The itchy, the scratchy and the wheezy 20th century

We often spend time congratulating ourselves on the medical advances of the 20th century that swept away many infectious disease killers from developed countries. The widespread use of vaccination and antibiotics ensured that smallpox is gone forever and polio almost unknown in western Europe.

We conveniently overlook the fact that the 20th century saw a phenomenal increase in the incidence of allergic diseases. Hay fever, asthma, eczema and reactions against certain foods such as peanuts had become everyday topics of conversation in the UK by the turn of the millennium.

While the death rate from allergies may be low compared with measles or whooping cough, its unexpectedness would often give rise to newspaper headlines. Their effect on the quality of life for sufferers is almost impossible to quantify. Against that one might wish to recognise that we probably would not have had A La Recherche du Temps Perdu if Marcel Proust's asthma had not effectively condemned him to a life in bed.

And yet the word "allergy" appeared in the clinical canon only 100 years ago this year. It is difficult to believe that such a significant proposal, elegantly described, could be published in the local weekly medical news sheet even of a city as significant as Munich. The globalisation of the medical (and scientific) literature has swept away such charming anachronisms.

Mark Jackson, who is a professor in the history of medicine at Exeter University, has provided us with a serious work. Indeed, the author acknowledges the support of the Wellcome Trust in undertaking the research that underpins the book. He rewards them (and us) with a huge number of references - nearly 1,000 in all. The book has an academic tone. For example, every person mentioned has both date of birth and date of death recorded.

One therefore assumes that such infelicities as "In a similar vein, some doctors injected..." (on page 30) are accidental rather than tongue in cheek.

To be fair, the text is leavened with a judicious selection of cartoons drawn from British newspapers during the half century after the Second World War.

For those who have never suffered from any allergy, it is difficult to imagine the distress and discomfort caused and, perhaps surprisingly, to imagine the effect on the economy. Those suffering before the advent of antihistamines would undoubtedly be less economically productive, while the debate (not yet resolved) about the timing of school examinations being moved away from the peak hay fever season has maundered on for decades.

Oddly enough there have also been positive economic effects. Super-improved vacuum cleaners that can mop up cat and dog hairs and the shedded skin of humans with equal efficiency are sold with explicit advertising about reducing eczema and asthma. The annual sales of over-the-counter treatments for hay fever run into hundreds of millions of pounds in the UK alone.

Jackson describes the development of the allergy clinic at St Mary's Hospital during the reign of the (in)famous Almroth Wright and the inception (in 1961) of the universally heeded "pollen count" from its roof.

Much of his attention is on asthma rather than the equally common but usually less lethal eczema or hay fever, or the less common, but often fatal, peanut and bee-sting allergies. They do, however, all merit a mention.

His last (and shortest) chapter "Futures" is not encouraging for sufferers, although he could not have known that, as he finished his text, scientists would claim that defects in the gene encoding the protein filaggrin would cause the skin to be leaky to a wide range of molecules that should normally be excluded and could then give rise to allergies.

Finally, Jackson seems to be tempting fate or at least provoking patients by the discussion about the fashionable nature of allergy and its tendency to concentrate on the upper classes. His musings about the extent to which some allergies are psychosomatic are also unlikely to find sympathy with genuine sufferers, even if some will admit that emotional stress can exacerbate both asthma and eczema.

This is very much an excellent reference work for the physician and historian, rather than for a patient seeking solace.

Alan Malcolm is chief executive, Institute of Biology.