Allergic: Our Irritated Bodies in a Changing World

by Theresa MacPhail

An eye-opening exploration of allergies, from their first medical description in 1819 to the cutting-edge science that is illuminating the changes in our environment and lifestyles that are making so many of us sick

Hay fever. Peanut allergies. Eczema. Either you have an allergy or you know someone who does. Billions of people worldwide—an estimated 30 percent to 40 percent of the global population—have some form of allergy. Even more concerning is that fact that over the last decade the number of people diagnosed with an allergy has been steadily increasing, placing an ever-growing medical burden on individuals, families, communities, and healthcare systems.

Medical anthropologist Theresa MacPhail, herself an allergy sufferer whose father died from a bee sting, set out to understand why. In pursuit of answers, MacPhail studied the dangerous experiments of early immunologists as well as the mind-bending recent development of biologics and immunotherapies that are giving the most severely impacted patients hope. She scaled a roof with an air-quality controller who diligently counts pollen by hand for hours every day; met a mother who struggled to use WIC benefits for her daughter with severe food allergies; spoke with doctors at some of the finest allergy clinics in the world; and discussed the intersecting problems of climate change, pollution, and pollen with biologists who study seasonal respiratory allergies. This is the story of what they are, why we have them, and what that might mean for the fate of humanity in a rapidly changing world.

Genres: Nonfiction, Science, Health, Medicine, Audiobook, Medical, History

352 pages, Kindle Edition

First published May 1, 2023

About the author

I’m a medical anthropologist and writer, usually of nonfiction, mostly about topics in public health and medicine. I’m also an Associate Professor of Science & Technology Studies at Stevens Institute of Technology in Hoboken, NJ.

My first book for Random House is out now (2023). It’s called Allergic: Our Irritated Bodies In a Changing World and it tells the story of the global rise in allergies over the last 200 years.

My next book, that I’m currently researching, is on aging. It dives into what happens to our bodies and minds as we age and why acceptance of aging (and our eventual deaths) is the key to “aging well.” Think of it like a “user’s manual” to your aging body (with a lot of troubleshooting sections). But, more importantly, it also traces out the long history of our fascination with aging and how and why aging transformed from a natural, normal, and healthy life experience into a medical problem or disease that needs to be “solved.” And what that approach to aging is doing to us collectively. (Spoiler: it’s not terrific.)

To book me for a speaking engagement, please contact the Random House Speakers Bureau.

Reviews

[Clif Hostetler · Rating 4 out of 5]

This book provides a presentation that is as clear and systematic as possible about an unclear subject with multiple definitions and involves functions of the human body which are not fully understood. The prevalence of allergies among humans further complicates the subject with an array of remedies based on anecdotal stories and in some cases hucksters selling cures with no tested validity.

People often confuse sensitivity and intolerance with allergies. Even allergists will sometimes use the term allergy loosely. For simplicity's sake, the author followed the following basic rubric for determining what an allergy is—and what it isn't. (bold emphasis is mine)

If your body's immune system responds to an exposure to an antigen or allergen, then you have an allergy. Typically, that will usually mean that you also have an IgE response, but not necessarily. What's more important is that your immune system has a hyperactive response to an otherwise harmless substance. If you have symptoms similar to a food allergy, but they are being caused by some bodily system, condition, or mechanism other than the immune system itself, then you have an intolerance (which, to be perfectly clear, is not an allergy). If you develop a localized wheal reaction to a skin-prick test (which we'll explore more in chapter 2) but don't experience allergic symptoms when exposed to that allergen, then you have a sensitivity, not an allergy. (p.21)

The big mystery related to allergies is why is it increasing, and this is a large part of my motivation for reading this book. The author says there are many differences in option regarding the cause, but everybody agrees that the rate of allergy suffering is increasing.

Hospital admissions for asthma tripled in just two decades, between the 1970s and the 1990s, before leveling off to a steady rate today. And although rates of asthma in developed nations have been slowing, they continue to climb in underdeveloped parts of the world, causing the overall rate to continue its rise globally, even while it remains constant in places like the United States.

This is why experts predict that allergy rates will continue to rise for the next several decades. Allergic disease is less prevalent in rural areas of low-income countries, but allergic sensitization is at the same level (quick reminder: you can have a sensitivity without developing an allergy). In other words, people everywhere have the same sensitization, but there are fewer active symptoms and fewer cases of active disease in rural areas of poor countries. As countries begin to develop, rates of allergy tend to rise. Why? (p.58)

Another motive of mine for reading this book was to see if the author agrees with my own favorite cause to blame for the increase in allergies, the hygiene hypothesis. This book sights much of the evidence to support the hygiene hypothesis but concludes that it can't account for all of the increase. Other reasons discussed by the book are genetics, increased pollen exposure, global warming, air pollution, gut microbiome, stress, and lifestyle.

One cause which the author specifically knocks down is genetically modified food as a cause for allergy increase. There's one sentence in the book where she says that there is no credible evidence to link GMOs to increased rates of allergies. At another place in the book it's mentioned that genetic engineering may actually be a key to reducing some allergies by creating plants which lack the allergic irritant components.

