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This chapter explains how mold spores can cause allergies. Spores carry proteins on their surface, and those that act as antigens can cause a cascade of immune responses resulting in the miseries of allergic rhinitis or hay fever, allergic conjunctivitis, skin allergies, asthma, eczema or atopic dermatitis, and hypersensitivity pneumonitis. This chapter describes interactions between immune cells in allergies mediated by IgE and IgG, providing a primer on this complex field of medicine. The idea that allergy is a perversion of a response that evolved to combat parasitic infestations is discussed, along with the hygiene hypothesis that has been advanced as an explanation for the increasing prevalence of asthma.

Black molds feed by secreting enzymes that dissolve complex molecules, like cellulose, as their filamentous hyphae insinuate themselves in their food sources. Many of the molds that grow in buildings represent single phases in complex microbial life cycles. The diversity of mold species is astonishing, but relatively few species are prevalent in homes. Molds have a variety of effects upon human health. Many provoke allergies, some are implicated in fungal sinusitis, and a small subset can cause life-threatening infections. Evidence of the ubiquity of black molds is found in the fact that their growth on the exterior of office buildings in cities is usually mistaken for the effects of pollution.

In a footnote in Darwin on Man, it was suggested that Charles Darwin may have become ill because of “a severe allergy, possibly to pigeons, with which Darwin associated much”. However, there is no evidence that he was allergic to pigeons. Every day, from 1856 through 1858, he would go to the aviary and closely examine the pigeons. Yet his illness was subacute and did not become especially severe. He does not seem to have been exposed to pigeons during the very severe exacerbations of his illness (1839–42, 1848–49, 1863–64, and 1865). In addition, the main symptoms of his illness were not similar to the symptoms of pigeon allergy.

This chapter highlights the role of the peanut in making food allergy respectable. More than any other food allergen, peanuts became synonymous with food allergy and the subject of grassroots activism, voluntary industry action, legislation, and extensive media coverage. Unlike other developments in the history of food allergy—which were dominated by ideological debates among physicians, the clinical challenges of diagnosis and treatment, and the politics and economics of allergy—patients and parents were instrumental in putting the spotlight on peanut allergy by raising awareness, monitoring for peanut contamination, lobbying for better labels, and raising funds for research. Allergy associations and the food industry were also able to harness public concern about and interest in peanut allergy in order to shape understandings of food allergy in ways that were in their own interests.

This concluding chapter begins with a discussion of the lack of medical interest and the paucity of research on the rise of allergy and other immune dysfunctions. It argues that 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 have expended their energies on defending restrictive dogmas and debating about precise definitions. The chapter suggests that in order to explain the explosion of anaphylactic allergy and other allergic diseases, food allergists and orthodox allergists should look to reconcile their differences and examine food allergy afresh in a more pluralistic, open-minded, and holistic fashion.

Cancer of the pancreas is slightly more common among men than women. Survival rarely exceeds six months. Trends in pancreatic cancer incidence in developed countries are slightly declining. The disease shows evidence of a familial occurrence. Tobacco smoking is the only established exogenous cause of the disease; smoking cessation is quickly followed by a reduction in risk. Consumption of fruits and vegetables is inversely associated. Alcohol, either consumed in moderate amounts or abused, does not substantially affect risk, although pancreatitis, frequently linked to excessive alcohol intake, has been found to slightly increase the risk of the disease. Among occupational factors the evidence is relatively strong only for chlorinated hydrocarbon solvents frequently used in dry cleaning. Adult-onset diabetes mellitus and perhaps pernicious anemia may increase the risk of pancreatic cancer, possibly through the action of gastrointestinal hormones or insulin. Several reports indicate that allergies may be inversely related to the risk of pancreatic cancer.

This chapter examines the independent and combined effects of perinatal or childhood exposures and adult lifestyle on the development of both allergic and non-allergic lung disease. Topics discussed include the development of ventilary function, effects of childhood chest illness on lung function and respiratory disease, allergic sensitization, and later influences on adult respiratory disease. It also reviews trends in chronic obstructive pulmonary disease, asthma, and allergy.

This introductory chapter begins with a review of some contemporary statistics about food allergy. Food allergies, for instance, occur when the immune system overreacts to proteins found in food. Today it is estimated that 4 percent of adults and 8 percent of children in North America are allergic to some food, including peanuts, eggs, and milk. The chapter then sets out the book's purpose, namely to describe the history of food allergy in order to address the following questions: Why has food allergy transformed from a questionable medical entity to a condition deemed serious enough to change the ways in which we produce, prepare, and consume food? Why has food allergy always been so controversial? Why have explanations for food allergy been so elusive? And why are more and more children allergic to food. An overview of the subsequent chapters is also presented.

