24th Symposium: Bermuda 2002

Light Minutes of the 24th Symposium of the Collegium Internationale Allergologicum held in Bermuda in November 2002

By STEPHEN J. GALLI

The 24th meeting of the Collegium Internationale Allergologicum, entitled: “Allergy Frontiers and Futures”, was held from November 1-6, 2002, on the island of Bermuda. 

The meeting got off to a strange start Saturday morning. The final program listed an Opening Ceremony. However, because of what was called “some confusion in putting the program together”, there in fact was no Opening Ceremony. When this oversight was detected, someone asked whether Johannes Ring might “perform” for us instead. What this actually meant was left to our imagination. Unfortunately, Johannes refused. In the end, we were told that we had fifteen minutes that were free and, very generously, we were told that we could do anything we liked with them.

The confusion in the program continued, as the first scientific presentation, entitled: “Mast cell-nerve communication: an important regulator of many physiologic functions”, by John Bienenstock, listed in the program as the Paul Kallos Lecture was, in fact, the Carl Prausnitz Memorial Lecture. The actual Kallos lecture, entitled: “Inhibition of allergic inflammation by a low molecular weight DC modulator”, was given on Monday by Jan de Vries. Oh, well.

Whatever its name, John’s talk ushered in the scientific part of the program. In the CIA tradition, the utmost respect was accorded to each of the presenters. For example, never one to keep his opinions to himself, Tom Platts-Mills prefaced his question to one of our speakers by referring to that person’s “so-called model of asthma”. This served to set the tone for the amusing interaction that followed. Later, Jan de Vries, in reference to Tom’s presentation, entitled: “The influence of cat ownership on immune responses to cat, dog and birch allergens in a mite free environment”, noted that, at past meetings, Tom promoted the concept of a washing machine for cats (apparently, to make them less allergenic) but now Tom was “peddling cats” (that was the wording used by Jan, I am just quoting it here), apparently to induce tolerance. Jan also pointed out that Tom now has, and again I quote, “400% of the cat market in Sweden”. I guess Jan was making the point that Tom, having studied the relationship of cats, allergy and asthma for some time, wants now, to use a common term for this sort of thing, “have it both ways”.

As usual, the CIA Council meeting on Sunday produced some memorable comments. For example, Barry Kay quoted John Bienenstock as saying that there was “too much science going on at the meeting, so I am going to the beach!” Recall that John himself had given the Prausnitz Lecture just the day before. Perhaps one can conclude from this that there is no criticism as heart-felt as self-criticism. At the special dinner that night at the Royal Dockyard, Susan Denburg, seeing an opportunity to help us dispel the intellectual, social and physical tensions that developed over the first two intense days of the meeting, led us in a lively conga line. The only problem with this was that some of our members seemed disinclined to grab hold of the bodies of certain other members, resulting in a bit of shuffling of the order of progression.

For me, one of the most memorable presentations was by Kanami Orihara, representing Yoji Iikura’s group, entitled: “Relation of the cytokine SNPs and clinical characteristics in children with atopy”. In the course of her presentation, Dr. Orihara volunteered the information that she not only was one of Professor Iikura’s students, but also had been one of his patients. Sadly, Yoji already was quite ill at that time and is one of our members who died in the interval between the Bermuda and Bornholm meetings. So, this represented the last scientific presentation of Yoji’s group to the CIA, an organization he enjoyed greatly and which he served faithfully as a member of Council. This final contribution to the CIA program displayed both Yojii’s devotion to the science of allergy and also his commitment to the mentoring of young scientists.

Robert Clancy, in his presentation of an approach to down regulate allergy with an oral preparation of Lactobacillus acidophilus, noted that the treatment also can be used for oral candidiasis in edentulous patients, including his cleaning lady. Thanks for sharing that, Robert.

Eva Untersmayer, describing what may be the next scourge of the super-rich, namely, allergy to Beluga caviar, remarked: “Everyone remembers his first taste of caviar”. She also described studies of mice that were fed caviar with or without antacids. This sets a very high bar for others who also experiment with mice but give them only processed mouse chow.  

Gerhard Obermeyer reported on the genetic engineering of tobacco plants to produce large quantities of plant allergens, such as Art v 1, a highly glycosylated pollen allergen from the mugwort (Artemisia vulgaris). In his talk, he introduced the latest member of the series that now includes in vitro, in vivo, ex vivo and in silico, namely, “in planta”. However, what was not mentioned in the presentation was that this approach, in theory, also could be used to make highly allergenic tobacco products, such as snuff, chewing tobacco and even cigarettes. On the plus side, this approach could be used to help wean those who use tobacco from their habit. However, in the hands of multinational conglomerates, it could be used as a strategy to increase the sales of anti-allergy medications. Also, think of the product labeling opportunities. The time-honored slogan on the package of Camel cigarettes: “I’d walk a mile for a Camel” could become “I’d be willing to wheeze a while for a Camel”.

