Theresa MacPhail (Allen Lane)
WHILE driving through his New Hampshire hometown one August morning in 1996, 47-year-old salesman James MacPhail was stung by a bee 鈥� and died.
He hadn鈥檛 known that he was allergic to bees, but, having been stung a few weeks previously, his immune system recognised the threat and redoubled its response, creating fatal anaphylactic shock.
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His daughter Theresa wondered at the paradox of having such a strong physical response that 鈥渋n addition to protecting you鈥� it can kill you鈥�. What made one body collapse at a threat easily brushed off by another? How could someone react so differently to the same trigger just a few weeks later?
Decades after her father鈥檚 death, MacPhail, by then a writer and medical anthropologist, set out to investigate this through the lens of her own struggle with respiratory sickness. The result is Allergic: How our immune system reacts to a changing world, a thoroughly reported, memoir-style work that shows both MacPhail鈥檚 personal connection to her subject and its wide-reaching relevance.
For a while, she was satisfied with her own vague diagnosis of 鈥渁llergies鈥�, taking it as proof of the scale of the problem. About 40 per cent of the global population have allergies, from minor irritations to life-threatening reactions. By 2030, she says, experts predict this figure will reach 50 per cent.
There is now widespread awareness and acceptance of the potential seriousness of allergies, hastened in the UK after after eating at sandwich shop Pret a Manger.
MacPhail explores how slack approaches to packaging and policies (and stereotyping of people with allergies as weak) endanger lives. But even as allergies are recognised, their parameters aren鈥檛 consistently described, or even understood, she says.
This means that an asthmatic reaction, say, can be caused by many conditions and doesn鈥檛 always indicate an underlying allergy. The ambiguities of self-reporting, definitions and interpretation of test results also complicate analysis.
Likewise, discussion of food sensitivity and intolerances can trigger the 鈥渘ocebo effect鈥�. As MacPhail writes: 鈥淚f a person anticipates that they will feel worse after they ingest the foods they think are causing their symptoms, they actually do.鈥�
Early humans might have had asthma and anaphylaxis in response to snake or insect venom, but they weren鈥檛 likely to have experienced hay fever or food allergies. Tracking their rise over the past 200 years, MacPhail highlights another complication: the impact of environment and lifestyle. From the first medical description of an allergy in 1819, our immune systems have adjusted to our changing world, not always proportionately. Pollution, chemicals and antibiotics play havoc with them, adding to the costs of global public health. For example, the number of children with eczema has doubled between 1997 and 2018, MacPhail reports.
Urbanisation and the climate crisis are influencing individual experiences of allergies, mostly for the worse, as those with hay fever know well. As MacPhail warns, in some ways those individuals are canaries in the coal mine.
As a former journalist with a wide interest in public health, MacPhail makes an engaging guide through an often elusive subject. Led by curiosity, informed by personal experience and good reporting, Allergic has plenty to offer readers interested in the interplay between individuals and their environment, and the fraught, fluid line between sensitivity and intolerance we tread. As MacPhail says, 鈥渨e鈥檙e all in this increasingly irritated world together鈥�.
Elle Hunt is a writer based聽in聽Norfolk,聽UK
