Book Review: An Epidemic of Absence – A New Way of Understanding Allergies and Auto-Immune Diseases

Epidemic of abscenceAbout a half-dozen years ago, I suddenly developed allergies and mild asthma. I had had mild hay fever in the past, but things changed notably in a short period of time. This is all fairly easy to treat, but I’ve been wondering why the sudden change occurred. I came across this book, An Epidemic of Absence – A New Way of Understanding Allergies and Auto-Immune Diseases, browsing on Amazon recently, and, since I’m curious, I thought it would be interesting to understand why this sort of disease has been on the rise. (, Amazon UK)

Author Moises Velasquez-Manoff has an auto-immune disease himself: alopecia areata, a disease where his body has attacked his hair follicles, making him hairless. He begins the book by giving a glimpse of one possible therapy for auto-immune diseases: he has set out to Mexico to purchase some hookworms with the goal of infecting himself and rebooting his immune system.

But what’s going on? Auto-immune diseases have been on the rise around the world, first in industrialized countries, then in developing nations. Starting with diseases like hay fever, which was considered to be a disease of the upper class, these illnesses include multiple sclerosis, allergies, rheumatoid arthritis (and many other forms of arthritis), asthma, some types of thyroid diseases, celiac disease, Crohn’s disease, fibromyalgia, and others. And the author also discusses the obesity epidemic; obesity is, he says, an inflammatory disease. Some 100 auto-immune diseases are known, and others are being discovered regularly.

Velasquez-Manoff ‘s thesis is that this epidemic is caused by the absence of something. It is well known that children who grow up on farms, and who are exposed to more pollen and a variety of microbes from various animals, have fewer allergies and less asthma. Taken further, it seems likely that our lack of contact with pathogens and microbes has caused our immune systems to overreact. If our immune systems have evolved to manage bacteria and parasites that have been part of the human landscape for tens of thousands, even millions of years, and those interlopers are removed, by our suddenly having clean water, for example, then our immune systems incorrectly recognize other proteins – those of our bodies themselves – as attackers. Our immune systems become hyper-reactive.

The author presents a detailed account of research into these ideas, from the gut microbiome (the bacteria that lives in our intestines),worms, to the overuse of antibiotics. Indeed, the prevalence of some auto-immune disorders can be mapped to show they are more common in areas with clean, parasite-free water. We tend to think of these little creatures as dangerous, and they certainly can be, but in the right balance, our immune systems react to hold them in check.

There’s a lot of detail in this book; sometimes a bit too much of the minutia of experiments carried out on different diseases and different parasites. But over time, one starts to see the pattern, and the hypothesis looks intriguing. This all started out as fringe science, and is becoming more mainstream. It is already accepted that children should no longer use anti-bacterial soaps as much as they do, and that their bodies are healthier with a good range of dirt. It is known that kids that grow up with pets have fewer allergies and less asthma. Perhaps all our children need even more exposure to pathogens.

Velasquez-Manoff then discusses the underground movement of people voluntarily infecting themselves with worms, and describes his own experiment. This gets into extremes, as the potential for harm could be substantial, but there is anecdotal evidence that some people treated this way find their symptoms improve radically.

This book raises some very interesting questions, and it documents research that may change the way doctors treat auto-immune diseases. It’s not one of those medical books that tells you how to cure yourself by eating specific foods, but rather a solid piece of science journalism that maps out an intriguing new field of research. If you’re curious about auto-immune diseases, or if you have one yourself, you’ll find this an interesting read.

Listen to Moises Velasquez-Manoff give a TED talk, Reshaping the Immune System: