With this history of allergy, Mark Jackson has completed an ambitious project for which he was uniquely equipped, being both a practising doctor and a historian. It is clear from the text that he has also had some personal experience of allergy, not unusual among those who have worked and written in this field.
In order to tell the story of a century of research and experimentation, Jackson starts with the creator of the word, Clemens von Pirquet. He explains in detail von Pirquet's general acceptance of allergy as an altered reactivity of the body to various substances. The remainder of the book documents the propagation of the word in successive waves and describes how its meaning has become increasingly distant from the original intention of its progenitor.
Jackson has planned a global and multidisciplinary history, along two main themes, the scientific exploration of allergy, and the investigation of its socio-cultural significance. At first sight, these are two separate lines of research. The first deals with the clinical observation of strange disorders following the contact of the body with antigens (“allergens”) of various kinds through various routes. The second is concerned with the popular understanding and management of so-called allergic troubles. But it is soon evident that these are not two parallel stories but a unique multilayered epic, combining numerous actors: academic institutions and practising therapists, politicians targeting public health, and journalists eager to identify the demons of their times and understand their fellow citizens' concerns. Jackson's history of allergy covers all aspects, from laboratory research to epidemiological studies, and examines the contribution of both conventional and alternative medicines to the relief of patients suffering from chronic ailments.
Among the many issues dealt with, Jackson puts a particular emphasis on the epidemiology of allergy. He points to historical changes and geographical disparities in the distribution of allergic troubles. First comes the historical question. Has the number of allergies risen in the contemporary world? The answer involves a clear delimitation of the pathological entities listed as allergies. But the epistemological lesson drawn from the book is the elusive nature of medical truths, the volatile character of classifications, and the controversial character of tests used to diagnose allergies or follow up their treatment. Consequently, the complete answer to the question raised is reported in a hypothetical future, if the improvement of both conceptual and laboratory tools permits it.
The treatment of allergic disorders has also constantly been prone to alternate fads and eclipses. Jackson relates how desensitizing therapy, through controlled exposure to small doses of allergens, has flourished in Britain in various guises from Almroth Wright's time at the turn of the century with ups and downs, but almost collapsed in the 1970s, a perfect illustration of swift changes in medical modes of thinking. But this was by no means the end of the story. In the last chapter, we watch the re-emergence, with “ecological medicine”, of a new modish style of desensitization, this time by the methodical extraction of allergens from food and the environment.
The geographical dimension is treated in a more cursory way. There are a few pages about the alleged rise of allergy in developing countries, referring to epidemiologists' controversial findings. Do southern populations suffer less from allergy because they are protected by their reactions to the parasitic burden of their bodies (i.e. in blood and gut)? Or, on the contrary, is the threat of allergic disorders more severe in those parts of the world where pollution is unrestrained and unmonitored? Compared to the mass of information available on the industrialized world, Jackson's treatment of the developing world is sketchy at best. The lack of data points to an urgent need to assess the consequences for public health of the rapid changes in environment and lifestyle, the poor quality and adulteration of food, in many poor countries. Research has been very limited in this field, a limitation for which Jackson is clearly not responsible.
While science is constantly renewing its approach and allergy has historically pointed to different phenomena and symptoms labelled differently, by contrast, allergy as a whole appears continuously throughout time to have framed the way people express their uneasiness with the external world and with the Other. In recent years, allergy has even symbolized a form of resistance to modernity, a way of manifesting the crying need for a new contract with Nature, as Michel Serres has put it, the terms of which remain to be defined.
Despite his prevailing emphasis on the Anglo-Saxon world, Mark Jackson has probably come as close as is possible to writing a global history of allergy. He provides the general reader with a fascinating story and all the historical and scientific elements of the allergy nexus. His excellent bibliography will meet the needs of the academic readership. Still more important, he has brought proof that the cultural history of a malady can succeed in offering more definite conclusions than a scientific one. While the evolutionary significance of allergy is still unclear (is it an accident of immunity gone astray, or a phase in the constitution of immunity, or an autonomous line of defence against a growing range of pathogens?), Jackson has demonstrated that allergy is a flexible term that captures the holistic character of the illness and translates the profound interaction between the biological and the cultural, the body and the mind, in the individual.
At the end, Jackson plays masterfully with the multiple meanings of allergy and suggests that the metaphor has been strained to the point of suggesting a general call for “tolerance” (of the Other?), a term antithetic to allergy, another both immunological and sociological term that links biomedicine and politics and raises multiple echoes in the reader's mind after closing the book.