After first addressing the definition of allergies in the first part of the book and the cause of its increase in the second part, the book moves on discuss treatment options and prospects for improved treatments in the future. I would think that anybody who suffers from allergies would find this discussion of treatments to be of interest.

Among the cases discussed by the book are some of the sad incidents of fatalities caused by allergic reactions. The author decided to begin the book with the story of her father who died from a bee sting. That was a sobering story to begin the book, and it certainly made the point that allergies are a very serious matter for some individuals.

[Quirkyreader · Rating 5 out of 5]

I won this book through a goodreads giveaway. Thank you Random House and Penguin RandomHouse.

This book is mostly about how we deal with our loads and how changes in the environment are causing our loads to change. A good description for load can be found at The Lancet website. I have included a link as well: https://www.thelancet.com/journals/la...

I enjoyed reading the history of how treatments have changed since the 19th century.

The book does not belong to one specific non-fiction genre, so give it a go and see where it fits for you.

[Rossdavidh · Rating 3 out of 5]

Theresa MacPhail opens her book on "Our Irritated Bodies in a Changing World" in an attention-grabbing way: the story of how her father died of an allergic reaction to a bee sting.

Or rather, to be more precise, her father's body's immune system so massively overreacted to a bee sting, that it killed him. This is the central truth about allergies; it's not really the allergen that is causing the problem, it's our body's reaction to it. For most people, a bee sting is annoying and painful for a minute or two, but for some people it's life-threatening. Once you know that it's primarily an immune system response, it makes more sense that allergies can be acquired. Immune systems are learning systems, and need to be, but that means that occasionally they can learn the wrong thing.

The second most important thing to know about allergies, is that we (humanity) seem to be having more of them lately, and there is still some debate as to why. The leading candidate is the "hygiene hypothesis", which is that because our immune systems don't have as many actual problems to deal with (due to the improvements in hygiene, sewage treatment, etc. over the last couple centuries), they no longer know what a real problem looks like.

I get the strong impression that Theresa MacPhail just doesn't like this idea very much, though she grudgingly admits that it is probably part of the problem. I think it is because the most obvious solution, which is to not be so manic about disinfecting everything and accept that a certain amount of dirt is good for you, rubs her the wrong way. It probably doesn't help that she was writing this book when the pandemic lockdown happened, and that did not cause most people to respond favorably to the idea that we all need to disinfect less. So, she looks at a few other possibilities, such as that ubiquitous pollutants, many of them including synthetic organic compounds, could be confusing our body's immune systems somehow. Maybe. She also tries to tie global warming in somehow. Eh.

She also spends a good deal of time covering the story of how we have been grappling with this question for the last century or so. Because they are (normally) not as severe as, say, diseases that kill you or blind you or cripple you, the early decades saw only a few lone cranks investigating.

But really, another problem is that in order to get scientists to investigate something, you need to convince them of two things:

1) it's important

2) they have a good chance of making at least some headway

Point 2 is probably more important than point 1, from the point of view of the scientist's career. The hard reality is that the immune system is extremely complex and multi-faceted, and if you don't understand how it's supposed to work, it's hard to figure out why it is misfiring. MacPhail does a good job of covering the basics, and not-quite-so-basics, of what is known about how our immune systems work.

MacPhail also spends some time convincing the reader that allergies are, for some, not only a big deal if you are at risk of anaphylactic shock like her father. Some people live in mortal fear that their child will encounter a peanut, and carry an EpiPen with them wherever they go (which is in itself a complicated process because they have to be kept within a certain temperature range). I am convinced, not that I needed to be, that it is a Big Deal for some people and has a major impact on their quality of life.

The weakest part of the book is the last chapter, for two reasons:

1) it suffers from the bane of every popular science book written at this time; it tries to tie it all to Covid-19

2) there is no real ending to this story, because the plain truth is we haven't made all that much progress on understanding allergies or preventing them; we aren't even really all that good a diagnosing them

Nonetheless, it is a well written look at the scientific and human sides of what is looking to be a slowly but inexorably rising world health crisis. Just don't expect to read about any real solutions on the horizon.

[Alisha · Rating 4 out of 5]

An interesting look at the science behind allergies (including food allergies), the possible reasons for their increase in today's world, and the historic/current/future treatments. I was most interested in the middle section of the book, which went into the sociological aspects of how human behavior & innovation have changed allergies over the years. The author is fair in bringing forward a number of likely factors for the worsening allergy rate, but then always backing away from each theory and emphasizing that no one thing can be the entire story. Still, there's a lot of food for thought here, some of which involves things that individuals can (maybe, somewhat) control -- don't overuse antibiotics, don't insist on too sterile of an environment, take care of your digestion, pets in the home & exposure to other possible allergens can be helpful for children's immune systems if they don't already have an allergy, etc. -- and some of which are larger societal issues.

Most intriguing to me is the idea of the skin barrier and the integrity of the gastrointestinal tract being absolutely crucial to statistically reducing the development of allergic reactions. An extract:

The barrier regulation hypothesis dovetails nicely with the conception of our immune system as a whole—microbiome included—as curator of what can and cannot be a part of us. Without the regulation that those barrier cells provide, entire proteins can pass through our skin or our gut into the bloodstream, where they encounter our immune cells. The allergic person’s immune system is wholly functional; it is simply doing the job it was meant to do. The ultimate problem, at least from Nagler’s point of view, is that it’s being asked to perform a job different from the one it was initially trained to do. So, from this perspective, allergic disease is a barrier problem, not necessarily an immune system problem.

