instance, it was only in the 30s that what is now called food allergies, would be considered, strictly speaking, as allergies.
Since then, the term “allergy” has been transformed into a generic term commonly used to describe unexpected and nonimmunologic immunologic reactions, including drug side effects, psychological reactions attributable to environmental factors, and controversial adverse food reactions, and food additives, etc.
Von Pirquet developed a new idea that has been the foundation of modern clinical immunology. He referred to the theory of the ambivalent, prejudicial and / or protective nature of the immune response and summarized it in the term ‘allergy’.
Igea JM. The history of the idea of allergy. Allergy 2013; 68: 966–973
The History of Allergies and Asthma
Histoire de l’anaphylaxie et de l’allergie, par Bernard David
Le de propria vita de Jérôme Cardan, médecin et philosophe, par André Arcellaschi
Intérêts et pratiques de l’allergologie par les médecins généralistes : résultats d’une étude observationnelle réalisée auprès des médecins généralistes de la région Auvergne-Rhône-Alpes. Analyse de 403 réponses.
Thèse d’exercice en médecine, présentée à l’Université Claude Bernard Lyon 1 et soutenue publiquement le 13 octobre 2017 en vue d’obtenir le grade de Docteur en Médecine par Matthieu SALVIDANT, sous la direction du Dr Franck Godesky.
John Bostock, the man who ‘discovered’ hay fever, By Justin Parkinson – BBC News Magazine, 1 July 2014