Allergy: The History of a Modern Malady (review)

How did allergy, a seemingly obscure condition that emerged in the early twentieth century at the laboratory bench and the patient's bedside, become symptomatic of, and indeed synonymous with, the multitude of risks and exposures that define modern life in the twenty-first century? In this engaging and highly informative book, Mark Jackson offers a compelling history of the shifting understanding and changing personality of allergy and its explosive growth in the global trade of disease, ideas, and commerce.

Jackson places the origins of allergy as a concept and a condition firmly within clinical and experimental research on immunity, anaphylaxis, and serum sickness that occupied physicians and bench scientists at the turn of the twentieth century. The birth of allergy as an idea owed much to the clinical observations of the Vienna physician Clemens von Pirquet and his definition of allergy as "altered biological reactivity" in an effort to link the processes of immunity and hypersensitivity. Although, as Jackson shows, leading researchers such as Charles Richet took exception to its introduction, "allergy" gained a foothold in medicine and Western society through shared clinical treatments (notably desensitization), the growth of a specialty field, and the increasing professional, economic, and public awareness of the spread of allergic diseases across geography, class, and culture.

Allergy, Jackson contends, effectively replaced tuberculosis as a disease of modern civilization. Indeed, one of the many strengths of his book is his brilliant analysis of how hay fever, asthma, and eczema took on global importance in the postwar period—tied to the "global research, surveillance, and educational initiatives of the WHO," and fueled by the push for technological solutions to combat allergies and the subsequent profits to be had in the cleaning, cosmetic, drug, and food industries (p. 116). But, if the technological progress of modern civilization generated hope for allergy sufferers, it also came to be seen as the source of their ailment. Since the late nineteenth century, allergic diseases such as hay fever have always been seen as a disease of progress, a symptom and sign of the conditions that accompanied modern civilized life. What constituted the precise pathology of progress, as Jackson astutely observes, has been dynamic, responsive to changing cultural, material, and socioeconomic relations. In the late nineteenth century, for example, hay-fever sufferers ascribed their affliction to the nervous exhaustion brought on by modern urban life. After the Second World War, physicians like Warren Vaughan, who promoted allergy as a "malady of civilization," regarded modern industrial and technological development and, in particular, the flood of new chemicals then being introduced into the environment as contributive causes. More recently, it is not impure civilization, but the too-hygienic conditions of modern life that allergists and journalists have seized upon as an explanation for the increased prevalence of immune-system hypersensitivity and allergy.

Although physicians and scientists circumscribed the definition of allergy to an IgE-mediated reaction after the isolation and identification of this new class of immunoglobulin by the Ishizakas in 1967, such a restrictive use was widely contested by clinical ecologists within the medical profession and by the public, for whom allergy had come to refer to a variety of physical and psychological conditions. Jackson suggests that the focus on environmental determinants of allergy in the late twentieth century—from air pollution, to dust mites, to chemicals in food—is a feature of more recent formulations of the relationships between civilization and disease and the preoccupations of a risk society. But it is questionable to what extent such perceptions have actually shifted the weight of clinical intervention and prevention to the reduction of environmental risks in the treatment of allergy in the postwar years. Advair and Flovent, for example, two of the leading prescribed drugs for asthma, made up 20 percent of GlaxoSmithKline's $32 billion in worldwide pharmaceutical sales in 2005. By altering the complex interrelationships of the immune system hidden within the body, drugs make it possible for allergy sufferers to...