Book Review

Breathing Space: How Allergies Shape Our Lives and Landscapes

N Engl J Med 2007; 357:2312-2313November 29, 2007

Article

Breathing Space: How Allergies Shape Our Lives and Landscapes
By Gregg Mitman. 312 pp., illustrated. New Haven, CT, Yale University Press, 2007. $30. ISBN: 978-0-300-11035-7

The Grand Hotel on Mackinac Island in Michigan is a magnificent structure, or so it appeared to me when I visited as a graduating senior on a high school trip. I wondered why such a huge hotel was situated in such a remote area. Mackinac Island is far to the north, where Lake Michigan and Lake Huron come together. Gregg Mitman clears up this mystery in his book with a photo from the 1890s highlighting Mackinac Island as a haven for persons with hay fever and showing a steamer that well-heeled patients were about to board for their trip back to Chicago. In those days, the best treatment for patients with hay fever was an escape from places polluted by pollen to sites such as the White Mountains, Mackinac Island, or the north shore of Lake Superior.

Mitman traces the history of allergy from the viewpoint of a person who has allergies, from its early beginnings in England with the discoveries of John Bostock and Charles Blackley through the recognition of “pollen as poison” in the United States and the attempts of patients to escape it. He tells us of the war against ragweed in New York City in the 1940s. He provides the background for understanding the location of allergy and respiratory research centers in such places as Tucson, Arizona, and Denver.

Scanning Electron Micrograph of Ambrosia trifida (Great Ragweed).

The chapter entitled “Choking Cities” vividly recounts the New Orleans asthma epidemic, the Donora Zinc Works disaster, and the epidemic of asthma in inner cities among blacks. He describes efforts after World War II to remedy allergy by cleansing indoor air, the impact of air-conditioning, the use of 2,4-dichlorophenoxyacetic acid to eradicate pollen-producing weeds, and the discovery that the dust mite and the cockroach are important causes of indoor allergy. Mitman tells us about the battle during the 1980s between the scientific mainstream and advocates of the theory of multiple chemical sensitivities. The final chapter, “An Inhaler in Every Pocket,” richly documents the huge effect the pharmaceutical industry has on allergic diseases and the delicate dance between the pharmaceutical industry and professional allergy societies — with its continuing threat to the independence of these societies.

In telling the story of allergy in the United States, Mitman weaves a rich tapestry with a variety of colorful characters, beginning with the actor Mr. T (Lawrence Tureaud) and his “Lake Forest Chain Saw Massacre” and touching on many of the movers and shakers of allergy in the 20th century, including leaders of professional allergy societies. He tells of William Dunbar and passive immunization against pollens; of Leonard Noon and John Freeman and active immunization (immunotherapy) against pollens; of Oren Durham and pollen surveys and pollen collections; of Carl Prausnitz and Heinz Küstner and skin-sensitizing antibody; of the first U.S. allergy clinics and their efforts to lessen sensitivity; of Sir Henry Dale and his discovery of the effects of histamine; and of Kimishige Ishizaka and Teruko Ishizaka, Gunnar Johansson, and Hans Bennich and IgE. He tells of the synthesis of A524, later known as Benadryl, by George Rieveschl; the testing of this drug at Johns Hopkins University by Leslie Gay and his colleagues; and the serendipitous discovery of Dramamine and its effect on the military.

This book is a masterful recounting of society's struggles with allergy, and Mitman tells the story with a powerful emphasis on the social and personal factors that influenced the outcomes. Mitman, who had asthma as a child, is especially aware of the suffering of patients with allergies, particularly those who are most vulnerable in our society. A minor deficiency of the book, keeping in mind the author's goals, is the relative neglect of the parallel scientific progress, although Mitman does note the discovery of IgE and the ability to objectively quantify this molecule. The book might have profited from one more chapter on mast cells, basophils, and eosinophils, and on the network of cytokines and chemokines that determine the occurrence of allergic sensitization. Nonetheless, the lessons learned from the history and the richness of the exposition make this book a must-read for all serious students of allergy and allergic respiratory diseases. The story not only is interesting but also is told with such panache that it is a page turner and at times even a whodunit.

Gerald J. Gleich, M.D.
University of Utah School of Medicine, Salt Lake City, UT 84132
gerald.gleich@hsc.utah.edu