Another Pe rson’s Poison
A History of Food Allergy
Matthew Smith
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Conclusion
In a provocative 1997 article,
the biophysicist Richard Cone and the an-
thropologist Emily Martin described how human bodies were increasingly in disharmony with the environment, resulting in epidemic levels of autoimmune disease, including not only allergy and asthma but also multiple sclerosis, arthritis, lupus erythematosus, and diabetes.1 One of the reasons for this upsurge in immune pathology, according to the authors, had to do with diet. Unlike in the past, when most people were more likely to consume seasonal and local fruits and vegetables as well as a wider range of animal tissues, the modern diet, and especially that of the urban poor, consisted increasingly of a limited range of fats, sugars, and starches, often found in the form of processed foods produced in faraway places. One consequence of this change in diet was that people were less likely to come in contact with proteins that matched those found in the body and were essential for health. By not eating chicken stock prepared by boiling the entire chicken, including bones, tendons, and other tissues, for example, an individual’s immune system would be less likely to recognize its own connective tissue and usher an immune response against it, otherwise known as arthritis. By not eating local honey, a person would have less exposure to harmless airborne proteins found in the local atmosphere, including pollens, dust, and molds, meaning that her immune system might react to such inhalants in the form of asthma or hay fever. Pesticides and preservatives exacerbated the problem
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by acting as adjuvants, tricking the immune system into thinking that a harmless food protein, such as lactose, was actually toxic and required an immune response. In the two decades since Cone and Martin’s article was published, it has been regularly cited and reproduced in science studies literature but has been completely ignored by medical scientists. To a degree, this is not be particularly surprising. Although it cited a number of contemporary scientific studies and was published in a respected journal, the article was largely speculative, acknowledging that more research was required to prove such theories. But viewed in another way, the lack of medical interest, in addition to the paucity of research done to test other theories to explain the rise of allergy and other immune dysfunctions, is depressing, and thus highlights a fundamental problem in how chronic conditions such as these have been explored by at least the mainstream medical community. Specifically, rather than thinking imaginatively or creatively about such diseases, their causes, and what they might denote about our changing relationship with our foods, the environment, or our lifestyles, most clinicians and researchers, especially in the case of food allergy, have expended their energies on defending restrictive dogmas and debating about precise definitions. Worse, this lack of curiosity has flourished not because one theory has been masterful in answering all the questions asked of it but because of the economic and political concerns of allergists—at the expense of patients’ health. Rather than contemplating that rising rates of food allergy might be related to changes in Western diets, orthodox allergists continually narrowed the scope of their interest until food allergy was effectively limited to allergies to peanuts and a handful of other foods. Instead of treating patients’ accounts at face value, allergists depended on unreliable skin tests and dismissed their symptoms as hypochondriasis if the tests revealed nothing. Likewise, for every Theron Randolph or Albert Rowe meticulously recording the results of elimination diets, there were unscrupulous physicians willing to take advantage of new technologies and immunological theories to sell patients dubious mail-order allergy tests. Unwilling to acknowledge that the link between allergy and mental disturbance might flow in both directions, clinicians either deemed patients to be suffering psychosomatically or, in contrast, failed to recognize that stressful situations could exacerbate an allergic reaction. While there were notable exceptions—A. W. Frankland and Ben Feingold spring to mind—allergists for the most part were polarized by food allergy, resulting
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in an diminished understanding of what the condition meant, let alone how best to prevent or treat it. Faced by the epistemological vacuum formed by this stalemate, people who suspect that their chronic health problems are caused by the food that they eat have turned elsewhere, away from allergy. Whether it be the “freefrom” aisle at a traditional supermarket or the health-conscious organic alternatives, such as Trader Joe’s and Whole Foods Market, the alternative food industry has capitalized on such health concerns, as have a wide range of lay nutritionists, offering dietary advice along with expensive specialty foods.2 Although there is nothing inherently wrong with people taking ownership over their diets, and although self-medicating using food has been and continues to be central to health practices in countless medical traditions, there remains the risk that many individuals are being exploited, spending too much on hypoallergenic or “free-from” foods that do little to address their specific health problems.3 Beyond this, however, is the more fundamental problem of the growing nutritional knowledge gap, fueled by growing cynicism about food advice and the food industry. As the food expert Gyorgy Scrinis argues, the politics