Allergies Explained - go back to home page Allergies

Grass pollen discharging granules on exposure to water - picture by Dr H Morrow Brown

Dust Mite - picture by Dr H Morrow Brown

Dr H Morrow Brown MD
FRCP (Edin) FAAAAI (USA)
General Medical Council Registered Specialist
for Allergy and Respiratory Medicine

Explained

About Dr H Morrow Brown

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Professional Status

There are so few allergists in this country that many dubious practitioners have attempted to satisfy this unmet need. For this reason it is essential to establish my medical professional status by a brief account of my career.

I qualified as MB ChB at Edinburgh University in 1939, and served in the Royal Army Medical Corps throughout the war, mainly in India, until 1946. Post-graduate studies in Edinburgh led to the award of the degree of MD with Commendation in 1950 for my thesis on "Adaptation and Adaptive Dysfunction". In 1949 I became a Member of the Royal College of Physicians of Edinburgh, and was elected a Fellow of the College in 1965.

After experience in the Professorial Unit at Dundee Medical School under Professor Sir Ian Hill, and in the Dundee Chest Clinic, I was appointed Consultant Chest Physician South Derbyshire In 1953, and later Allergist to the Derwent Hospital, Derby Chest Clinic, and the Derby Children's Hospital.

So many practitioners in the Derbyshire/Nottingham area who knew me well have retired, and younger colleagues are unaware that I am still in active consulting practice. It may be helpful when requesting a referral that your doctor should be made aware that, firstly, I am one of the very few GMC Registered Specialists for Allergy and Respiratory Medicine, secondly, of this website and, thirdly, of my international reputation

Allergy Research

I carried out many research projects in allergy and in aerobiology during the last 30 years. I also founded that Midlands Asthma and Allergy Research Association in 1968 to support allergy research in the Midlands and organised five International Symposia on Clinical Allergy at Nottingham University.

In 1993 I was awarded the Charles Blackley Lectureship by the British Society for Allergy and Clinical Immunology, in 1999 the William Frankland Medal for services to Clinical Allergy, and in 2004 I received an Honorary Doctorate from Derby University.

I belong to the British, American, and European Societies for Allergy and Clinical Immunology and still present new research at annual meetings. In 2006 I was elected as an International Fellow of the American Academy of Allergy Asthma and Immunology, being only the tenth British doctor thus honoured by the most prestigious Allergy Association in the world. I continue in active clinical practice not only because I enjoy seeing patients and solving their problems, but because there are so few allergy specialists. It is a paradox that while Britain has the highest incidence of allergic disease in the world, it also has the most inadequate allergy service.

My objective has always been to find the cause rather than suppress the symptoms with drugs which may have side-effects and can never cure. For example antibiotics will cure an infection completely, but drugs for allergies only suppress the symptoms of asthma, rhinitis, or eczema. To rely on drugs alone without at least trying to find the cause seems an inadequate approach to allergic problems.

 

Major Researches - A Brief Outline

In 1958 I demonstrated that if many eosinophil cells, which are typical of allergy, were present in the sputum from patients with asthma they would be greatly helped by oral steroid tablets. When eosinophil cells were absent patients did not improve when given steroids, and the correct diagnosis was chronic bronchitis. The publication of this work in the Lancet by only one researcher, not double-blind, and with only one table of results and no statistics, would never have had a hope of being accepted for publication today, but has proved to be a really important observation because it enabled selection of the patients who would benefit from oral steroids from those who would not, and is used widely in important research to this very day.

Mast Cell in nasal smear
Eosinophils stained red in sputum

Macrophages in bronchitic sputum

Mast Cell in nasal smear Eosinophils stained red in sputum Macrophages in bronchitic sputum

Following this development I soon had hundreds of very happy asthmatic patients taking steroid tablets. Unfortunately oral steroids also have long-term side-effects, and in my opinion should be regarded as a chemical crutch to control the allergy while a search is made for the cause. In my contribution to a Symposium on Airways Obstruction at the Royal Festival Hall in 1969 I stated "Steroids pave the primrose path of therapeutic dalliance, leading only to a mirage of apparent health and well-being". Perhaps this was an extreme view, but sometimes appropriate.

Because the presence of many eosinophil cells usually indicates that an allergic reaction is taking place I became deeply involved in allergy research directed at finding the innumerable causes of asthma, rather than relying on indefinite suppression of symptoms with drugs. It seemed obvious that if the cause or causes of the asthma could be found and avoided there would some possibility of getting patients off steroid treatment, or at least controlling the asthma with a smaller dosage of steroid.

If the cause was found to be unavoidable desensitising injections could then be given in the patients no longer reacted to the allergen, and then steroids could be stopped altogether or the dosage reduced considerably. Success with these methods, particularly in asthma, encouraged my interest in finding the causes of other allergic diseases such as allergic rhinitis, hay fever, eczema, anaphylaxis, and food allergies, often involving other medical specialties.

 

The Rescue of Becotide, the first Inhaled Steroid

The ability to select the allergic patients most likely to respond to steroids by sputum examination, was the reason why I was given the opportunity to carry out a clinical trial of the very first inhaled steroid, Beclomethasone Dipropionate, (later named Becotide) beginning in July 1970.