There are a number of interesting takeaways from this, but ultimately this book isn't really a how-to on avoiding the problem, but a broad look at why it's at the point it is.

[Louise · Rating 5 out of 5]

Overall, I enjoyed reading this one, and felt like it struck a good balance between being super educational yet not getting too in-the-weeds academic. The author is careful to use correct scientific terminology and makes an effort to explain complex biological concepts, while at the same time clearly explaining those concepts and terms in a way that could probably be understood by anyone who paid attention in high school biology class — but to be clear, you do need to have actually paid attention; this is not a total-newbie level book, either.

What the book ultimately concludes is that there’s just still a lot that we don’t know about what precisely causes various types of allergies and atopic reactions, nor how to cure them, or even effectively treat them in some cases. Allergy treatment options are better now than they ever have been historically, true, but allergies are more common and more severe now than they ever have been historically, too.

I would recommend this book to anyone with allergies, or who cares about someone with allergies, who simply wants to know more about both the specific biological mechanisms behind their symptoms and the history of this field of medicine more generally — or really just anyone who loves a good deep dive into a science-y subject.

Full review at Lone Star on a Lark

[Emma Deplores Goodreads Censorship · Rating 3 out of 5]

An interesting book; I learned from it. Allergies are becoming a huge medical issue despite being largely a recent phenomenon, and this book investigates why, as well as what allergies are exactly, how they work, the benefits and drawbacks of available and upcoming treatments.

Allergies seem to be largely driven by environmental factors that scientists are still working out. The first record of allergic reactions (hay fever, specifically) is only about 200 years old, and allergies were originally associated with well-off city folk with nervous temperaments. Since then allergies have boomed until an enormous number of people have them, often coming in waves: for instance, food allergies took off in the 1980s and 1990s; red meat allergies following tick bites appeared even more recently than that. Respiratory and skin allergies are becoming increasingly common.

It’s not quite as simple as “overly clean environments cause immune systems to overreact,” though people exposed to lots of stable dust as infants seem to be far less vulnerable, while use of antibiotics in young children seems to increase allergies. On the other hand, many people become allergic to plants they work with all the time, and children growing up in more polluted indoor and outdoor environments are far more likely to develop allergies. Allergies are also often directly related to modernity in ways difficult for individual families to prevent: for instance, compounds in diesel fuel in the air bind to allergens, causing them to penetrate more deeply into the lungs than they otherwise would. And climate change is a factor too, leading to longer pollen seasons, while more carbon dioxide in the air allows allergenic plants like ragweed to proliferate.

Meanwhile, many treatments aren’t particularly effective, or at least not for everyone; some, like controlled exposure to small amounts of food allergens in order to build up a mild tolerance, cause more allergic reactions than they prevent (although in a less dangerous context); and there are lots of bogus treatments out there, as well as companies making a profit by inflating the prices of necessary products like EpiPens.

So overall, definitely an informative read, and fairly readable on the whole. I didn’t always get along with the author’s writing style: sometimes she seemed to treat easy-to-understand concepts as more difficult than they were, while at other times getting deep into the scientific weeds or not quite connecting propositions to each other (if stress increases stomach acids and antacids reduce them, why are antacids a problem, exactly?). That said, overall it’s a well-written, accessible but reasonably in-depth primer on the topic, likely to be useful to those personally affected and informative to the rest.

[Stewart Tame · Rating 3 out of 5]

Full disclosure: I won a free hardcover of this book in a Goodreads giveaway.

As the cover promises, this is everything you ever wanted to know about allergies, and then some. McPhail does a masterful job of communicating some complex concepts in easy-to-understand prose. And it is definitely a complex subject. Even the very definition of the word, "allergy," is open to some degree of interpretation. She covers the past and present, and speculates about the potential future.

There's not a lot to say, really. From the cover, you know what you're getting into. I'm always up for a good nonfiction read, and I learned a lot. Recommended!

[BethFishReads · Rating 3 out of 5]

A solid exploration of the current state of knowledge about allergies and why they seem to be on the rise.

MacPhial does a good job balancing the science and medicine of allergies with personal narratives from allergy sufferers, researchers, and doctors. She covers the basics -- what an allergy is and isn't -- and then reviews and discusses a variety of current hypotheses for why we have allergies, what triggers allergies, and what may be causing the perceived rise in incidence.

Because I have a deep background in human biology, I found the material to be accessible and easy to understand. YMMV. Among the more interesting conclusions is the realization of just how little researchers and doctors know about allergies.

Although there wasn't anything particularly new or revealing, readers looking for a starting place to understand the science of allergies won't go wrong with this book.

Thanks to the publisher for a review copy.