of nutrition advice during the postwar period resulted in not only unhelpful dietary advice but also ideologically driven schisms about basic nutritional questions: Are all calories created equal? Are there good fats and bad fats? Are some sugars worse for you than others? Should we take vitamins? Are there such things as cancer-fighting foods?4 Of course the food industry itself has long played and continues to play a tremendous role in influencing the answers to these questions, but with the rise of so many chronic conditions with certain or presumed links to food consumption (obesity, cancer, heart disease, diabetes, and autoimmune diseases, just to name a few), it is also incumbent on national and international health institutions to work harder to resolve such debates in a more constructive and unbiased fashion. The divisions within allergy about food allergy are, in many ways, writ large in the science of food and nutrition more generally. The seemingly intractable situation in allergy is also reminiscent of another medical field, that of psychiatry, which has similarly suffered from ideological rigidity, internecine debates, and crises of legitimacy. Just as allergy has struggled to explain why some people are allergic and why rates of allergy appear to be increasing, psychiatrists have lurched from one paradigm to the other, each explanation ultimately proving unsatisfactory.5
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Psychoanalytical theories have vied with genetic, organic, and social hypotheses, with scant appetite for negotiation, compromise, or even the basic recognition that human behavior is complicated and predicated on a wide range of factors.6 For psychiatry, as with allergy, defining the very subject at hand has been central to these disputes. The rise of peanut allergy has contributed to narrowing the definition of food allergy in a way that suits orthodox allergy, the food industry, and pharmaceutical companies. In addition, the mass-marketing of mental disorder and psychiatric drugs has paradoxically widened the scope of what is considered to be mental illness, so much so that WHO reckons that depression will soon become the biggest threat to the world’s health, outpacing both cancer and heart disease. In both cases, however, sophisticated understandings of what mental illness and food allergy actually are, how best to define them, and why they appear to be increasing have proved to be frustratingly elusive. While psychiatrists might at least point hopefully to some strands of DNA or the images from a brain scan, allergists have chosen instead to avoid such issues as much as possible. There is the argument that pluralistic, nuanced conceptualizations of disease undermine the efficient and inexpensive treatment of patients. Sorting the genetic aspects of a child’s hyperactivity from the nutritional, environmental, and psychological aspects is much more difficult than simply prescribing some Ritalin®. Dismissing a patient’s symptoms as psychosomatic because those symptoms cannot be linked incontrovertibly to a food allergen by use of a skin test is also much easier than engaging that patient openly and honestly about diet and its possible relationship to chronic health problems. But such approaches do little to add to our deeper understanding of such conditions and, in the long run, are not in the best interest of patients or the potential patients of the future. Research into peanut allergy desensitization is eminently sensible, but surely as much effort should be put into exploring the escalation of such allergies in recent decades, no matter how uncomfortable the answers are. It could well be that, as with psychiatry, the answers are multifaceted, complicated, and troubling, but such is the case with most riddles in medicine. The ultimate goal of medicine is to prevent illness. This is what is truly in the best interest of patients and health-care systems; both psychiatrists and allergists need to renew their efforts to stem the tide of burgeoning mental illness and allergic disease with proactive measures rather than focusing disproportionately on treatment.
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There is also, necessarily, a role for history in all of this. In setting out to write this book, I have not attempted to resolve the debates about food allergy or, even more foolishly, explain why allergies to foods such as peanuts are on the increase. This is not what I am trained to do. What I am trained to do as a historian is to analyze why allergists have struggled to answer these questions and to make suggestions, based on the available historical evidence and through the process of looking at the evidence from a wide range of perspectives, about how they might approach such problems differently in the future—a little bit like a management consultant but without the exorbitant salary. If there are any lessons for allergists in this book, they are the same as I have offered to psychiatrists, often for similar reasons. Food allergy, much like mental illness, is a perplexing, alarming, and deeply personal condition, as the observations of insightful physicians dating back to Hippocrates and Galen suggest. And food allergy should be understood as such, not as a neat, precise concept easily defined and described but as an amorphous and complex phenomenon, or set of phenomena, that has and will continue to change over time.7 It takes creativity, imagination, and open-mindedness to see food allergy in this way, qualities that are not always engendered in either medical education or health-care economies. Nonetheless, if the riddle posed by food allergy is to be solved, it will be attributes such as these that will be most important.