Becotide inhalerThis clinical trial was of crucial importance because trials in Edinburgh from 1968 had failed to show any benefit, probably because cases of chronic bronchitis were selected. The makers, Allen & Hanburys, were just about to discard Becotide as a useless drug on the basis of these poor results, but their Medical Director did not agree because he had heard me lecture about selecting responders to steroids by sputum cytology. He wrote to me stating that his last act before taking up a new appointment was to ask me to try the steroid aerosol because he was so sure that it would be effective. I then commenced a clinical trial selecting only patients with eosinophils, and my results, monitored for the very first time by giving peak flow meters to every single patient, were so impressive that after six months the manufacturers wrote stating that they had decided "to give the steroid aerosol another chance".

Thus the first steroid aerosol was rescued from the dustbin and a new era in the treatment of asthma began. I was the first in the world to publish reports on the remarkable effectiveness of inhaled steroids in both adults and children in the British Medical Journal in 1971 and 1972.

This research would have been very difficult to carry out under the strictures which govern clinical trials today, and would be unacceptable for publication because this was not a double blind study where neither doctors nor patients know who is receiving active drug or placebo. By using daily peak flow readings In this trial the improvements were so obvious that the results were accepted without question.

This treatment was soon used all over the world because inhaled steroid aerosols act directly on the bronchial tubes and control asthma without side-effects, while oral steroids circulate in the bloodstream, causing side-effects as well as remarkable benefits, depending on the dose. One of the most important findings was that many patients dependent on oral steroids could stop the tablets and be controlled by the inhaled steroid instead without side-effects.

Aerosol inhaler spray patternInhaled steroids are now acknowledged to be the most important development in the treatment of asthma in the last thirty years, so I am very proud that the trials in Derby were the first to show their effectiveness. Very few asthmatics need oral steroids today except in emergency, and total dependence on oral steroids is unusual.

Many effective inhaled steroid compounds were developed over the following years, but recent improvements in the propellant gas used in the aerosol have resulted in the particles of the aerosol being so small that they penetrate to the very smallest bronchial tubes, enabling the whole bronchial tree to be treated for the very first time. This may be very important for chronic asthmatic children who have to take inhaled steroids for life.

When I arrived in Derby in 1953 tuberculosis was a major problem, Chest Clinics looked after the whole family from cradle to grave, and patients were followed up from infancy onwards. After tuberculosis was controlled allergy became my major interest and, as the old TB clinic organization allowed me to treat children, I continued to do so, and to observe how allergy or intolerance to milk and other foods could be inherited.

This unique personal experience would be impossible today because the development of organ specialties has created barriers to the generalised approach which, in my opinion, is essential for the recognition of the diverse clinical problems caused by faulty adaptation to the environment, of which the commonest manifestation is allergy.



Recent Researches and Publications

During my time within the National Health Service I was fortunate to have freedom to follow my research interests and develop a very active research unit. I am certain that these achievements would have been quite impossible under the restrictive bureaucracy imposed today. Fortunately, the development of the World Wide Web gives me a wonderful opportunity to publish these researches and experience for all to share.

LupinsI continue to publish new research, and recently was involved in a report in the Lancet where I personally diagnosed the first case of anaphylaxis in the UK to be caused by lupin flour. This is a hidden menace because the commonest dangerous food allergy is to peanuts, and many peanut allergics are also sensitive to lupin, which did not have to be declared on the label until recently.

In recent years I have seen an increasingly wide range of illnesses not usually recognized as due to allergy or intolerance, especially IBS and similar gut disorders. Dietary manipulation has been very helpful in many cases.

In 2007 The Annals of Allergy and Clinical Immunology, a prestigious American medical Journal, published my long letter to the editor suggesting that very very gradual reintroduction of a food such as peanut in microscopic doses, increased carefully until tolerated without reactions, might be a better approach than strict avoidance with the constant fear of anaphylaxis from eating a trace of peanut. Another letter relating the story of how Becotide, the most important advance in treatment in the last 35 years, was nearly discarded as useless was also published in this journal in 2007

Specialised Facilities for Investigation and Treatment

I see patients of all ages, especially children, including infants with feeding problems. At my consulting rooms I have developed specialised facilities for the out-patient investigation of all sorts of allergies. These include a very wide range of skin tests, patch tests if necessary, electronic lung function testing, oximetry, and typmpanometry for investigating glue ears etc.

Olympus BX51 Laboratory MicroscopeMicroscopical examination of the cells in the sputum or nasal discharge, and of samples of house-dust when required, is carried out on the spot, and relevant blood tests are available when required.

A completely unique investigation is making special extracts from samples of the patient's own house dust or the hair of their pets. This is make a skin test from the patientís own environmental dust to establish the importance of the patient's own home environment. This innovative and logical method of investigation can pinpoint the source of allergy in the home, assess its importance, and indicate what action should be taken.

Allergy problems are often complicated and require much time and expertise to sort out, so I find it best to regard the sufferer as a partner in the investigation rather than as a patient.

The objectives of an allergy consultation are to identify the cause of the problem, assess its severity and impact on the quality of life, and to ensure that the most up-to-date treatments are being used in the most effective manner.

Patients always receive a copy of my report, as well the family doctor, because this prevents misunderstandings, encourages compliance with my suggestions, reassures the patient, and provides a back-up against loss of medical records.

 

 

"It is a paradox that while Britain has the highest incidence of allergic disease in the world, it also has the most inadequate allergy service"

 
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