The Magazine

Scratch 'n' Sniff

When the body overreacts, all hell breaks loose.

Dec 17, 2007, Vol. 13, No. 14 • By KEVIN R. KOSAR
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Breathing Space

How Allergies Shape Our Lives and Landscapes

by Gregg Mitman

Yale, 336 pp., $30

In my youth, I figured I probably had allergies. My eyes itched and my nose dripped every time I mowed the lawn. My preferred remedy was to quit mowing the lawn, but Mother would have none of that. So I would pop an over-the-counter allergy pill before pull-starting the Toro. In a serene, spacey antihistamine stupor, I pushed the mower about the yard, often in whirly patterns. A long nap on the couch followed, and upon my return to consciousness, I inevitably found our yard looking like it had the mange--tufts and clumps of grass sticking up here and there. Mother was not pleased.

She dragooned me to an allergist, who asked me questions, took blood, then shooed us from his office with our hands full of samples of antihistamines. A couple weeks later, we returned to the good doctor's office and were shown a printout that purported to show the dozens of things to which I was allergic: grasses, trees, mold .  .  . Legumes? What the devil are those, I wondered. We were informed that the best approach to my problem was "immunotherapy." Every two weeks for half a year, I was to come to the allergist's office and get shots loaded with increasing quantities of the substances to which I was allergic.

Once I had completed my immunization treatment, I was cured of allergies. The great outdoors was no longer a threat--until I wandered into a patch of poison ivy on a golf course (one of the perils of a persistent duck hook) which left my body swollen and itching so horribly I could not sleep. A bit of urshiol, the oil in the ivy that causes the dermatitis, had not been included in the serum. Still, provided I stayed clear of poison ivy, I was cured.

If only. Upon taking up residence in Washington, D.C., I got hay fever symptoms again. The allergens here are not the same as those in Ohio or New York. Marrying a woman who owned a cat did not help, either. Back to the pills I went.

My allergy story is not novel. As Gregg Mitman demonstrates, man has struggled haplessly against allergies for over a century. In the late 19th century, urbanism and industrialization were blamed for allergic rhinitis, more commonly known as hay fever. Cooped up in offices all day, choked in the street by smoke and made jittery by the hustle and bustle, city-dwellers were estranged from nature. Rather than address the sources of their discomfort, allergy sufferers of means simply took long holidays in the purifying country. Resort towns like Mackinac Island, Michigan, and Bethlehem, New Hampshire, sold themselves as hygienic places with "tonic" air.

In 1906, scientists invented the word "allergy," derived from the Greek terms allos (other) and energia (energy), to refer to the body's frenetic response to foreign substances. The source of our suffering rested in one of man's strengths: our ability to cleanse ourselves of alien substances. Allergies, scientists theorized, were an overreaction of the immune system, the most extreme form being the sometimes-fatal anaphylactic shock.

Despite this intellectual breakthrough, man continued to flounder in the search for relief. In 1930, Dr. Murray Peshkin, head of the Mount Sinai Hospital's Children Allergy Clinic, argued that allergens and irritants were merely the "sensitizing substances" that excited a response. The real problem lay in the nervous system of the afflicted. So Peshkin shot up allergy-suffering children with adrenalin, and when that did not do the trick, he subjected them to a "parentectomy." Sniffling kids were shipped away from their homes to live in fresh-air locales like Denver or Tucson for six months or more, free from their tension-inducing progenitors.

The quest for cures could be cruel to adults, too. Mitman relates the tale of "Poor Mr. G., [a] fifty-one-year-old bronchial asthmatic [who] had been suffering daily from severe asthma attacks for almost five years." Mr. G went to a medical facility at the University of Pennsylvania. During his treatment, he was placed in a room where an "air washer" was running. His symptoms ceased. Attendants then moved him into a room without an air washer and his suffering began anew. Not convinced that this experiment had verified the utility of the air washer, the attending physicians moved Mr. G. back into the other room. His symptoms subsided, whereupon they scattered house dust in his room, sending the poor sod into a violent fit of gasps that had to be remedied through drug injections.

American business saw the opportunities in aiding the afflicted. Vacations to posh clean-air resorts were marketed to eager sufferers, such as the well-heeled members of the United States Hay Fever Association. Industry -ballyhooed to the common man air conditioning, air purifiers, vacuum cleaners, hypoallergenic pillows, and chemical fixes like Dust-Seal, which was supposed to reduce airborne dust in the home by making it stick to carpets where it had been applied.

And obviously, there were drugs: antihistamines in the form of pills and corticosteroids delivered via inhalers. If you could not escape the allergens, you could inoculate yourself against them, at least temporarily.

To a great degree, Gregg Mitman's version of the fight against allergies is a tale of futility and foolishness. As land was cleared for railroad tracks, leading to pollen-free towns, ragweed took root in the loose soil and followed. Weed-killing chemicals might have some utility in eradicating allergenic menaces like ragweed. But municipalities' habit of blasting gallons of it along their roads wreaked environmental havoc--and did nothing to address the pollens produced by the lush green lawns its citizens coaxed forth and the ornamental plants they tended.

Drugs have alleviated the suffering of millions, but have come with their costs, not least overreliance upon them, and addiction. (Witness the case of the asthmatic woman who lived with "two very heavy smokers" and did nothing to help herself beyond sucking on "an isoproterenol inhaler every few minutes.") Quite sensibly, Mitman notes that we have been hampered in our response by grasping for the magic bullet, for failing to see that we can make our allergies better or worse by manipulating our environment.

Although sometimes enlightening and amusing, Breathing Space is, ultimately, a rather messy book. Mitman is a historian of science; yet throughout the book, science takes a back seat to storytelling and cultural criticism. A detailed explanation of the biomechanics of allergic and asthmatic reactions does not appear until the sixth chapter. Often Mitman recounts medical disputes but then leaves them unsettled. We read, for example, that asthma-related mortality rose at the same time that the use of a certain type of inhaler increased. But Mitman does not bother to tell us why: "Whatever the cause of the apparent increase in death rates. .  .  ." Death, schmeath--whatever.

Mitman derides municipal efforts to reduce asthma suffering by cutting down ragweed in empty lots, but does not provide a convincing explanation to counter any reader's commonsensical intuition that a reduction in pollen-emitters would lead to less pollinated air. Oddly, Mitman often treats asthma sufferance as a proxy for allergy sufferance, which is not quite accurate. Asthma, an inflammation of the air passages, is caused in many cases by allergens, but may also be triggered by cold air, emotional stress, or viral infections.

Breathing Space reads as if it was written by a leftist literary wannabe. For one, it is phantasmagoric and ill-defined. There are six chapters, but they do not provide individual theses that add up to a coherent argument. Frequently, the reader finds himself sucked into lengthy asides that cannot be related to the chapter's point. While this is supposed to be about allergies, you read little about atopic dermatitis, the reaction of the skin to allergens or irritants, or allergic reactions caused by food, medicine, mold, or bee stings.

Additionally, Breathing Space is replete with staid rhetorical frameworks, clumsily employed. Mitman runs the old city/country opposition, writing of the early 20th century: "With the shift in medical understanding of hay fever as a disease of the immune rather than nervous system, treatment also shifted and expanded from the therapeutic wilderness to urban clinics." The reader is not sure how to square this thesis with Mitman's lengthy description of the building of an allergy clinic in the Arizona desert at the same time. Enraptured with spatial imagery, he describes the story of allergies as involving man's quest for "breathing spaces," and the movement of allergies "across the boundaries of geography, class, and gender."

Breathing Space is also shot through with peculiar claims. He writes that, at the middle of the past century, there was an "assumption that consumers, particularly women, [had] both a responsibility and a choice to make a healthy home. It is also a version of the American dream shaped largely by the values of the white middle class." Does this mean that nonwhites and others had an alternative vision--say, one where men were obliged to make their homes unsafe and messy? At least twice, Mitman seems to blame humans entirely for allergies: "Antihistamines and other biomedical wonders would soon offer a technological fix to an illness that modern civilization had begun." And "if civilization and progress spawned hay fever, then perhaps there was no better breeding ground than the burgeoning metropolis of Chicago."

The chapter on allergies and cities is both grossly one-sided and kooky. Mitman rails about the "ecology of injustice" and uncritically repeats the assertions of left-wing advocates for the poor and nonwhite. Mitman claims that vacant lots in urban areas are the "by-products of the inefficiencies and injustices of industrial capitalism." He asserts that, in the 1960s, "the black community transformed anger and rage into a positive force of social change." And he describes the Young Lords as "young Puerto Rican activists." He does not speak of those who burned and trashed whole swaths of Newark, Watts, Detroit, and other cities, nor does he lament the criminal activities of the Young Lords. Mitman complains about rats in the homes of the urban poor but then derides a New York City rat-eradication program as "like putting a Band-Aid on an internally hemorrhaging patient." Never mind that the people in the infested slum wanted the rats croaked; and never mind that the anti-rat campaign might have improved the living conditions in 6,000 buildings where 100,000 people reside. On page 150 Mitman reaches the zenith of weirdness: "To the residents of Central Harlem and Spanish Harlem, the cockroach was linked, not to race, but to the inhumanity of beings toward one another. In their eyes, the cockroach became an ally in the protest against economic, racial, and social injustice."

The history of allergies is an interesting one. Sufferers will have to wait for the arrival of another study to learn the full story.

Kevin R. Kosar is a writer in Washington.