Historical Perspective on Food Allergies
Over the years of coping with a family member’s food allergy, I became curious about the history of allergic diseases and how the understanding of these conditions has evolved over the years. I started to wonder how “new” the condition of food allergy is, and how long food allergies have been noted in society. A diagnosis of food allergy can be daunting, whether it is one’s own diagnosis or a family member or close friend. There is first the fear. The dread that accidentally consuming an allergen will cause a reaction that could be severe or even fatal. Then there can be the feeling of isolation, that one is alone in coping with this life-changing condition. Unfortunately, many people with food allergies or those caring for family members with an allergy may also encounter bias from others. That bias may manifest as a belief that the food allergy is not real, that the fear of severe reaction is unwarranted, or that the food allergic individual only wants special attention. In navigating those challenges, we can gain helpful perspective by looking back at the historical contexts of allergy. By acknowledging food allergy mentions throughout history, we can underscore that we are not alone. It is also fascinating to review how society’s understanding of allergic conditions and reactions have evolved over the years, with accelerated growth and discernment particularly in the past 30 years.
Although it is difficult to verify the presence of allergic disease in ancient history, there are references of allergic conditions in literature from various cultures, including in Egypt, China, Greece, and the Roman empire. We can find those references to food allergy, asthma, and what was likely eczema throughout medical and other historical writings, even if the term “allergy” was not yet employed. Medical knowledge and terminology have evolved over the centuries, thus it is challenging to interpret ancient texts through a modern lens. Nonetheless, let’s walk through just a few of the standout references to food allergies throughout the ages.
Starting with ancient times, the Chinese emperors Shen Nong and Huang Di (around 2500-2700 BCE) wrote that individuals with a certain type of skin lesion should avoid specific foods. This was likely one of the earliest allusions to food allergies.
Moving forward, Hippocrates (460 BCE - 375 BCE), the famed Greek physician, stated “Cheese does not harm all men alike; some can eat their fill of it without the slightest hurt, nay, those it agrees with are wonderfully strengthened thereby. Others come off badly.” Notably, he also wrote about the presence of “hostile humors” that made people “suffer badly” after cheese consumption. Centuries later, those “hostile humors” would come to be known as IgE, the antibodies implicated in allergic reactions. We also have a quotation from the Roman poet and philosopher Titus Lucretius Carus, who lived from approximately 99-55 BCE, that resonates yet today. He famously noted “What is food to one, is to others bitter poison.” Emperor Augustus, the first emperor of the Roman empire (63 BCE-14 CE) was noted to suffer from asthma, seasonal allergies and atopic eczema. His grandson, Claudius, who became the fourth Roman emperor, was also thought to have seasonal allergies and an allergy to horse dander. This would suggest a familial pattern of allergic disease, which we also frequently see in modern times.
Jumping ahead to the 12th century AD, the philosopher, rabbi and physician Moses Maimonides advised that those suffering from asthma should avoid foods including milk, nuts, and legumes. He seemed to believe that there was a strong relationship between dietary intake and asthma.
A few centuries later, in the 15th century AD, Richard III reigned as the king of England from 1483-1485. There are various reports of his allergy to strawberries, although the details of this are inconsistent.
In the next century, a Belgian physician by the name of Jean Baptiste van Helmont (1577-1644 AD) described asthma attacks following fish consumption.
In the 18th and early 19th centuries, an English dermatologist by the name of Robert Willan wrote in his Treatise on Dermatology on the subject of allergic conditions. He described instances of urticaria (itchy welts/hives) after consumption of almonds, mushrooms, fish and shellfish.
In the 20th century, the medical and scientific community’s understanding of allergic conditions developed at an accelerated pace, leading to the present time.
The discovery of anaphylaxis is accredited to Charles Richet, a French physiologist, along with physiologist Paul Portier and oceanographer Albert Grimaldi. While on a sea voyage, the three men studied the effects and symptoms after exposure to the Physalia (Portuguese man-o-war) toxin. They later replicated the results with another study using sea anemones. Richet published his findings in 1903.
In 1906, Austrian pediatrician Clemens von Pirquet defined allergy as “any form of altered biological reactivity.”
Skin testing for allergy was developed in the 1900s and 1910s, by von Pirquet, Isaac Chandler Walker, and John Freeman. In these tests, an extract of the allergen in question was injected under the skin. By the 1930s though, the accuracy of skin testing had come into question.
The concept of elimination diets came into vogue in the late 1920s. Patients consumed a hypoallergic diet of bland foods, kept a diary of symptoms, and eventually consumed foods suspected to provoke an allergic response.
In the contemporary era spanning the past 30 to 40 years, the incidence of food allergies has escalated alarmingly, as have severe food allergy reactions. Food Allergy Research & Education (FARE) reports that approximately 33 million Americans now live with food allergies. This statistic breaks down to one in 10 adults and one in 13 children grappling with food allergies.
The transformation of our food system, with an increasing reliance on processed foods, further complicates the landscape for those with food allergies. This shift has diminished individual control over food choices. Within that reality, food allergen avoidance remains the mainstay of food allergy disease treatment and safety maintenance.
The rise in food allergies prompts crucial questions about the underlying causes, even as our understanding of the underlying biological mechanisms of food allergy, diagnostic and management strategies improve. Compared to the early 20th century, we now have improved methods for allergy testing, including skin testing and blood antibody (IgE) level testing. Fortunately, we are starting to see the emergence of immunotherapy treatments, and even have strategies for prevention of peanut allergy through early exposure in infancy.
In conclusion, recognizing the historical backdrop of food allergies enriches our understanding of their significance today. It validates the experiences of our food allergy community and highlights the need for continued adaptation and innovation in our approach to food allergies. In essence, as our understanding of food allergies evolves, so too must our strategies for navigating them safely. As I reflect on the journey from ancient inklings and insights to modern challenges, a critical goal remains clear. We need to ensure an inclusive, safe and secure environment for the now 33 million Americans living with food allergies!
References:
1. Bergmann K-C, Ring J (eds): History of Allergy. Anaphylaxis. Chem Immunol Allergy. Basel, Karger, 2014, vol 100, pp 54–61.
2. Food Allergy Research & Education: https://www.foodallergy.org/resources/facts-and-statistics#:~:text=How Many People Have Food,roughly two in every classroom.
3. Sampson, H.A. Food allergy: Past, present and future. Allergology International. 2016 May: 65: 363-369.
4. Smith, M. CMAJ, “Witchcraft, a fad or a racket?” Food allergy in historical perspective. January 5, 2016, 188(1).
5. Tan, S.Y., Yamanuha, J. Charles Robert Richet (1850-1935): discoverer of anaphylaxis. Singapore Med J. 2010; 51(3): 184-185.
6. Ring, J. History of allergy in antiquity. Chem Immune Allergy. 2014: 100:2-14. dot: 10.1159/000358422. Pub 2014 May 22.