Matthew Smith. Another Person's Poison: A History of Food Allergy. Arts and Traditions of the Table: Perspectives on Culinary History Series. New York: Columbia University Press, 2015. xii + 290 pp. $29.95 (cloth), ISBN 978-0-231-16484-9.
Reviewed by Kendra Smith-Howard (University at Albany-SUNY)
Published on H-Sci-Med-Tech (May, 2016)
Commissioned by Ashton W. Merck
In Another Person’s Poison, Matthew Smith seeks to explain why and when food allergy became considered a serious condition, and how competing definitions of food allergy and the means of diagnosing it sparked controversies within the medical community.
Smith makes it easy for readers to understand the assumptions and actions of medical practitioners who approached food allergy very differently. Orthodox allergists, he explains, defined allergy narrowly, to only include instances that generated an immune response, such as an immediate, anaphylactic reaction. Hence, they saw food allergy as a rare condition. Food allergists, and especially clinical ecologists, rejected a narrow focus on hypersensitive acute reactions. Drawing on Clemens von Pirquet’s term “allergy” to describe “any form of altered biological reactivity,” they interpreted a broader array of conditions as results of food allergies, including headaches or inflammation that developed long after a food was eaten. Whereas orthodox allergists relied on skin testing or, after 1966, laboratory tests for elevated levels of IgE (immunoglobulin E) to identify the presence of allergy, food allergists and clinical ecologists relied more heavily on patient testimony, inductive reasoning, and elimination diets to identify and control allergic reactions. While conflicting definitions for food allergy had been articulated by 1906, fault lines between these positions intensified across the twentieth century, as food allergists such as Theron Randolph widened their scope to examine the effects of food additives and processed foods on chronic health conditions while orthodox allergists maintained a focus on immunological response.
Smith positions his study relative to other histories of medicine. He notes that the intense conflicts over food allergy derived, at least in part, from allergists’ marginal status among physicians more generally. He emphasizes the parallels with psychiatry, which also struggled with professional legitimacy. Orthodox allergists, concerned that food allergists’ approach relied too heavily on collaborative relationships with patients and not enough on precise scientific pathways, were especially reluctant to wed the subfield of allergy medicine to clinically focused practitioners. The orthodox allergists’ misgivings intensified as concerns about food additives in the popular culture mounted, and clinical ecologists who had long carefully recorded patients’ concerns and exposures to specific potential allergens were joined by more questionable practitioners who peddled cytotoxic tests directly to unsuspecting patients as money-making ventures. Orthodox allergists lumped these unsavory practitioners with clinical ecologists more generally. Hence, practitioners who held a more expansive view of food allergy found themselves ostracized from the medical community, identified in medical journals as quacks, and subject to review and condemnation by the American Academy of Allergy (AAA).
In the introduction to the work, Smith explicitly sets out to steer a middle course, contrasting his approach to recent works on the history of allergy, such as Gregg Mitman’s Breathing Space (2007), which privilege the ecological causes of allergy. Despite his aim for evenhandedness, Smith is not easy on orthodox allergists. He exposes the AAA’s heavy-handed tactics against clinically oriented practitioners, and notes how the orthodox allergists’ narrow focus on skin tests was dismissive or ineffective at addressing patients’ complaints.
Smith’s book might carry broader implications were he to consider the history of food allergy not simply in the context of the history of medicine, but also relative to histories of food, business, and gender. Historians of food and foodways have tended to pay more attention to the writings of nutritionists and reformers like Sylvester Graham than to allergists profiled here who urged the adoption of elimination diets. How might incorporating these physicians’ perspectives into food history alter our understanding of the ways in which food science is conveyed, and in particular, the ways in which foods were given scientific legitimacy or professional authority? Did the long history of lay food reform, or the placement of nutritionists in schools of home economics, contribute to orthodox allergists’ misgivings about the use of elimination diets by Drs. Albert Rowe, Arthur Coca, or Ben Feingold?
The author does much more to consider the ramifications of the rise of food allergy on the field of medicine than its implications for the food business. While the author touches on the peanut industry in the last chapter, this topic alone could be fodder for further research. Smith indicates that the food allergy advocacy group Food Allergy Network (FAN) received support from the industry-sponsored International Life Sciences Institute (ISLI) and partnered with the industry-sponsored International Food Information Council in publishing informational pamphlets about food allergy, but these connections are only the tip of the iceberg. How has the food industry responded and reacted to labeling requirements and its foods being identified as dangerous? What impact did food allergies have on peanut growers, and how did the agricultural industry respond? How did manufacturers push back against labeling laws? Future scholarship might examine food allergy and business more fully, drawing on the work of those who have documented the cranberry industry’s response to pesticide testing, the apple industry’s organized response to concerns about alar, or even the cigarette industry’s efforts to defend tobacco against public health. A comprehensive look at the businesses that capitalized on food allergy, such as Ditex Oat Crisps, Allerteen, Mull-Soy, and Ry-Krisps, that Smith mentions and the gluten-free concoctions of today would be illuminating as well.
Finally, Smith convincingly explains that one of the key distinctions between the diagnostic process of orthodox allergists and their clinically minded peers was that the latter relied heavily on patient testimony and experience to diagnose and treat allergy. The former, Smith writes, often viewed food allergy patients as “hypochondriacs” (p. 87). This language, combined with the fact that many of the most concerned parties about food allergy were parentsconcerned about their children’s health, at a time when women shouldered a disproportionate burden of child care, made me wish that Smith had done more to probe the gender dynamics of food allergy diagnosis and patient-practitioner relations. Perhaps orthodox allergists’ fierce suspicion of clinical allergy may have stemmed at least in part from clinical allergists’ willingness to work closely with women patients as it did from the distinction between inductive and deductive reasoning.
Another Person’s Poison is a focused, well-researched book that clarifies the origins of allergy as a medical specialty and food allergy within that specialty. It traces the tensions between orthodox and clinical practitioners, offering full and multidimensional portraits of practitioners in both camps. There is no doubt that it will stand as a definitive text on the history of food allergy for some time to come. But just as food allergy is complex and multifaceted, so is its history. This insightful monograph should inspire a host of other scholars to examine the issues Smith raises from a wider breadth of perspectives.
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Kendra Smith-Howard. Review of Smith, Matthew, Another Person's Poison: A History of Food Allergy.
H-Sci-Med-Tech, H-Net Reviews.
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