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Fiftieth anniversary of allergy
Editorial FIFTIETH
ANNlVERSARY
T
OF ALLERGY
HE fiftieth anniversary of Clemens von Pirquet’s classic paper suggest,& the word acllergy to denote the altered reactivity of living organisms to infective and antigenic agents presents an occasion to evaluate the progress that has been made in this field of knowledge. Although several of the phenomena included in the concept of allergy were already recognized in 1906 as anaphylaxis, the. Arthus phenomenon, serum sickness, and the Koch reaction, the formulation of the association between them was a brilliant contribution to the study of disease. The foresight of von Pirquet has been amply confirmed by subsequent studies, such as those by Landsteiner and Chase clarifying the relationship between the immediate and delayed types of reaction. Meanwhile, the application of the idea of allergy has supplied the key to the pathogenesis of many types of disease. Progress in this line of investigation is still continuing in the study of periarteritis nodosa, rheumatic fever, glomerular nephritis, and other conditions of obscure etiology. In chronic infections of known etiology, many pathologic features have been shown to result from allergy to the infective agent. Unlike many scientists, von Pirquet was equally adept in semantics. His word allergy has proved as popular and useful as the idea it was coined to denote. Despite the critics who have suggested that it was superfluous or inexact in meaning, its simplicity and euphony have made it familiar in many languages to denote not only the biologic phenomenon, but also the growing field of medical practice in which the concept is applied. After fifty years of vigorous growth, there is little doubt that both t,he thought and t.he. word are here to stay. Allergy has proved an important approach to the treatment of disease, and has contributed to the health and well-being of millions of patients. A tremendous amount of technical detail important for its practical application has been accumulated. The pathogenesis of allergic diseases has been approached with immunologic, chemical, physiologic, and genetic methods, and many important principles have been established. To one imbued with the discipline of allergy, the volume of accumulated knowledge may seem overwhelming. However, a few apt questions from an active mind which is not trained in our doctrines suffice to show that there. are tremendous gaps in our understanding of the basic whys and wherefores of allergy. Even in clinical 384
EDITORIAL
385
problems, such as the relation of infection to the common allergic diseases, and in practical methods of diagnosis and treatment, there is no unanimity among the many workers in the field. If allergy is to progress in the next fifty years as it has in the past, much careful study is needed, both in the basic sciences and in medical pract,ice. New approaches by alert investigators, unbound by tradition, must not only extend our knowledge in fresh directions, but also re-examine the evidence behind longestablished principles. It is encouraging that the American Foundation for Allergic Diseases and the National Institute. of Allergy and Infectious Diseases stand ready to back such endeavors. The greatest need now is for well-trained investigators with new ideas and t,he energy to pursue them.
ANNlVERSARY
T
OF ALLERGY
HE fiftieth anniversary of Clemens von Pirquet’s classic paper suggest,& the word acllergy to denote the altered reactivity of living organisms to infective and antigenic agents presents an occasion to evaluate the progress that has been made in this field of knowledge. Although several of the phenomena included in the concept of allergy were already recognized in 1906 as anaphylaxis, the. Arthus phenomenon, serum sickness, and the Koch reaction, the formulation of the association between them was a brilliant contribution to the study of disease. The foresight of von Pirquet has been amply confirmed by subsequent studies, such as those by Landsteiner and Chase clarifying the relationship between the immediate and delayed types of reaction. Meanwhile, the application of the idea of allergy has supplied the key to the pathogenesis of many types of disease. Progress in this line of investigation is still continuing in the study of periarteritis nodosa, rheumatic fever, glomerular nephritis, and other conditions of obscure etiology. In chronic infections of known etiology, many pathologic features have been shown to result from allergy to the infective agent. Unlike many scientists, von Pirquet was equally adept in semantics. His word allergy has proved as popular and useful as the idea it was coined to denote. Despite the critics who have suggested that it was superfluous or inexact in meaning, its simplicity and euphony have made it familiar in many languages to denote not only the biologic phenomenon, but also the growing field of medical practice in which the concept is applied. After fifty years of vigorous growth, there is little doubt that both t,he thought and t.he. word are here to stay. Allergy has proved an important approach to the treatment of disease, and has contributed to the health and well-being of millions of patients. A tremendous amount of technical detail important for its practical application has been accumulated. The pathogenesis of allergic diseases has been approached with immunologic, chemical, physiologic, and genetic methods, and many important principles have been established. To one imbued with the discipline of allergy, the volume of accumulated knowledge may seem overwhelming. However, a few apt questions from an active mind which is not trained in our doctrines suffice to show that there. are tremendous gaps in our understanding of the basic whys and wherefores of allergy. Even in clinical 384
EDITORIAL
385
problems, such as the relation of infection to the common allergic diseases, and in practical methods of diagnosis and treatment, there is no unanimity among the many workers in the field. If allergy is to progress in the next fifty years as it has in the past, much careful study is needed, both in the basic sciences and in medical pract,ice. New approaches by alert investigators, unbound by tradition, must not only extend our knowledge in fresh directions, but also re-examine the evidence behind longestablished principles. It is encouraging that the American Foundation for Allergic Diseases and the National Institute. of Allergy and Infectious Diseases stand ready to back such endeavors. The greatest need now is for well-trained investigators with new ideas and t,he energy to pursue them.