Hay fever. Peanut allergies. Eczema. Either you have an allergy or you know someone who does. Billions of people worldwide—an estimated 30 to 40 percent of the global population—have some form of allergy. Even more concerning, over the last decade the number of people diagnosed with an allergy has been steadily increasing, placing an ever-growing medical burden on individuals, families, communities, and healthcare systems.
Medical anthropologist Theresa MacPhail, herself an allergy sufferer whose father died of a beesting, set out to understand why. In pursuit of answers, MacPhail studied the dangerous experiments of early immunologists as well as the mind-bending recent development of biologics and immunotherapies that are giving the most severely impacted patients hope. She scaled a roof with an air-quality controller who diligently counts pollen by hand for hours every day; met a mother who struggled to use WIC benefits for her daughter with severe food allergies; spoke with doctors at some of the finest allergy clinics in the world; and discussed the intersecting problems of climate change, pollution, and pollen with biologists who study seasonal respiratory allergies.
This is the story of allergies: what they are, why we have them, and what that might mean about the fate of humanity in a rapidly changing world.
Hay fever. Peanut allergies. Eczema. Either you have an allergy or you know someone who does. Billions of people worldwide—an estimated 30 to 40 percent of the global population—have some form of allergy. Even more concerning, over the last decade the number of people diagnosed with an allergy has been steadily increasing, placing an ever-growing medical burden on individuals, families, communities, and healthcare systems.
Medical anthropologist Theresa MacPhail, herself an allergy sufferer whose father died of a beesting, set out to understand why. In pursuit of answers, MacPhail studied the dangerous experiments of early immunologists as well as the mind-bending recent development of biologics and immunotherapies that are giving the most severely impacted patients hope. She scaled a roof with an air-quality controller who diligently counts pollen by hand for hours every day; met a mother who struggled to use WIC benefits for her daughter with severe food allergies; spoke with doctors at some of the finest allergy clinics in the world; and discussed the intersecting problems of climate change, pollution, and pollen with biologists who study seasonal respiratory allergies.
This is the story of allergies: what they are, why we have them, and what that might mean about the fate of humanity in a rapidly changing world.
Critiques-
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March 13, 2023
Medical anthropologist MacPhail (The Viral Network) delivers an uneven overview of the science on allergies. Explaining that they likely arise from a blend of genetic and environmental factors, she discusses the genetic mutation that puts certain people at risk of anaphylaxis from bee stings and research that found air pollution leads to higher rates of asthma and respiratory allergies. MacPhail admits “we’re stuck with largely unreliable data” on allergy frequency and treatment, a problem that leads to some notable inconsistencies. For instance, she questions whether evidence from surveys, insurance claims, and hospital admissions suggesting increased allergy rates merely indicate greater awareness and willingness to seek help, but later makes the contradictory claim that researchers “can all agree on one thing:... the number of allergy sufferers worldwide is likely to keep growing.” Her overview of treatments also gets bogged down in contradictions, as when she posits that air filters “probably don’t help, and they might actually make things worse,” but later suggests they “can filter some or most of the allergens, like pollen, from the air.” There are some enlightening tidbits (she outlines a damning take on how restrictive rules make federally funded food programs almost useless for many with severe food allergies), but MacPhail’s clumsy navigation of uncertainties in the scientific literature will leave readers feeling lost. This doesn’t come together. -
April 15, 2023
A holistic study of how allergies continue to bewilder medical science. As a medical anthropologist, MacPhail's subject matter is both professional and personal. In 1996, her father died suddenly of anaphylaxis after a bee sting. That event prompted the author to carry an EpiPen and to launch a research project examining the "puzzle of allergies." In a deft three-part analysis, she probes the biological processes of allergens and the misconceptions surrounding them. She then examines the "confusing maze" of diagnosis and the causative theories on why allergies are proliferating, and she explores possible solutions and the progress medical science has made (outside of antihistamines) treating global allergy issues, including the development of promising new vaccines. MacPhail cites historical information from the early 1800s, when the first allergy was medically documented, and consistently attempts to nail down the ever shifting definitions of what allergies actually are, tackling the vexing question of origin with informed speculation. Whether it be the cumulative effects of environmental changes, industrial development, food additives, or genetic mutations, specific people seem more vulnerable to certain allergens. The author optimistically reflects on modern immunological advancements that have provided relief, and she presents a series of crisply rendered perspectives of people who cited severe allergies to airborne allergens, dust mites, or specific foods--all frustrated by the lack of a definitive cause or the unaffordability/unavailability of longer-term remedies. "In a capitalistic system," she writes, "a patient is akin to a customer." While the culprits responsible for the increases in allergic sufferers are debatable moving targets, MacPhail skillfully narrows down the possibilities and some of the solutions, although her contradictory advice on air purifiers may confuse readers seeking solace. Nonetheless, the author's examination of the science of immunology from a social and cultural perspective will give readers plenty of relevant, thought-provoking information. An exhaustive and accessible report.COPYRIGHT(2023) Kirkus Reviews, ALL RIGHTS RESERVED.
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April 15, 2023
Allergic disease includes seasonal allergies, some types of asthma, antibiotic allergies, poison ivy rash, food allergies, and even death from anaphylaxis. Its occurrence is widespread and rising. Medical anthropologist and allergy sufferer MacPhail poses a seemingly straightforward question, "Why are we all so irritated?" She finds the answer is complex and incomplete. Her interest in the subject was sparked by the death of her father from a reaction to a bee sting. MacPhail interviews allergists, researchers, and patients. She reviews the diagnosis (skin-prick testing, blood tests, a good deal of detective work), theories about causation (genetic influence, environmental triggers, microbiome alterations, the hygiene hypothesis), and treatments of allergic disease. Pollen and air pollutants, IgE antibodies and mast cells, antihistamines and EpiPens receive appropriate attention. Newer therapies, including Dupixent for eczema and Palforzia for peanut allergy are spotlighted. Possible future remedies (gene therapy, vaccines to reduce symptoms, nanoparticle immunotherapy) are briefly introduced. Fundamentally, MacPhail addresses our vulnerability, noting that deteriorating air quality, worsening climate change, and pervasive chemical products are undeniably harming human health. Help cannot arrive soon enough for our overworked immune systems.COPYRIGHT(2023) Booklist, ALL RIGHTS RESERVED.
