In my last entry, I mentioned I had read an article in the June issue of the JACI "The Allergy Archives--Pioneers and Milestones" entitled "Food Allergens:  Landmarks along a historic trail" by Sheldon Cohen, MD".  It's a good article,  and I recommend  reading it.  But, while reading it I kept coming to an image:  the image of a man vainly searching in the dark, looking at the ground, in a parking lot.  He would look under one parking light, and then the next.  When a stranger came up and approached him and asked what he was doing, he said "I'm looking for my car keys...I dropped them".  The stranger asked why he was only looking under the lights.  "Because that's where I can see the best", he said. 

We all like to "look under the lights" when we are searching for something valuable.  But sometimes remembering that valuable things aren't just what can be seen easily under the lights is worthwhile too. 

As I had said last time, there were two great men highlighted in the article by Cohen.  One was Walter Vaughan, and the other was Oscar  M . Schloss, M.D.   As I've said before, to get your picture published in the JACI you generally (1) have to be dead and (2) have made a VERY valuable contribution to the allergy field.  I talked about Vaughan in my last entry, so let's talk about Schloss...

Cohen points out in his article that Schloss held the positions of professor and chairman in the Departments of Pediatrics at Cornell Medical College and at Harvard.  As noted by Cohen: 

"In 1912, the controlled, in depth study of Oscar Schloss established the practicability of scratch tests for clinical hypersensitivity". 

Pretty impressive.  But did Schloss do anything else equally impressive?  In the interim since my last blog, I was curious enough about Vaughan's works to order a rare first edition of his work, "Strange Malady, the Story of Allergy", published 67 years ago, in 1941.  In a moment of rare inspiration, I checked the index to find whether his contemporary, Dr. Schloss, was mentioned. 

                                           Indeed, he was....

Here's what Warren Vaughan says about Dr. Schloss (missing from the JACI article):

A child was brought to Dr. Oscar Schloss, a New York pediatrist.  There was a most unusual story of idiosyncrasy.  The lad had had diarrhea when ten days old and was treated with barley water and raw egg white.  This relieved the complaint and caused no unpleasant symptoms.  He received no more egg until he was fourteen months old.  Almost immediately after eating part of a soft-boiled egg he cried out, clawed at his mouth, and his tongue and mouth swelled until they were many times normal size.  Hives soon appeared around the mouth...When the boy was two years old his mother noticed that if he were to play with empty eggshells he would break out with hives on his hands and arms.  Schloss suggested that the boy's experience might be due to this new condition, recently receiving so much attention, called allergy....He injected the boys blood into a guinea pig.  Later he injected egg white.  The animal had typical shock...

 ...He mixed the white of a raw egg with water and diluted it so many times that you would scarcely have thought there was any egg left.  He fed this to the boy with a medicine dropper.  Nothing happened.  He kept on giving this curious medicine every day, increasing the number of drops each time and gradually increasing the strength of the solution...He finally increased the tolerance to such an extent that the lad could eat eggs in moderation with no consequent discomfort....Here again was something well worth telling to the world  Schloss published his report in 1912.

...Two methods of desensitization were now available--hypodermic and oral.  We use both today..." 
    

So, in 4 years, we'll be celebrating the 100th anniversary of successfully documented sublingual food desensitization.  Schloss published his findings, entitled "A Case of Allergy to Common Foods", in Am J Dis Child 3:341, 1912. 
Sounds like a landmark to me.  And hidden away in a forgotten allergy textbook by Warren Vaughan for decades..But was Schloss the first one?  According to Lisa Lundy, in her superb review paper entitled  "Historical background of food allergy", she writes that

A physician in England, Dr. Alfred Schofield, wrote in 1908 about successfully treating a boy who suffered from angioedema and asthma because of an allergy to eggs.  (Schofield, Alfred:  A Case of Egg Poisoning, Lancet, p. 716, 1908).  This egg desensitization was confirmed by Drs. Keston, Walters, and Hopkins (Keston, B, Walters, I, Gardner, J:  Oral Desensitization to common foods.  J Allergy 6:431, 1935). 

.So SLIT for foods was documented by multiple doctors  at the turn of the 20th century, nearly 100 years ago. But Schloss deserves a major credit nonetheless.   Can we learn something from the classical literature?  You bet.  Schloss used a serial dilution technique for successful desensitization in a patient highly allergic to eggs...Seems to me that's important....We can also learn that we all have a bit of arrogance in "modern allergy" in "copping an attitude" that everything worth knowing in the field has been published within the last 10 years (or mentioned in the latest CME exercise we did...)   

...Open-mindedness and an obsessive sense of curiosity is  a hallmark of the Renaissance Allergist.  As Renaissance Allergists, we're interested in looking not just "under the lights" of our accepted (and preconceived) notions that SLIT for foods is a "new" idea and "new" treatment, never tried before. We look everywhere...whether it's under a light or not.  An interest in classical allergy literature pays many dividends for the Renaissance Allergist.  Here's one more.    

Later, Dude.