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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.

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 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.

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 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 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?

The first decade of the twenty-first century became another golden age for baby-food makers. As nutrition studies found infants’ and toddlers’ diets to be deficient in fruits and vegetables and high in sugar, fat, and starches, health professionals as well as parents began to question the long-term effects of feeding infants and toddlers a largely industrial diet. Many began to challenge entrenched beliefs about and practices of infant feeding, inciting another push toward homemade baby food and even questioning the necessity and use of commercial pureed baby food itself.

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.

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).

Over the years, a variety of health professionals have developed terms or phrases to denote seemingly unique clinical combinations of symptoms and signs. A disorder or syndrome does not necessarily exist simply because it has been described in the medical literature. Some have stood the test of time, others overlap with syndromes described by different specialists, and additional terms may be favored by a single practitioner advocating a “cause.” This chapter reviews conditions that have overlapping features with fibromyalgia but are not yet regarded as full-blown, legitimate disorders by organized medicine. When Dr. Fine first met Wanda, she was a basket case. Wanda had canceled three prior appointments because smells from a new carpet had made her sick, Med fly agricultural spraying 30 miles away prevented her from getting out of bed, and she developed a severe headache when her neighbors’ house was being painted. She almost passed out in the elevator going to Dr. Fine’s office because somebody was smoking. Wanda had been to three allergists, who obtained normal skin tests and blood tests. Desperate, she traveled to Mexico, where “immune rejuvenating” injections were administered, and to Texas, where a clinical ecologist sequestered her in a pollution-free, environmentally safe quonset hut for a month. There she received daily colonies, antiyeast medication, and vitamin shots, to no avail. Dr. Fine elicited a history of aching, sleep disorder, a “leaky gut,” muscle pains, fatigue, and a spastic colon. His physical examination and mental status examination revealed evidence of anxiety, obsessive-compulsive tendencies, and fibromyalgia tender points. Wanda was treated with fluoxetine (Prozac) for pain and obsessive behavior, buspirone (Buspar), for anxiety during the day, and trazodone (Desyrel), a tricyclic, to help her sleep at night. She was referred to a psychologist who worked to improve Wanda’s socialization skills and encouraged her to go out rather than be a prisoner in her own home. Wanda is slowly improving but will need many months of therapy. Self-reported environmental sensitivities are observed in 15 percent of Americans.