The innate immune system includes our skin and internal mucous membranes from sinus and lips through the anus as blood stream barriers. It also conducts an inflammatory response to foreign proteins that breach these, using mast cells and basophils, phagocytes that scavenge bacteria, and natural killer cells with toxins that subdue virus captured cells.
Our innate immune system is “often enough to ward off infection”, MacPhail learned. The Terrain Theory of immunology lurks between the lines of dogmatic, professed faith in the Germ Theory of disease. The adaptive immune system “kicks in” when these defenses don’t defend the goal.
This is a “specific system because it is capable of remembering the things it encounters” with T cells. Some of these become memory fixated to identified invaders and activate B-lymphocytes, a type of white blood cell produced in bone marrow. They manufacture antibodies- predator proteins whose main function is to neutralize foreign substance like viruses and bacteria. They attach and block them from penetrating cell walls- another barrier. The Pentateuch of five antibodies, IgM, IgD, IgG, IgA and IgE-are not as catchy as the Seven Dwarfs names. Woke or Old School.
Type I “hypersensitivities” or allergic immune response involves IgE as inflammatory and IgF as modulating, while Type II and Type III autoimmune diseases involve IgG. So IgE levels are the diagnostic gold standard for “allergy”, an atopic (systemic) reaction to allergens in the environment.
Dr. Charles Richter, French physiologist, paranormal researcher, socialist, pacifist and early pilot, repeatedly injected Portuguese Man o’ War venom, seawater and sand into lab animals the summer of 1901. He speculated that they developed resistance to the toxin by repeated exposure, thus his pursuit of vaccine immunity was fired. Inoculating “their favorite dog, Neptune” as subject, with “repeated, spaced-out, minuscule doses”, backfired when it died of convulsions in less than a half hour with the last straw.
“It went against the reigning theory of germ theory, that the immune system was only about defending against outside invaders, and that priming it would induce immunity.” That’s actually vaccine theory, with a trap door for allergic injuries dropped into the Memory Hole.
Richter “learned to produce at will ‘hypersensitivity’ in dogs, rabbits and guinea pigs” with hypodermic syringe and allergen stews. He named his discovery of creating anaphylactic shock through injections, “backward defense”, an awkward name that didn’t catch on. Allergies came later, but Richter blamed human allergies on “inherited nervous dispositions that primed them.”
Sounds more rational than the “individuality run mad” theory of summer catarrh or hay fever in the 1880’s. Dr. Richter later won the Nobel Prize in Medicine for this discovery, but made the wrong conclusions about cause. It isn’t genetic, even with arcane algorithms rendering “one in a million” from uncounted and undiagnosed vaxx injuries.
IgE antibodies define allergic reactions, but the “serum sickness [from smallpox vaccines] that Clemens von Pirquetobserved in his Kinderklinik and used to coin the term ‘allergy’ " in 1906”, does not increase IgE, along with certain allergies that affect the esophagus, skin and bronchial breathing. Nevertheless, they are lumped into Type I Allergic Diseases.
Experts are divided over even “the exact meaning of allergy.” Dr. Hugh Sampson, a world renowned allergist, says reactions are “unique to each person and can express itself differently through time” with a “common underlying immune mechanism.” More money will be required to determine how this operates.
Dr. Gurjit Khurana Hershgey, director of Asthma Research at Cincinnati Children’s Hospital, defines it as “a whole body systemic disorder”, so holistic in theory. “Inflammation is the core problem that unites all the conditions under one umbrella. The puzzle is to understand why responses remain localized in some patients and distributed in others.” More money, more money.
Dr. Alkis Togias of the NIH, says it is a syndrome, a group of symptoms that occur together in different parts of the body, with the same underlying cause at the root. He’s dispensing the money., so get on board the gravy train.
Dr. Donald Leung of Jewish Health argues that “atopy- or out of place” is a better term for these disparate reactions. Since medicine is “hyperspecialized”, they are treated as separate conditions by “doctors who don’t notice or care” if the patient has other symptoms from “overexuberant response to common and other wise harmless stimuli in their environment.” He wants more money.
They further subdivide diagnoses with intolerance-symptoms not caused by the immune system activation, or sensitivity when reactions are caused by pin prick tests, but not from ingesting the allergen. Needless to say, “diagnostic messiness” gets a whole chapter in Allergic.
MacPhail got her “serological allergy test” in the winter of 2020, seeking an IgE antibody response. Everything came back negative. She was “completely nonreactive”, while “full blown hay fever” made her eyes “spontaneously produce tears as if I were crying.”
A grief counselor might help more than symptom relief from the OTC and prescription cornucopia. Instead Dr. PuriParikh reassured her that she was allergic. “You’re body is reacting to something, that’s clear, but it’s not reacting via the IgE pathway.” She diagnosed “localized allergic rhinitis.”
Dr. Parikh, “the detective, was unable to crack the case. The trigger of my allergies will remain a mystery.” An enigma, conundrum, riddle, conspiracy theory, puzzling, but not enough to drive her into the arms of alternative quacks offering natural cures.
Instead she went to the head panjandrum, Dr. Hugh Sampson, former director of the Elliot and Roslyn Jaffe Food Allergy Institute in NY City. After forty years of “researching, diagnosing and treating food allergies, he knows a thing or three.”
Back then, “they didn’t even think of this as a science”, since so little testing, diagnoses or treatment was reproducible, due to wide variations in commercial allergen products, reliability of data, antibody responses and symptom severity. That hasn’t actually changed, even though more money has been thrown at the field.
Plus, more patients are already prescribed “antihistamines, steroids, antidepressants, tranquilizers and other drugs that affect immune system function, throwing off skin test results.” False negatives and positives are hazards of the trade, with no “universally accepted system for interpreting tests, or collecting results, only generalized suggestions.” Nevertheless, medical science marches on following market share of a growing pie.
Americans spend $6 billion a year to relieve the nasal congestion, watery eyes and frequent sneezing of rhinitis (diagnosed or not), miss 4 million work and school days because of respiratory allergies, while 80% of those with allergies have serious sleep disturbance. About 10% of Americans report being sick with allergies in the winter, more than from colds and flus. More women, residents of the South, and those with highest and lowest incomes report allergies than men, other regions and middle income Americans.
About 2% of proteins from foods we eat, leak through our gut/blood barrier, where IgG antibodies form to render them harmless. IgG levels “might be protective of an allergic response.” Some allergists still test for these as indicating food allergies and typically recommend elimination of eggs, wheat and milk from their patients’ diets, with a handful of less ubiquitous foodstuffs.
The experts’ consensus is these restrictions “are basically useless or at worst dangerous”, even though “so many patients swear by the results.” Dr. Sampson shrugs it off, “when you spend that kind of money, you almost project that you feel better.” At a few hundred dollars for testing and the expense of restrictive shopping, compared to thousands for his services with little to no relief, sounds like professional projection.