[Mircea Petcu · Rating 5 out of 5]

La începutul secolului XX, medicul vienez Clemens von Pirquet a observat că unii copii cărora le fuseseră administrate vaccinuri realizate din ser cabalin reacționau mai rău la cea de-a doua doză, dezvoltând o erupție la locul injectării, mâncărimi și febră. Așa a început studiul științific al alergiilor. Tot Clemens von Pirquet a inventat termenul "alergie", care înseamnă "activitate diferită", fiind format din îmbinarea rădăcinilor grecești "ergon" și "allos".

Alergia este o reacție de hipersensibilitate de tip I, mediată de anticorpii IgE. Aceștia activează mastocitele și bazofilele pentru a elibera histamină și alți compuși care produc inflamație și celelalte simptome ale alergiei. În ciuda definiției, nu toate alergiile sunt mediate de anticorpi IgE, de exemplu, alergiile la medicamente sau boala serului (precum cea observată de doctorul Clemens).

Predispoziția genetică de a dezvolta o reacție de hipersensibilitate față de alergeni din mediu, mediată de IgE, poartă denumirea de atopie (de unde denumirea de dermatită atopică sau eczemă). Cei cu atopie au, în general, un titru mai mare de anticorpi IgE și mai mulți receptori pentru IgE pe suprafața mastocitelor.

În ignoranța mea, nu știam că există subspecializarea de medic alergolog, ceea ce arată cât de problematice sunt alergiile.

Recomand

[Grittel · Rating 4 out of 5]

This healed something in little me, who was so self-conscious because of her hayfever or other allergies and didn’t want to be seen outside during allergy attacks. Just want to give her a big hug and tell her that will be okayyyyy!!

[Cav · Rating 4 out of 5]

"Nut allergies. Hay fever. Asthma. Eczema. Either you have a frustrating allergy or allergy-related condition, or you know someone who does..."

Allergic was an interesting look into the topic.

Author Dr. Theresa MacPhail is a medical anthropologist, former journalist, and associate professor of science and technology studies who researches and writes about global health, biomedicine, and disease.

Theresa MacPhail:


MacPhail has a great writing style that's both interesting and engaging. The book also has a great flow, and shouldn't have trouble holding the finnicky reader's attention.

The book begins with a well-written intro. The author talks about her father's death from a bee sting. She also covers a brief history of the concept of immune dysfunction; and the related scientific orthodoxy at the time - which resisted talk about the immune system causing people harm.

The quote from the start of this review continues:

"...The latest statistics on allergies are sobering. Over the last decade, the number of adults and children diagnosed with mild, moderate, or severe allergies has been steadily increasing with each passing year. Billions of people worldwide, an estimated 30–40 percent of the general global population, currently have some form of allergic disease, and millions have one severe enough to actively endanger their health. But allergies don’t have to be deadly to impact your whole life. People with mild, moderate, and severe— but not deadly—allergic immune responses spend an inordinate amount of time, money, and focus on their conditions. Allergies can be a burden, even when they aren’t life-threatening. But because allergies don’t normally kill people, as a society we have a tendency not to take them very seriously. We joke about someone’s gluten intolerance or hay fever without thinking twice about how a person with those conditions might actually feel. The quality of life of someone with an active allergy is typically lower than someone without one. Their anxiety and stress levels are higher. They feel fatigued more often. Their ability to concentrate and their energy levels go down."

She writes about the nature of this increasing problem:

"It’s clear that our human immune system is becoming ever more sensitive to the panoply of natural and man-made allergens that we come into contact with on a daily basis. The problem is that immunologists working to understand the biological processes involved in allergic reactions aren’t entirely sure why. Worsening food, skin, insect, drug, and respiratory allergies remain some of the most pressing medical mysteries of the twenty-first century. Why are we all so irritated?"

Some more of what is covered here includes:
• What Allergy Is (and Isn’t)
• Our Allergic World: Measuring the Rise of Allergic Disease
• Allergic Inheritance: Allergies as a “Normal” Immune Response
• Nature Out of Whack
• Are We Doing This to Ourselves? The Modern Lifestyle and Allergy
• Remedies for the Irritated: Allergy Treatments Past, Present, and Future
• The Booming Business of Allergy Treatments
• What Makes a Treatment Effective? Weighing Benefits and Risks
• Allergy Is a Social Problem, Too
• Irritating Ourselves to Death: Allergy in the Time of COVID-19

***********************

I enjoyed this book. It was well-written and presented; for the most part. There unfortunately was a superfluous amount of leftist political rhetoric shoehorned into the book, somehow, however. Thankfully, she kept a bit of a tight leash on it.
I would still recommend this one to anyone interested.
4 stars.

[Kate Laycoax · Rating 2 out of 5]

I really had high expectations for this, because I am so interested in learning more about allergies and not only how they affect us, but how they can be treated in order to live a better life. If you're looking for a book that helps guide you in figuring out how to treat your allergies to live a better life and get healthier, look elsewhere. This is simply a book that details the history of allergies and that is it. I could have gotten this exact info from a Wikipedia page, a condensed and quicker read, rather than a lengthy book that didn't really help me solve anything. One part of the summary says "what that might mean about the fate of humanity in a rapidly changing world", when referring to allergies, but the book actually doesn't give any advice on what to do for allergies, short of a small excerpt about a medication called Dupixent. That is it. I felt like this book was mainly just for the author to work through her own stuff, as the reason why she wrote the book is because someone in her family died from an allergic reaction. I don't really think we needed a whole book on that, especially when we aren't told how we can help ourselves. It's basically just a 300+ page story, with some history thrown in there. I would not spend the money on this book, nor would I recommend it to others.