Let’s get back to Barry Kay. Unlike John Bienenstock, who thought the meeting had “too much science”, Barry apparently thought that the program was not proceeding fast enough. How else to explain that he arose to give his talk one paper too soon? He seemed to be very eager to report that even though there had been “a scurrilous attempt to kill off eosinophils a few years ago”, happily (at least for Barry), “reports of their death are premature.” Tom Platts-Mills asked why patients treated for a year with anti-IL-5 showed no improvement of their asthma, to which Barry replied: “That’s a very loaded question.” Jeff Drazen jumped in with the observation that “Eosinophils aren’t dead, they are just completely marginalized”. While, in Jeff’s opinion, eosinophils have been “marginalized” in asthma, an abstract by Christer Peterson et al. concluded that the measurement of certain eosinophil products, especially eosinophil protein X, in faeces “could be a valuable marker for the presence and status of subclinical gastrointestinal inflammation in patients with suspected food hypersensitivity”. There is a vulgar expression that can be used when a stock or other item of potentially significant value has lost much of its worth, namely: “X has gone right down the toilet”. Could that be applied here? Just kidding, of course. To be continued……………

Exercising the moderator’s prerogative, Kurt Blaser solemnly noted that there was no time for any more questions, but that Bob Schleimer could go ahead and ask one anyway.

Sven-Erik Dahlen noted that at typical meetings one shows “clean cut results” that represent a “small piece of the cake”. However, he said that at CIA meetings he likes to present five years of work that has produced conflicting results. He then proceeded with his talk, which included a slide of the famous statue entitled “Manneken Pis” (and we all know what that means). Sven-Erik noted that he was “sorry” about showing this slide, remarked that “I realize this is very sensitive” and, finally, enlightened the anatomically and physiologically challenged members of the audience with the observation that “urine is far from the lung”. Did I mention that his talk had to do with asthma?

Heidrun Berhrendt, proposed the term “pollotrienes” as a new word to refer to certain lipids (also called “phyto-octadecanoids”), that she showed were present in pollen and could mediate biological effects like those of leukotrienes. As interesting as these findings were, purists in the audience raised objections to both components of the word “pollotrienes”; Tom Platts-Mills to “pollo”, which he thought was Latin for chicken, and Sven-Erik Dahlen to “trienes”, to which he objected without proof of chemical structure.

Rob Aalberse’s presentation on “IgE crossreactivity between exogenous and autologous antigens revealed by basophil histamine release” provoked a number of probing questions from the floor, including a request for his thoughts about what was described as a highly significant correlation between IgE autoreactivity and allergy symptoms. Rob responded: “These are outstanding questions, but you won’t hear the answers from me.” This was both funny and ambiguous. Did he mean that he simply didn’t know the answers; that he did know, but wasn’t willing to say; or that if he gave us the answers, we weren’t ready to accept them?

Of 154 abstracts originally placed in the program, 7 were withdrawn. These appeared in the program with an abstract number, but nothing else except the word “withdrawn”. Perhaps this is supposed to create an air of mystery. However, in future, we may require that any withdrawn abstract list the authors, the original title of the paper, and a few words of explanation as to why it was withdrawn, such as: “we can’t replicate the initial data”, or “we realized we had presented exactly the same study at the last CIA meeting”, or “we decided that we didn’t want our competitor, Professor X, to hear our results”, or “I was just at another meeting in Bermuda”, etc. It seems to me that this would be more interesting then just noting that the paper had been withdrawn.

While no formal poll was conducted, I can report that many of our members found the scientific program to be quite stimulating, the setting in Bermuda to be very attractive, the hotel accommodations to be rather expensive, and the boat ride to Hawkins Island, and the other official (and unofficial) social events to be delightful. All-in-all, a most enjoyable and successful meeting.

In other words, the 24th meeting was much like past meetings of this now (in 2004, when these minutes were read) 50 year old organization. One of our current CIA traditions is that each meeting has a cultural or, in the words of the program, “relaxing”, evening lecture. In Bermuda, David Foote presented this talk, which was entitled: “The world of demographics and the demographics of the world”, a fascinating, and in many ways sobering rather than relaxing, account of demographic trends in the developed and the developing worlds. In summary, those in the developed world, from which most members of the CIA hail, appear to be forgetting how to reproduce (please note: I am not necessarily suggesting that these two facts are related). By contrast, the developing world contributes few members of the CIA, but is reproducing quite robustly, in many cases under appalling conditions. In other words, the world as we know it is changing rapidly. If we were to pursue the concept of the rapidity of change, and attempt to rank aspects of the natural and human world in order of increasing rate of change, it would be: astronomical time > (i.e., is slower than) geological time > biological/evolutionary time > human (the very hopefully named species, Homo sapiens) time, and, finally, social/political/organizational time. Viewed this way, 50 years is the smallest part of the blink of an eye. Yet, an increasing proportion of our membership now belongs to a society that has existed longer than they have. How long will the CIA go on? Indeed, how long will we go on? Thankfully, we don’t (and can’t) know. All the more reason that we should attempt to make the most of the here and now, which is called in English, and can be understood in both meanings of the word, “the present”.  

In that spirit, please join me in showing our deep appreciation to the people who made a present to us of the 24th CIA meeting, its organizer, Larry Lichtenstein, our president and Carl Prausnitz Memorial Lecturer for that meeting, John Bienenstock, and all those who made our gathering in Bermuda scientifically edifying and socially refreshing.