One of the truly nice things about a blog is the truly remarkable people that you can meet...Dr. Clifton Meador dropped by and mentioned I might like his book, "Symptoms of Unknown Origin". 

How right he was... 

I've been slowly reading it, kind of like sipping a fine glass of wine...savoring a chapter or so every few days...and afraid I'll come to the end of it too soon.  Every allergist should read this book.  Although an endocrinologist by training, Dr. Meador's insights reasonate with me.  In the next few blogs, I'll sermonize on various aspects of his book, but let's just take a few excerpts for starters"

"Scientific reduction is not the same process as clinical medicine...It is the sheer scientific power of the biomolecular model that has blinded so many as to its clinical limitations and restrictions...The biomolecular model is so pervasive that unless one can posit a possible molecular explanation for a phenomenon, the subject is excluded from research.  In other words, until the molecular basis is known, no phenomenon exists..."

Note to allergists:  replace the words "biomolecular model" with "IgE immunological model", and re-read the above paragraph. 

What "nonphenomena" exist in the allergy world today?  Many.  Here are just two examples (among many):

1.  What is the clinical significance of the late phase skin test reaction?  This is a phenomenon I see every day.  Most allergists ignore it because it doesn't fit into a nice "IgE model" of illness.  Since we don't understand it, it doesn't exist.  So it's not something to talk about in polite allergy circles.  Yet, for example, it is certain that the strong delayed reaction to molds is not without biological significance.  In my experience, delayed mold skin tests correlate with delayed sickness in these patients. 

2.  How much of a role does the central nervous system have in responding to allergens?  This is a subject also not talked about in polite allergy circles.  Since this is an organ system that isn't "ours" like the sinus and respiratory tract, we simply exclude it from our interest...to the detriment of our patients.  The patient who gets extremely tired after breathing mold or eating the wrong food is...simply put...a nonphenomenon. 

What distinguishes superior physicians like Dr. Meador, in my opinion, is an overwhelming sense of curiosity...I've blogged about this before, in my entry "Curiosity Killed the Cat"  When approaching a difficult or challenging patient with a sense of curiosity, an open mind, and a strong sense of compassion, often unexpectedly great insights can be obtained.  Too often the allergist is trying to "document" or "not document" IgE mediated allergic disease.  Nothing wrong with that--provided we're open to other avenues of immunologic aberrations.  Too often, however, curiosity is an inadvertant casuality of the visit to the allergist.  Nonphenomena happen.  And the allergist has one of the longest lists of "nonphenomena" that any specialty has. 

Later, Dude