Thank you to NetGalley and Random House for a digital ARC of this book.

[Zoe · Rating 3 out of 5]

Great info I learned a lot but this book is repetitive. At times I just flipped over the pages because there are so many similar little anecdotes. Get to the point lady!

[Lilisa · Rating 3 out of 5]

Exploring allergies - what causes them, why some get them, how to treat them (which is so challenging), and escalation of new ones that continue to baffle the world. This book runs the gamut and opens up the complex and painstaking art of figuring out how to treat allergies, many of which continue to be tested and solutions found. I felt the first third of the book challenging to get through - it was a bit “ploddy” and dry. Unlike Ed Yong who makes complex information understandable, interesting, and easy to digest, I found my eyes getting crossed here. It got better as the book went on and I started to find my pace and interest growing. I’m glad I stuck with it. Overall, I learned a lot about allergies and how so much is yet a mystery, with no definitive proven direct cause/effect for many cases, but facts pointing to strong causes. Many thanks to the author, publisher, and NetGalley for the opportunity to read and review this book.

[Tara Cignarella · Rating 4 out of 5]

Allergic: Our Irritated Bodies in a Changing World by Theresa MacPhail
Audio Version
Overall Grade: B-
Information: C+
Writing/Organization: B
Narration: B
Best Aspect: Some interesting facts about allergies.
Worst Aspect: Like always the science isn’t complete enough to make allegy issue better and even through there is a lot of info in this it doesn’t change anything for my family.
Recommend: Yes.

[Jennifer Schultz · Rating 4 out of 5]

(First of all--in no way does this indicate that this is a how-to on managing allergies. As the book clearly spells out, that varies significantly between individuals and allergies.)

As someone who has dealt with seasonal allergies since childhood and enjoy medical narratives, this intrigued me right from the start. Starting with her father's surprising death from a bee sting allergy, Theresa MacPhail investigates why allergies have become more widespread, how parents, allergy sufferers, and researchers are desparately trying to find ways to treat or cure allergies (that are not as limiting as food avoidance diets are), and more. Although it is a bit academic at parts, this is a very accessible and eye-opening read.

Many thanks to Random House and NetGalley for a digital review copy in exchange for an honest review.

[Jonna Higgins-Freese · Rating 3 out of 5]

I appreciated that the author was careful not to claim too much, but it felt like maybe this book is premature. The only thing I came away from this book knowing for sure is: allergies are increasing, for humans and their pets, and we don't really understand why.

One thing that was interesting to me: I grew up in Iowa (with outdoor vs. indoor pets) but near cornfields and playing outdoors. My allergies were very sudden onset - basically instant - and debilitating. But that onset occurred while I was living under a freeway in grad school in Boston. And "air pollution can act as a transport mechanism for allergens. Diesel exhaust, so ubiquitous in urban areas, is one of the main culprits." The allergens bind to the diesel particles to move them deep into the lungs (112). Children who lived closer to an interstate at very young ages had higher asthma rates at age 7 than those who lived further away (113)

HEPA filtering likely doesn't help - it increases levels of NO2, and exposure to filtered air plus an allergen produced worse symptoms of respiratory allergy than either the allergen alone, nitrogen dioxide alone, or unfiltered air plus the allergen (114). Once again - we can't protect ourselves individually from *public* health threats, as Sandra Steingraber has so eloquently shown.

More frequently, practitioners make little distinction between "allergic asthma and other forms, like exercise-induced asthma, since most asthma patients also have allergies and are triggered by a variety of environmental irritants" (117)

Nearly every botanist becomes allergic to something at some point in their careers, "since they are encountering the same pollen at greater levels than they would outside the research laboratory, and more frequently, their immune systems have more opportunities - and incentive - to respond negatively" (123)

Hay fever increases when the timing of spring changes (123)

poison ivy is dramatically more common now than it used to be due to climate change (124) - and some such plants love the additional carbon dioxide and nitrogen released by burning fossil fuels.

Might have something to do with Vitamin D, but might not.

Alpha-gal allergy - becoming allergic to red meat due to the combination of a tick and its saliva!

Honestly, at the end of the book, I still don't understand the difference between allergy, some other word she keeps using, and autoimmune responses. And I pay pretty close attention when I read. And although throughout the book she kept saying, "well, it might be this (diesel exhaust), but . . . so we really don't know," at the end she suddenly gets very sweeping: "the stark truth is that our overworked immune systems aren't faring well in the twenty-first century. A decrease in overall air quality around the globe - from increased air pollution to higher pollen counts - is slowly making it harder for all of us to breathe. But it's not just climate change and our relationship to our natural environment that may doom us; it's everything about how we live now." (Really? After saying the whole book "it might be this, but maybe not, we don't know"?). "Changes in food production and diets, along with increased reliance on antibiotics, are contributing to higher rates of allergy everywhere. New chemical and industural products are making our skin more irritated. Everything we've been doing for the last two hundred years (as the new alpha-gal allergy attests) is irritating us -- slowly, imperceptibly, constantly" (287-288). I just didn't feel she'd earned this.

