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Food Allergy

Looking Back for the Future of Food Allergy: Q&A with Historian Matthew Smith

smithCourtesy University of Strathclyde

To start his new book Another Person’s Poison, which covers more than 100 years of the medical and cultural history of food allergy, author Matthew Smith spirits the reader away to Edmonton, Canada in 2009. An AC/DC concert is soon to take place in the local football stadium, and tens of thousands of fans have just learned that there is a peanut ban in place. An online shouting match erupts over the merits of the rule. Several fans seem, well, “Thunderstruck” that they can’t chomp on peanuts while headbanging along to the band’s music, while stadium officials counter by citing the swiftly rising rates of food allergy and the seriousness of anaphylactic reactions.

Smith, a medical historian, employs the colorful, contemporary anecdote as an entry point into an intriguing and thorough history of how food allergy has been transformed from being considered a “fringe” discipline at best, and “witchcraft” or “fad” at worst. In the process, Smith manages to trace food allergy’s path through the wilderness of 20th century medical science.

The author doesn’t shy away from the politics – corporate, medical and governmental – over the decades. Also at the core of his story are the mavericks in the field – from the likes of London physician Alfred Schofield, who in 1908 became an early pioneer of desensitizing patients with egg allergies, to a pair of German researchers who proved early connections of food allergy to immunological mechanisms by using themselves as human guinea pigs to test theories.

The winding road from the discovery of IgE antibodies to banning peanuts from large public events is strewn with turf wars among research scientists, clinicians and patients, whose voices went virtually unheard during some periods. Smith’s history shows that food allergy has undergone not just one, but several revolutions in medical approach over the course of 100-plus years.

Allergic Living’s Jason Rehel caught up with Matthew Smith by phone from Glasgow where he works as a senior lecturer at the University of Strathclyde’s Centre for the Social History of Health and Healthcare to discuss his book.

Charting more than a century of food allergy history is an ambitious undertaking. What is your overriding message in this book?

The big story has to do with how we as physicians, patients, parents, policy-makers, manufacturers, all those parties – how we make decisions about controversial areas in medicine. To understand that, you need to understand why these topics are controversial in the first place.

In the first chapters, you see that these controversies have their roots in the 19th century and even further back. And when we want to solve controversies, we turn to the sciences. You hear it all the time: “The science says this, the science says that.” But what exactly is this science, and how did we get to that? That’s really what the book is about.

Can you tell us why you found food allergy rich terrain for a broader discussion of how medicine is practiced?

Using food allergy as a case study shows that these debates are very basic ideas about how you derive medical knowledge, what role you see the environment, broadly defined, playing in changes to human health. In the later chapters of my book, a lot of this evolves into a question about  pathologies of progress.

To what degree is food allergy an example of a disease of our civilization? So my overall argument is that if we want to resolve a lot of these issues, if we want to really find out what food allergy is and why it’s seemingly on the increase, we need to marry some of these contrasting viewpoints.

The precise definition of food allergy was hotly contested throughout the 20th century. Do you think this is partly because people blurred the lines to include a wider range of patients who self-diagnosed?

People self-identify with having intolerances. And there’s such a vast continuum. More orthodox allergists would say there’s a spectrum, and this is where [food allergy] starts and this is where it stops. History tells me that it’s more of a continuum. And partly because of the psychosomatic parts of it, it’s difficult to draw that line.

Now gluten-free (diets) is the big one, and they’re not just catering to people with celiac disease, or people that have definite gluten intolerance. Once the continuum gets past real intolerances, and gets to people going on these gluten-free diets – not because gluten does anything to their digestion, but they think it makes them fat, or whatever – they’re definitely self-identifying, and now there’s this massive food industry that’s willing to cater to their wishes. And I hesitate to say whether that’s right or wrong. It certainly speaks to our fraught relationship with food.

Next: The importance of the patient viewpoint

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