Lehigh County Health & Medicine Spring 2020 - 7

L C M E D S O C .O R G

sthma is a very ancient disease.
A major breakthrough came during the was my attendance at that clinic during a
It was first described by Hippo- 1870s in England when Charles Blackley pulmonary rotation where I first became
crates in the 5th Century B.C. deliberately provoked symptoms of hay interested and inspired to become an alHe also believed that conditions fever by self exposure to various pollens. lergist. Allergy treatment has come a long
existed where phlegm which originated in He observed that dust stirred up by a way since all we had at first was the use of
the brain flowed down to the lung via the passing carriage produced symptoms and small doses of allergic material to immunize
nose. At the time of Julius Caesar in the that a sample of the dust contained grass or build protective antibodies for allergy
1st Century B.C., a Roman scholar wrote pollen. He then applied pollen to his patients in 1911. The use of nebulized
that very small animals grow in damp nose, eyes, tongue, lips and throat and solutions did not occur until the late 1940s.
places, so tiny that they cannot be seen by inhaled the pollen through his nose and At that time a glass bulb with a rubber
the eye; floating in the air that we breathe, mouth. He also invented five devices for squeeze bulb to atomize the material was
they pass through the nose and mouth into measuring pollens in the atmosphere and used to administer isoproterenol. The use
the body where they give rise to serious was able to study the effects of sunshine, of corticosteroids in asthma did not occur
diseases. Celsus defined asthma as the rain, wind and humidity on the amount until the 1950's. It was soon discovered that
inability to breathe without making noise. of pollen in the atmosphere. By the end of overuse of this drug could result in side
In the year 400 A.D., one of the Roman the 19th Century it was established that effects such as diabetes, hypertension and
physicians stated that asthma should be pollen was the cause of seasonal catarrh, obesity. No further major advances remain
treated by stays at the seaside. We now although not until the 20th Century was it until the introduction of a combination
know that there is less mold in the air when realized that mechanism was immunological of bronchodilator with inhaled steroids
at the beach since sand doesn't support the rather than toxic. Dr. Henry Salter in 1860 in 2001. This occurred shortly before the
growth of mold. Ancient Romans also appreciated the hereditary nature and the tragedy in New York on 9/11/2001.
described food allergy with the following fact that there were many triggers for this
sentence: "What is normal food for some such as exposure to horses, cats and other
Monoclonal antibodies for the treatment
can be deadly poison for others."
animals. The first allergy immunotherapy of asthma occurred around 2003. Since then
was started in London in 1911. The first four other monoclonal antibodies have been
The ancient Pharaoh Menes, who died scratch test was described in 1912. In 1908 invented which have a beneficial effect on
in the year 2641 B.C. after the sting of a the skin was tested by intracutaneous or asthma. These must be injected at regular
wasp, was regarded as the first documented intradermal injections and in 1930 by a intervals and are extremely effective for
case of anaphylaxis. A famous Middle puncture test which was a precursor of patients' not responding to more simpler
Ages physician known as Maimonides the prick test. Prick tests have been used techniques of bronchodilation. Lastly, we
became the personal physician to the since 1959. In 1915 a young physician are still using hyposensitization which
Sultan Saladin (1135 to 1204). He wrote from Holmdel, NJ named Robert Cooke was invented in 1911 to decrease patients
a thesis on asthma and presented a concept (1880-1960) went to New York to study reactivity to allergic phenomenon in the air.
for treatment which included relaxation, and had to drive horse-drawn ambulances. This is extremely important as it alters the
personal hygiene, avoidance of noxious He became allergic to the horses and after cause of allergic rhinitis and asthma together.
environmental influences, avoidance of that became interested in other allergic
opiates (which we now know cause direct diseases. The term atopy was started by
If you are not responding to medications
histamine release) and intoxicating drugs. Dr. Arthur Coca and Dr. Robert Cooke.
alone or have intolerable side effects to
He recommended that asthmatics avoid
the medications, whether for asthma or
poultry, milk and nuts, while he allowed
Drs. Coca and Cooke founded the first allergic rhinitis, then it is time to consult
salad, cauliflower and eggplant. He also Allergy Clinic at New York Hospital in an allergist.
wrote that the disorder known as asthma February of 1919. It served as an outpaoften starts with the common cold, espe- tient service for the treatment of allergic
cially in the rainy season, and the patient individuals and also a center for research
is forced to gasp for breath day and night. and training for allergists. Ironically, Dr.
Cooke grew up in Holmdel, 3 miles down
There were no further advancements until the road from where I grew up in a little
the 1870s when Dr. Paul Ehrlich discovered town called Lincroft. In another ironic
mast cells, basaophils and eosinophils in twist of fate, one of Dr. Cooke's students
the tissues associated with pollen exposure. was a young man from upstate New York
The phrase catarrh and asthma was described by the name of Dr. William Woodin. Dr.
by Dr. William Heberden as early as 1802. Woodin established the Allergy Clinic at
Upstate Medical Center in Syracuse. It
SPRING 2020 | Lehigh County Health & Medicine 7

http://www.LCMEDSOC.ORG

Lehigh County Health & Medicine Spring 2020

Table of Contents for the Digital Edition of Lehigh County Health & Medicine Spring 2020