ABSTRACT
The earliest report of allergic diseases is that of King Menes of Egypt, who succumbed to the sting of a wasp sometime between 3640 and 3300 B.C.1 The astute Roman philosopher, Lucretius observed exaggerated responses in some humans to commonly occurring substances but not in others and remarked “what is food for some may be fi erce poisons for others”.2 It is to be noted he brought into focus the concept that the clinical disease was due to the interaction of environmental agents (in this case food) with some (susceptible) humans but not all humans. However, the modern era of allergy started in 1819 with the classical description of hay fever (allergic rhinitis) by John Bostock.3 In 1869 Charles Blackley, investigated his own affl iction with hay fever, by performing the fi rst skin test by applying pollen through a small break in the skin and noting that in 20 min the site of the prick had a hive-like response. He also noted that a similar break in skin to which pollen was not applied, had no hives.4 This is the birth of allergen skin testing and also highlights the value of a negative control. Following the descriptions of the two Englishman, Bostock and Blackley, Morrill Wyman a physician in Boston challenged himself and eight others with pollen from wormwood (a member of the ragweed family, Ambrosia). He and some of his subjects experienced features that resembled autumnal catarrh. Later, he described in his own family consisting of his father, his siblings and his children, autumnal catarrh over three generations. Morrill thus added the familial nature of the disease as well as the role of an in vivo provocative challenge-an observation that led to oral food challenge in the diagnosis of food allergy. Thus, the sentinel elements of an allergic disease, that generally harmless environmental stimuli cause adverse airway reaction in some but not all, often with a familial clustering, and which can be reproduced by skin tests or provocative
Harvard Medical School, Massachusetts General Hospital, Boston, MA.