For example - she says alpha-gal "illustrates how allergy causation is a blend of our immune reactions, climate change, man-made ecological changes to our natural environments, and our lifestyles." But that's a pretty tall order. It's caused when a person is bitten by a tick, whose saliva is irritating, and if the tick's last meal was a mammal, the sugar molecule galactose-a-a, 1,3 galactose) can become associated in the immune system's mind with that irritation, leading to the allergy. (Which _is_ unusual in that it is a sugar, not a protein, as most allergens are, and that it, like eosinphilic esophagitis (EOE) is not mediated by IgE antibody reactions like most allergies).

Lone start ticks being pushed north due to expansion of fire ants, b/c of climate change, which prey on ticks and "various other ecological shifts" (164)

discovered when cancer patients had allergeic reactions on first administration of new drug cetuximab. Turned out that those who reacted already had antibodies - most lived in central TN, one in TX, none in Boston. "so it had nothing to do with cancer, or taking the drug alone, and everything to do with living in central TN" (165)

So if the range of ticks is expanding due to climate change, fine. But that doesn't explain why they weren't giving alpha-gal allergies to people in the places where they _used_ to live (167). Though they do say there's been an explosion of deer and wild turkey populations, which are common hosts. "There's probably more white-tailed deer in the US today than there were back before the colonists started wiping out the deer population" (167). 12 deer in CT in 1896. Humans don't have alpha gal in our bodies, so we can make antibodies to it in our guts.

BUT: "Even someone without meat allergy will produce antibodies to alpha-gal when they consume meat. But -- and this is a big but -- not everyone will make alpha -gal antibodies after a lone star tick bite. And even when someone makes the antibody, they won't necessarily have a negative immune response. Some will and some won't. . . . the presence of the antibody for alpha-gal in the general population is about one in five. But the disease only happens in a fraction of that population. . .. In Australia, where they also have alpha-gal allergy, the same tick that causes alpha-gal can also cause anaphylaxis. But it doesn't cause anaphylactic responses here in the US."

But then "Tom thinks the key to understanding why lies in understanding the composition of the saliva of the tick itself. It's the tick plus its saliva that is likely triggering the allergic response. In other words, adding a tick bite before the consumption of red meat is the magic ingredient that produces meat allergy" (169). But she already said that. And it doesn't actually address what she said in the previous paragraph: why Australian alpha-gal allergy produces anaphylaxis but the US based one doesn't.

[Alyssa McKendry · Rating 4 out of 5]

Solid overview of allergies from the time they were initially first discovered and seen as a real health issue until now.

I learned from this book that we really don’t know much about allergies at all. Even the top experts have a lot of trouble figuring out why our bodies and immune systems behave the way they do when in contact with certain allergens. Physically, they have a good understanding of what’s happening inside the body when our body comes in contact with something it deems harmful, but the question still stands as to “why?” and “how can we stop this from happening?”

We don’t really have a solid plan to fix the rise in allergies in the 21st century either, it’s more guesswork and testing for possible solutions/treatments. I guess I was unrealistically hoping for more answers in this book as to why we react the way we do to allergens that we are particularly sensitive to, but that goes to show that science is always evolving and the answers are not always clear, especially on a topic as broad as allergies across the globe.

Very interesting book and I definitely did gain some good, new insights from reading this!

[Sarah · Rating 5 out of 5]

I really enjoyed this book! I knew very little about allergies going in, and I appreciated the holistic approach MacPhail took, covering the biological mechanisms behind allergies, experiences of allergy sufferers/parents of affected children, social perception of allergies, history of how allergies were discovered and treated, theories around why allergies are getting more widespread every year, pharmaceutical research in the allergy space, and ethical questions about who gets access to allergy care. The book has an especially personal touch because the author’s father died of an allergic reaction to a bee sting. This was really comprehensive, really interesting, and a worthwhile read! I learned a lot and was engaged throughout.

[Bethany DeHaven · Rating 4 out of 5]

Nonfiction is not my strong suit but this was worth the effort. I learned a lot about my own allergies (& how they are connected to each other), as well as political, environmental, and financial factors that impact allergies and their management. If you feel like your allergies are getting worse or that allergies are getting more common, it's because they are. I'm walking away from this book with an increased dedication to environmental advocacy, a better understanding of myself and my loved ones, and more reasons to despise the pharmaceutical industry

[Peter Chung · Rating 5 out of 5]

An amazing and well researched book. Interesting throughout with a mix of amazing asides (political immunity predates medical immunity) while staying focused. The medical anthropology done in this book is outstanding and involved research with dozens if not hundreds of people. My understanding of allergies has expanded as well as my knowledge of treatments. Allergies are extremely complicated and overlooked. I’d recommend this book to anyone.

[Alex · Rating 5 out of 5]

I loved this. reinforced my passion for allergy and definitely gave me a tonnn more allergic dilemmas & innovations to think about. I appreciated the parallel that was drawn between COVID and the rise of allergy, about both being a social issue just as much as a biological one!