This chapter examines how physicians in previous centuries came to understand and explain the bizarre symptoms that some people experienced after eating particular foods. Rather than attempting to prove that reports of bizarre food reactions were what we would now call food allergy, it shows how such responses were understood prior to the emergence of allergy as a medical and cultural phenomenon. How did physicians interpret strange responses to food before 1906? Were they common explanations for otherwise unexplained symptoms? If they were not a regular feature of medical practice, does this mean that reactions to food were unheard of—a conclusion that might support some current theories about the epidemiology of food allergy—or does it mean instead that compared with the vast amount of endemic infectious disease and nasty pathogens commonly found in poorly preserved food, they were believed to be clinically unimportant? Either way, what bearing does the history of such reactions, the prehistory of food allergy, have on the understandings of food allergy that emerged after von Pirquet coined his term?

This chapter charts the emergence of allergy as a specific field of medical inquiry in the early years of the twentieth century. It considers debates about food allergy, which could be distilled to how one defined allergy and how one applied such definitions in clinical practice. Anaphylaxis denoted a restricted definition of food allergy, which was limited to certain reactions and, by extension, certain kinds of food. For orthodox allergists, who believed that the rates of food allergy were exaggerated, it was Charles Richet's definition of anaphylaxis that mattered most. Allergy, as defined by Clemens von Pirquet, widened the spectrum, allowing for a greater array of symptoms, especially chronic complaints, to be included under its umbrella. Physicians who regarded food allergy as a widespread clinical phenomenon adhered to this definition. But for some, including the clinical ecologists who defected from allergy in the 1960s, even von Pirquet's term did not go far enough. They, instead, turned away from the immune system and toward Francis Hare, whose inductive process had convinced them that food played a key role in countless chronic health problems, including mental illness.

This chapter describes the excitement and controversy generated by clinical and popular interest in food allergy during the first several decades of the twentieth century. It became apparent that although food allergy was included in the same family of allergic disease as hay fever and pet dander allergy, it did not always follow the same rules as those conditions. Early food allergists had to diagnose, treat, and classify food allergy differently than orthodox allergists who focused on other allergies. They also relied more on the testimony and cooperation of their patients. The two factions that would emerge within allergy—food allergists, who employed a broad definition of food allergy and thought it was widespread, and orthodox allergists, who employed a narrower definition of food allergy and thought it was rare—would contest how to understand, explain, and treat food allergy throughout the twentieth century.

During the postwar period, disputes about food allergy were framed on competing ideologies, one rooted in the emerging environmental movement and concerns about processed foods and food chemicals, and the other centered on the mid-twentieth-century fascination with psychosomatic medicine and Freudian psychoanalysis. In order to understand the impact of both of these models of allergic disease, this chapter concentrates on how the relationship between mental illness and food allergy was variously depicted by food allergists and psychoanalytically oriented allergists. The resulting divisions split the allergy community and, indeed, led many food allergists to abandon both the field—and the concept—of allergy altogether and turn instead to a new discipline: clinical ecology.

This chapter discusses how the schism between food allergists and orthodox allergists was finally made complete by the discovery of immunoglobulin E (IgE) in 1966. For academic immunologists and orthodox allergists, IgE was and is an immunological marker for allergic reactions, proving to them that much of what food allergists had claimed was food allergy was in fact either intolerance or psychosomatic. Although IgE ushered in a new era of scientific respectability for orthodox allergists, it pushed many food allergists to the fringes of medical practice. IgE also made it possible for unscrupulous allergists to market dubious allergy tests, which marginalized food allergists and clinical ecologists even farther.

An 18-year-old Iranian man was brought to the emergency department unconscious. He was pyrexial, hypotensive, and had a petechial rash. A computerised tomography (CT) scan of head was normal and he was ventilated on intensive care. He was treated with intravenous ceftriaxone for presumed meningitis and recovered with persistent hearing loss. Blood cultures were positive for Neisseria meningitidis serogroup Y.

One year later he presented with a rash, headache, and neck stiffness. He was afebrile, conscious, and alert. He was treated with intravenous ceftriaxone for presumed meningitis and blood cultures confirmed Neisseria meningitidis (which was ‘not typable’ and therefore not serogroup A, B, or C).

This chapter presents Levinas's idea of discourse, as proposed in the pages of Totality and Infinity, as providing a description of the conditions of possibility for interparadigmatic dialogue, that is, for engendering a dialogue in situations where the common logos that would mediate a dia-logos cannot be effectively located, and thus cannot perform its mediatory function. Following Levinas's own definitions, the chapter defines discourse as “an original, non-allergic, ethical relationship with alterity productive of a meaning capable of founding communal meaning,”. The exposition follows the elements of this definition in dealing with the way in which the separated terms requisite for discourse (the relation as “non-allergic”) are, for Levinas, evinced, first, in the ethical separation (transcendence) of the other from the same and from the system that, as the same, it operates; and secondly, in the separation of the same from any system of totality.