2 of 4
Mitman's chapter "Choking Cities" puts a face on the plight of asthmatics too poor to escape. Moved to compassion after viewing a Gordon Parks photograph in Life magazine, Americans brought a young asthmatic from the slums of Rio de Janeiro to the United States for treatment: "On 7 July 1961, a forty-six-pound, malnourished twelve-year-old boy from a Rio de Janerio favela—or slum—stepped off a plane in Denver, hoping to escape the shackles of poverty and longing for a life free from the struggle to breathe." As readers, we rejoice with this young boy, yet thousands of Flavio's counterparts continue to suffer anonymously in the slums of Rio and Mexico City—and Harlem and New Orleans—with little hope of relief. Indeed, throughout his book, Mitman is particularly attentive to asthmatics trapped in such circumstances, revealing an aspect of poverty that has not received as much notice as it deserves.
Here and in other respects, Allergy and Breathing Space diverge in their emphases (although they do not disagree with one another—Mitman is enthusiastically cited by Jackson). Mitman's book is more accessible and engaging for the general reader. Those who wish to know more of the mechanisms of allergy and the history of our thinking about the subject—how it has been variously conceptualized—will find much of value in Jackson's book.
It is Jackson, for example, who introduces us to Clemens von Pirquet, the father of allergy science. Born in Vienna May 1874, Pirquet pioneered the discovery of the elusive relationships between antibody, antigen, and immunity. During Pirquet's day, it was accepted that if a bee stung you and death ensued, the bee's venom was the cause of death. The same was believed about invading bacteria. Radically and counterintuitively, Pirquet postulated that it was the body's own response to the venom or agent that caused symptoms and death. This is why Lewis Thomas referred to allergy as a "mistake."
Alas, the world was a harsh place for Pirquet. Mirroring the reactions he saw on a cellular level, Pirquet and his wife committed suicide in 1929. We owe much of our understanding of allergy to this single individual who coined the malady's very name.
But how do allergies work? How do they develop? We are not born with them. It's not possible to have an allergic reaction to penicillin, or bee venom, if we've not previously been exposed because the body has no antibodies present. In simple terms, an allergy develops when we are exposed to a foreign substance; the body's immune system then recognizes the foreign object as "not self" and makes antibodies. These antibodies are designed to work with chemicals and white blood cells to eliminate the invading substance. Sometimes they work too hard.
For example, when our body "sees" pollen invading the mucous membranes, antibodies (IgE type) may bind with the pollen and activate white blood cells (mast cells), causing them to release chemicals such as histamine. Histamine, in turn, causes our eyes to water, nose to run, and airways to contract.
Of the allergic responses, one of the most serious and debilitating is asthma. Asthma may be the result of antibodies reacting to proteins in pollen or dog dander. It may also result from irritants such as coal dust. Much time and effort has been spent trying to divine the relative importance of irritant versus allergenic causes of asthma. In the real world, this argument often plays out with enormous financial stakes. If soot from a smokestack causes a rise in asthma rates, it is convenient to blame it on allergens since coal soot is a known irritant but may not cause an immune reaction. This controversy mirrors the battles over asbestos' role in lung disease and cancer. The manufacturers of asbestos tried to blame the disease on cigarettes if a victim smoked, while cigarette manufacturers tried to blame cancer among smokers on asbestos. What became clear eventually was that the two were additive.
share this page
RSS Feed