[Sarah · Rating 5 out of 5]

Audible version, narrated by Jaime Lamchick.

I really enjoyed this, even if it was slightly disheartening that we don’t have answers or solutions to our allergy woes yet.

Her suggestions, avoiding “over cleaning” (especially with antibacterial cleaners), protecting our microbiomes and avoiding synthetic chemicals in our food and on our skin, are already things I try to do. But it’s nice to feel like I’m on the right track, despite the fact that my seasonal allergies are currently in full swing.

I did feel like this helped me feel informed about things that likely WON’T help (or haven’t been proven to do so yet), such as those mail in food allergy tests, probiotic pills and (sadly) allergy shots for seasonal allergies.

Overall I really enjoyed this book! I wish it had solutions to offer, but hey, if they don’t exist yet that’s not on the author. Great read!

[Tutankhamun18 · Rating 4 out of 5]

This is a well written journey into the medicine and history and sociopolitical context of allergies. We start of by learning about the difference between an allergy, a sensitivity, an intolerance and an autoimmune disorder.

We learn that humans have an innate immune system, fully functional from birth that gives us a nonspecific form of defense against foreign bodies (mucus membranes and skin are part of this - the inside and outside linings of your body- and mast cells and bastcells) and an adaptive immune system, which includes T cells that remember previous encounters with similar organisms. T cells become memory T cells after a successful encounter and activate B lymphocytes, which in turn release large amounts of antibodies into our blood. These y shaped proteins neutralise foreign bodies like viruses and bacteria. Antibodies attach themselves to foreign bodies to prevent them from being able to attach to or penetrate our cell walls and can also activate our immune system and promoting an immune response. Antibodies exist in 5 types: IgM, IgD, IgG, IgA and IgE.

* type I hypersensitivities = IgE
* Type II &III hypersensitive immune responses (lupus and rheumatoid artheritis) = IgG

„A genetic predisposition to IgE sensitization to allergend in the environment is called an atopy.“

IgE is the only antibody known to regularly bind to allergens to begin an immune response. IgE antibodies are primarily responsible for binding to parasites like intestinal worms, but in an allergic reaction, they trigger your mast cells and basophils (the other first responders) to release histamine and other compounds that then cause inflammation and all of the symptoms you typically associate with your allergy.
Atopic, or allergy-prone, people tend to have not only higher levels of IgE but also more receptors for IgE on their mast cells, which is likely part of the reason they are more sensitive to things in their environments in the first place and tend to develop allergic responses to multiple allergens.

„But in essence, and for all practical purposes, the term allergy" in the twenty-first century has come to mean any negative immune reaction driven by IgE antibodies. The presence of IgE in response to an exposure to an antigen has become the standard of measurement and confirmation for what is known as a Type I hypersensitivity or "allergy. - Using the presence or absence of IgE antibodies alone to categorize an allergy quickly becomes problematic if a patient has low levels of the antibody to begin with.“

*„If your body's immune system responds to an exposure to an antigen of al-lergen, then you have an allergy. Typically, that will usually mean that you also have an IgE response, but not necessarily. What's more important is that your immune system has a hyperactive response to an otherwise harmless substance. If you have symptoms similar to a food allergy, but they are being caused by some bodily system, condition, or mechanism other than the immune system itself, then you have an intolerance (which, to be perfectly clear, is not an allergy). If you develop a localized wheal reaction to a skin-prick test (which we'll explore more in chapter 2) but don't experience allergic symptoms when exposed to that allergen, then you have a sensitivity, not an allergy.“*

Then we learn about ways to test for allergies and that as you digest food in your stomach, a small amount of the proteins passes through the gut barrier and triggers our antibodies. Therefore, your blood will contain some IgG antigens against every food you have recently consumed and thus
IgG blood tests are a bad test of food allergies. There is zero evidence that IgG triggers any negative effects in the body and in fact if your body stops producing those IgGs as you are avoiding a food, you could become allergic in the future.

Next the author takes us through three theories as to why the incidence of allergies seems to be on the rise: 1) a natural immune response to potential dangers (expell toxins and carcinogens and potentially lower rates of cancer) or a gene that codes for certain allergies also codes for other brain functions such as peanut allergy and memory having a link in mice (inhibits IL 4 protein inhibtior = no peanut allergy and forgetful), but which cannot keep up with the changing human environment. 2) climate change and environmental changes (average pollen load in air (controlled by temperature) , air quality and indirect effects of CC such as mold spores) and also pollen interacting with diesel exhaust molecules to hitch a ride into your lungs. 3)Modern lifestyle; hygenie hypothesis, loss of fibre and gain of very processed foods alters gut bacteria, very close to dust mites in our sofa and bed all the time, stress (release of cortisol and adrenaline) and immune system. For example, mast cells are very sensitive to CRF1 (corticotropin-releasing factor and in mice, less CRF1 caused 54% reduction in allergic disease.

In the final section she goes into treatments that are available at the moment and historically. This was the least interesting part to me, as my personal interest was about what could be causing the increased rates of allergies, but I did also think this section was well done. I like how the author had three “case studies” of people with an allergy and then talked about how they would have been treated pre 1900 vs. today. Her final chapter on the social stigma of allergies where she talked about a woman being embarassed for asking people to not serve/ eat peanuts on a plane tide with her was VERY interesting and called me out, because I have NEVER thought about that before.

