In the 1930’s “renowned allergists” decided that injecting hypersensitivity was different than inherited tendencies for developing asthma and hay fever, which they called “atopy”, while anaphylaxis was “usually acquired”, leaving out the role of inoculation.
This “was evidence of the body’s inborn resentment against its environment, the last stand of the race against adulteration.” Native Americans did not have allergies then, even when living and working in the same environment as whites of European descent. Allergy patients seen by doctors were typically “white, urbanized and wealthy families, and in their children.” For eugenicists, even inherited nervous dispositions were evidence of white superiority. Now, allergies are common across race, gender, nationality and income levels.
Hospital admissions for severe allergic reactions average every two hours in the U.S. Asthma ER visits tripled between the 1970’s and 90’s before leveling off, as global rates continue to increase. Prescriptions for adrenaline autoinjectorsthat reverse anaphylaxis, primarily EpiPens, rose by 336%.
No longer just a Western malady, allergies have gone global. MacPhail parades some dismal numbers for the world, 235 million asthmatics, pharmaceutical drug allergies cause 20% of hospitalized patients, 200 million have hay fever. Twenty to thirty percent of Indians, the most populous nation, have at least one allergic condition. Half of Europeans and Ugandans have a chronic allergy, while 7.7% of Chinese children have a food allergy. (They eat far less wheat and milk, and more white rice, among the least allergenic foods.) Estimates vary from 10-40% of the world having hay fever, or rhinitis.
She calculates almost 11% of Americans have a specific food allergy, while 19% self identify as having one. Only 5% of all respondents had been diagnosed by a doctor. Others estimate 5% of adults and 8% of children suffer from food allergies, with “growing evidence of an increase in prevalence.”
The Oral Food Challenge is the gold standard for testing to confirm food allergies, but time consuming and expensive. The OFC is both “the best way of confirming,” and the “least likely to be performed.” Symptoms mimic gastrointestinal diseases and non allergic conditions, with different fields and specialists.
Dr. Ruchi Gupta, director of Northwestern’s Center for Food Allergy and Asthma Research, devised a lengthy questionnaire she believes provides an accurate indication of actual food allergies causing intestinal discomfort and pain, rather than conditions ranging from intolerance, oral allergy syndrome, celiac, Irritable Bowel Syndrome, to Crohn’s Disease. “It’s hard for people to tell us what’s happening in their bodies.” Again, a somatic therapist would be an appropriate referral.
The savior of Big Data in Medicine is the ultimate hope of Dr. Gupta for salvation, but for now “we’re stuck with largely unreliable data about the true scope of an already massive epidemic of allergic disease. All that new knowledge will help biomedical engineers to invent new diagnostic test or innovate older version to deliver more precise and accurate results.”
Of course there’s genetic research, promising personal precision medicine when they decode the fractal language of our genomes. By the 1950’s, the Allergy Foundation of America “assured the public that allergies were not inherited, only the genetic tendency to develop allergies”, but “every allergy was unique. ” Causes were too.
When Dr. Scott Sicherer began working at the Jaffe Food Allergy Institute in 1997, 1-250 children reported allergy to peanuts or tree nuts. By 2008, it was 1-70. “We’re also seeing less food allergy being outgrown and more emerging.” Genes don’t evolve that rapidly.
Dr. Dean Metcalfe of the NIH, admitted the “mechanisms behind allergy are very complex and we’re really far behind.” MacPhail admits “Even the basic cell biology behind allergic reactions, driven in part by our genetics, is not well understood.” Genetic mining is mostly sifting 30,000 genes of human’s DNA for clues, without knowing what they are searching for except patterns and correlations that are “not necessarily causation.”
“Asthma is a garbage term.” Dr. Neeru Khurana Hershey of Cincinnati Children’s Hospital told her. A syndrome, not a disease, caused by many different paths, not all true allergic reactions, although environmental triggers may cause some. Same with hay fever, and eczema.
The experts favor a middle ground between genetic susceptibility and environmental interactions with our internal terrain, external toxins and each other. Environmental causes or triggers are not as potentially profitable as manipulating genes.
Blocking their expression in “skin defects” could prevent “eczema, wheeze and nasal blockages in babies as young as six months old, by somehow making leaky skin less permeable.” The skin barrier theory of allergy causation, “posits when the skin is more porous in early age [due to this genetic variation], it allows foreign material to pass through into the bloodstream triggering immune cell responses.”
No concerns about hypodermic syringes injecting foreign antigens directly into the bloodstream. No need for genetic defects, but somehow that guaranteed permeability is overlooked by the NIH. They’ve been funding genetic research for a decade or more, hoping for cures, not causes.
Dr. Joshua Milner, a former NIH researcher, is now a professor in the Institute for Genomic Medicine at Columbia University, producing research linking immunodeficiency diseases with allergies.
“Genes are actually not the main factor”, Dr. Marc Rohthenberg, told her. He’s Milner’s “close friend and colleague, at the world famous Cincinnati Children’s Hospital”, the leading expert on the rare disorder of esophageal allergies. “We cannot alter our DNA to control allergy, but we might be able to alter our environments.”
His cryogenic tank holds over thirty thousand inflamed tissue samples from these people, so not that rare. He’s not looking for environmental causes, only genetic data for a “clear signal to noise ratio” from this fringe subset. Like a needle in a smaller haystack, finding it could apply to “more common allergic pathways.”
“Most of the nerds” he went to MIT with had allergies. His specialty may be the most nerdy of allergies. Researchers at MIT were able to identify T cells that produced inflammation in food allergy patients who react to peanuts. Now, they’re studying them to see if immunotherapy changes them to T- Helpers that reduce inflammation.
The allergic person is a victim of evolutionary forces, even though “genes cannot be the sole- or even primary-cause of all our irritation and hypersensitivity. " Genes are “not the proverbial smoking gun.” Inheritance is “no longer even the correct question. The solution to allergies isn’t necessarily a biological solution, it’s a collective solution about what we do about all these other things hat are impacting the rise of allergies. People with allergic conditions are the canaries in the environmental change coal mine.”
Nevertheless, MacPhail and her experts remain spectacularly uninterested in primary, causative agents, other than currently acceptable toxins like microplastics and air pollution.