During his residency at the University Wisconsin, Dr. Michael Weiss had the scare of a lifetime. His wife, Dr. Leslie Garrison, suffered a very severe anaphylactic reaction to a snack that unknowingly had nuts in it. “The severity of her reaction got her admitted into the ICU, and she came close to being intubated. Basically they couldn’t oxygenate her,” Weiss says.
As he tells the story, he explains how the stages of her anaphylaxis included the common symptoms: intense itching of the hands, feet and throat; an overwhelming sense of impending doom as chemicals are released into the body, signaling that something is wrong; plus throat swelling, difficulty breathing and closing of the bronchial tubes.
When his wife experienced all of these things, because he was working at the hospital at the time, Weiss was part of the team to treat her. That night, after she was stable, he spent a long time researching severe nut allergy anaphylaxis in preparation to present her case the next day to other medical professionals. “I found it extremely fascinating,” Weiss says. It was this major experience, coupled with the support of an inspirational teacher, that led to Weiss’s decision to go into the allergy and clinical immunology field. “You can help folks a lot too, and that was really appealing.”
After his residency, Weiss, a native of Long Island, New York, went on to study at Johns Hopkins University School of Medicine where he pursued research surrounding severe anaphylactic reactions, including those caused by venom and prescription drugs. After medical school, he and Garrison moved to Seattle to start a family. Garrison, a trained pediatrician with a master’s degree in public health, went to work at Immunex, the booming biotech company. Weiss continued in the allergy and clinical immunology field, becoming the president of Washington State Society of Allergy, Asthma and Immunology and eventually the chief of staff at EvergreenHealth Medical Center. Additionally, he spent a few years acting as an allergy advisor to the FDA. Currently, he practices at Northwest Asthma & Allergy and holds an academic position as clinical professor of medicine at the University of Washington School of Medicine.
Through his decades of experience, Weiss says the field continues to intrigue him on a daily basis, mostly because it is undergoing a tremendous amount of innovation and growth as the medical industry as a whole understands more about the immune system. “When I was starting in medical school, you spent two days on the immune system. Now it’s an eight-week class.” Weiss cites revolutionary new drugs for severe asthma and chronic hives as some of the exciting treatments coming down the pipeline. Weiss is also thrilled at the amount of research being conducted surrounding food allergies. He says while all the information is still new, progress in understanding peanut allergies, wheat allergies and so on has come a long way.
Interestingly, it’s also a field, he says, experiencing a bit of a boom, and not necessarily for the better. “If you look at allergies in general in westernized societies, there’s been a fairly recent and huge increase in all allergic problems. There’s more hay fever than 30 years ago, more asthma, more eczema and more food allergies,” he says. “We are also seeing conditions we have never even seen before like a condition called eosinophilic esophagitis, which is a pretty fascinating disease where immune cells inflame the esophagus and cause problems. It is now showing up all the time.”
As a practitioner, researcher and educator, Weiss spends a lot of time thinking about this trend. He says while he and his peers have a pretty good understanding of what is causing the rise of allergies, it’s not an easy fix. “The leading theory, which is gaining more and more evidence, almost going from theory to proof of concept, is something called the hygiene hypothesis,” he says. “It’s a problem found in countries that have good sewage systems and vaccinations because kids in their first year or two are exposed to less infections, less contaminated water. We’re finding that it actually skews their immune system. This presents itself in a bias toward allergies. We have a lot less infection, but our kids are growing up with more allergies.”
This theory, he goes on to explain, is widely accepted across the country, but he says living and working in Seattle and the Eastside presents a unique population that really demonstrates the premise in real life.
“It’s very apparent when you have a population like we have on the Eastside. There’s a group of residents that move from China and India to work at Microsoft, and we see so many of those kids. What happens is the parents or older children are fine, no allergies. But when they have kids here, the kids grow up with food allergies, eczema. We saw the same thing after the Vietnam War, when there was a huge influx of Vietnamese people.”
Weiss says the answer isn’t clear-cut because nobody wants to start drinking untreated water. “Our challenge is going to be figuring out how to not increase childhood infections while at the same time not skew the immune system so much,” he says.
This is just one of many areas in which the ever-growing field of allergy and clinical immunology is helping the medical field understand the highly complex immune system. Other interesting topics include how the immune system responds to cancer, HIV and severe asthma, and Weiss is thrilled to be a part of it all.
The field of allergy and clinical immunology includes quite a loaded vocabulary. Here’s a little cheat sheet of phrases you might hear if you visit Dr. Weiss:
(e-o-sin-o-FILL-ik uh-sof-uh-JIE-tis), a type of white blood cell (eosinophil) builds up in the lining of the tube that connects your mouth to your stomach (esophagus). This buildup, which is a reaction to foods, allergens or acid reflux, can inflame or injure the esophageal tissue. Damaged esophageal tissue can lead to difficulty swallowing or cause food to get caught when you swallow.
Eosinophilic esophagitis is a chronic immune system disease. It has been identified only in the past two decades, but is now considered a major cause of digestive system (gastrointestinal) illness.
Chronic Urticaria: (ur-ti-kair-ee-uh)
Urticaria (hives) is a skin reaction that causes red or white itchy welts. The welts vary in size and appear and fade repeatedly as the reaction runs its course. Chronic hives are a condition in which the welts last more than six weeks or recur over months or years. Chronic hives usually aren't life-threatening. But the condition can be very uncomfortable and interfere with sleep and daily activities. Often, the cause of chronic hives is not clear. In some cases, chronic hives are a sign of an underlying health problem, such as thyroid disease or lupus.
Dermatographia is a condition also known as skin writing. When people who have dermatographia lightly scratch their skin, the scratches redden into a raised welt similar to hives. These marks usually disappear within 30 minutes.The cause of dermatographia is unknown, but it can be triggered in some people by infections, emotional upset or medications such as penicillin.