All About Allergies: Everything You Need to Know About Asthma, Food Allergies, Hay Fever, and More

The father of medicine is generally considered to be the Greek physician and philosopher Hippocrates (circa 460-377 BC). In a collection of over sixty of his medical works, called the Corpus Hippocraticum, there is no mention of allergic rhinitis. While it is possible that it did not exist in ancient Greece, the more likely explanation is that the symptoms were not severe enough to warrant the attention of physicians. Asthma was described in this text ten times, and there is one passage that refers to the breathing noise as "if somebody was whistling through a pipe." Hippocrates also described how you could be allergic to exercise: "After exercise the pain occurs in one or another area on the chest or the back and the body will be covered with wheals like after contact with nettles." This passage also infers the concept of contact urticaria. Hippocrates used the word knidosis to describe urticaria. He also observed that some people reacted strangely after eating cheese, which likely referred to a food allergy.

There were some famous individuals who may have suffered from allergic diseases in antiquity. The first likely documented case of a fatal allergic reaction known as anaphylaxis has been attributed to Pharaoh Menes in 2641 BC. Hieroglyphs from his tomb indicate that he probably died after a sting from a wasp, a cause of death that in most cases is due to anaphylaxis. Roman Emperor Augustus likely suffered from asthma, allergic rhinitis, and eczema. His great-nephew, Emperor Claudius, suffered from allergic rhinitis. Britannicus, the son of Claudius, apparently suffered from an allergy to horses.

ALLERGIES IN THE MIDDLE AGES AND RENAISSANCE

Significant medical advancements came from the Middle East during the Middle Ages. Abu Bakr al-Razi (865-932), also known as Rhazes, was a Persian physician who gave the first description of "rose fever" in his paper "Dissertation regarding the course of Coryza occurring in spring when the roses emit their odor." The descriptions of rose fever are similar to the symptoms of allergic rhinoconjunctivitis. This concept became pervasive during the Middle Ages. German physician Veit Riedlin (1656-1724) performed provocation tests: He hid a pouch of rose leaves in the coat of his patient without their knowing, to see if symptoms were reproducible.

The Jewish physician Moses Maimonides (1135-1204) was the personal physician to Sultan Saladin in Egypt. He wrote a thesis on treating asthma, and many of his recommendations are relevant even today. Maimonides recommended personal hygiene, relaxation, exercise, massage, and avoiding noxious environmental triggers and drugs such as opium. He also recommended that patients with asthma avoid foods such as milk, nuts, and chicken.

Food allergies may have influenced a famous figure in English history. Sir Thomas More (1478-1535), who was a lawyer, reported that King Richard III of England (1452-1485) was sensitive to strawberries because they would cause him to experience hives. The king used this reaction in front of his council to claim that his political opponent Lord William Hastings was trying to poison him, so he had Hastings executed.

Up until the nineteenth century, skin disorders were not considered to be a problem, because it was believed that the skin was an organ meant to eliminate waste from the body. Therefore, skin eruptions—especially oozing ones—were considered to be beneficial. Physicians for most of human history did not want to treat skin diseases, because they thought it was dangerous to try to heal them. This belief was based on the humoral theory, which has often been credited to Hippocrates, though the theory predates him. In his theory, the human body contains four humors: blood, phlegm, yellow bile, and black bile. If these humors are out of balance, then diseases will occur. This theory was replaced by germ theory by the end of the nineteenth century.

ALLERGY DURING THE NINETEENTH CENTURY

Major strides in our foundational understanding of allergy and immunology started in the nineteenth century. The first thorough description of allergic rhinitis came from John Bostock (1773-1846), who initially called it catarrhus aestivus in 1819. However, by 1828, the more popular term, hay fever, was wide spread and is still used today. At that time, it was believed that the smell of hay during the summer and harvest months caused the symptoms. In the 1870s, Charles Blackley (1820-1900) identified the cause of hay fever to be pollen. He invented devices to measure pollen in the atmosphere as well as the first skin-testing devices.

While asthma had been described in the medical literature numerous times at this point, the first classical descriptions of asthma came in 1860 from English physician Henry Hyde Salter (1823-1871). His explanation of asthma was based on hundreds of cases he had seen and his personal experience with the disease. Salter's definition of asthma was "paroxysmal dyspnoea of a peculiar character, generally periodic with intervals of healthy respiration between the attacks." He believed that asthma was a nervous disorder, a notion that has been perpetuated in popular culture even to this day. However, Salter also knew that asthma was due to many other triggers, such as exposure to cats and horses. He recommended coffee, which was one of the earliest effective treatments for asthma because caffeine can temporarily relax the muscles in your airways to improve lung function. French physician René Laënnec (1781-1826) invented the stethoscope, which paved the way for the physical diagnosis of chest diseases, including asthma.

Paul Ehrlich (1854-1915) was a Nobel Prize-winning German physician and scientist who was considered one of the fathers of immunology, specifically of the humoral adaptive immune system. His work in staining cells under a microscope led to his discovery of the mast cell in 1878, which is an important cell in causing allergic reactions. Ehrlich initially named them Mästzellen; he thought these cells had a nutritional function because of the granules inside them. The German word maesten means to stuff or force-feed. A year later, Ehrlich discovered eosinophils, which are white blood cells that are also important in causing allergic reactions. He was the first scientist to develop a medication to treat syphilis; it was an arsenic-based compound called Salvarsan. To top it all off, Ehrlich coined the term chemotherapy.