When I give an introductory lecture on anaphylaxis to medical students, I usually start with the story of a child in our neighbourhood who had a peanut allergy. While he was at a friend’s home he was served ice cream. He read the ingredients on the carton, and saw that peanuts weren’t mentioned. However, on his first mouthful he realized from the rapid onset of symptoms that peanuts must have been included. He was rushed to the emergency room, but there apparently was a delay before he received epinephrine (adrenaline) and he died. It turned out that while peanuts in fact were not listed on the carton, they were in the candy bar that was mentioned in the ice cream’s ingredients. This phenomenon, anaphylaxis, a catastrophic and sometimes fatal allergic reaction to an otherwise innocuous substance, represents arguably the most grotesque imbalance between the cost and benefit of an immune response.

As Johannes Ring will tell us in detail, it turns out that observations of anaphylaxis extend far back in antiquity. For example, it is thought that Pharaoh Menes died from a reaction to a wasp sting some 4500 years ago. More recently, about 100 years ago, in an attempt to develop an anti-toxin to the venom of the Portuguese man-of-war (Physaliaphysalis), Charles R. Richet and Paul Jules Portier instead discovered anaphylaxis. They named the phenomenon anaphylaxis, taking ‘phylaxis’ from the Greek for ‘immunity’or ‘protection’, and, according to one account, adding the ‘ana’simply to make the term euphonic. This history is detailed in Estelle Simon’s wonderful book The Ancestors of Allergy (Simons 1994). Apparently, receiving the Nobel Prize can induce paroxysms of modesty in those so honoured. Richet wrote that,‘The discovery of anaphylaxis is not at all the result of deep thinking, but of simple observation, almost accidental. It had no other merit than that of not refusing to see the facts which presented themselves before me completely evident.’