I liked that the author mentioned some intersections of class and race and privilege when it comes to allergy awareness and allergy care.

[Alyssa Harvie · Rating 5 out of 5]

This was a fascinating deep dive into allergies! The book covers the mechanics behind what an allergy actually is and isn't, its history, treatments, and theories about why allergies are on the rise globally. I learned so much and found it very engaging. The author does a great job of finding a nuanced and balanced approach to explaining why allergy ails us in our current lifestyles. Highly recommend to everyone, as we all either suffer from allergies, know someone who does, or will have family members who deal with them in the future. Thanks so much to Random House for the advance digital copy in exchange for an honest review!

[Jenna · Rating 3 out of 5]

There’s nothing inherently wrong with this book, but it did drag quite a bit for me. Also a writing pet peeve of mine is when an author tells me I need to wait til an upcoming chapter for a deeper dive “I’ll cover more of this in chapter five…” kind of thing. Bold to assume I will remember every minute detail of your current argument by the time I reach chapter five. I did learn a lot, but I felt like I really had to work for it.

[Abby · Rating 3 out of 5]

A comprehensive overview of our current understanding of why so many of us have allergies. Big takeaways for me: (1) We don't really know anything about how to prevent allergies, so don't freak out, (2) avoid antibiotics as much as you can, especially for small children (which feels almost impossible), and (3) keep eating diverse diets rich in whole foods and nutrients.

[Rachel Mansfield · Rating 2 out of 5]

I only read part of this but I'm not wasting any more time reading it. This is not a generally helpful book either to understand allergies or to help someone suffering from allergies. The author does not report in a clear way, nor does she seem to be able to appropriately synthesize information. My two cents based on not reading the whole thing.

[Cindy · Rating 3 out of 5]

Covering allergies and how the immune system goes awry for a general audience is challenging. MacPhail does a decent job of balancing the technical aspects with a better broad understanding, with engaging writing and interesting experts. She excels and explaining and demonstrating just how complex a topic this is, and its impact on individuals, families, and society. I am on board with her central theses: how individual and complicated treating allergies can be, and the many complex causes for the increase in allergy sufferers.

Obviously this book isn't meant to be a comprehensive treatment, but I was surprised by a few omissions and choices of emphasis.

The first is the almost-omission of Xolair in favor of a lengthy discussion of Dupixent as biologic treatments. Xolair is the older of the two, and straight-up targets IgE antibodies. Dupixent is approved to treat a wider variety of conditions and is possibly more effective, however I would have expected a bit of discussion to that effect. I suspect it was because she ended up getting interviews with Sanofi/Regeneron.

Then I was disappointed that most of the book looks at food allergies and/or eczema, with a dash of allergic rhinitis. Really, there's just some minimal discussion of asthma. I understand her point of food allergies being deadly, and atopic dermatitis being a larger and life-impacting condition. However, asthma can also be deadly.

Finally, I was most concerned by the the last confusion/omission - MacPhail discusses at length oral immunotherapy for food allergies, however she doesn't make the important distinction between this and sublingual immunotherapy given as an alternative to allergy shots. A couple of times I was scratching my head because I think readers might end up being confused by the difference. In addition, there was no discussion of the controversy and differing opinions on sublingual immunotherapy vs subcutaneous immunotherapy (SLIT vs SCIT). I would have loved to read more on efficacy, treatment, etc. My understanding is that there is quite a divide in the allergy world with these two treatments, as well as the difference between seeing an allergist, and ENT, and a pulmonologist, all of whom have administered different allergy therapies to me over the years.

[Adam K · Rating 4 out of 5]

As a lifelong sufferer of seasonal and environmental allergies, I was very keen to see what this book had to say on the topic. The information floating around public circles is confusion and often contradictory, so I was hoping for some authoritative and well-researched data to ground the rumors.

Theresa MacPhail breaks the book into three sections, each dealing with a different aspect of allergies: diagnosis, theories, and treatments. Each section provides us with a history lesson of where we came from before providing an overview of where we are now. For example, we learn about the "discovery" of anaphylactic shock and the eventual acceptance that allergies are caused by the normal processes of our immune system. Because of the way she structured her book, there is a bit of repetition and overlap, but it wasn't to the point of distraction.

Unfortunately, the public has a lot of cause to be confused about allergies--there is still a great deal humans do not yet understand about how our immune system works. Finding effective treatments and/or cures for something as complex and nuanced as "allergy" is borderline impossible with our current knowledge and technology. This book does not provide any easy answers, but it does give a good overview of what research has and is being done in relation to the increasing number of allergy sufferers around the world. Even for those longtime allergy sufferers who have done their own research into the subject will likely find some new information, perspectives, or ideas here.

It's interesting how closely this book ties in with some others I have read lately about climate change and other contemporary issues we face as a species. It serves as a reminder that everything is connected in some way and, though we may find it easier to zoom-in on individual problems, it is important to be conscious of the larger picture lest we miss something gravely important.