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The American Academy of Environmental Medicine (AAEM)


The American Academy of Environmental Medicine (AAEM) was founded in 1965 by a group of Board certified allergists who banded together and formed a medical society that has evolved into the American Academy of Environmental Medicine. The AAEM is an international organization representing physicians who specialize in Environmental Medicine. The AAEM is accredited by the Accreditation Council for Continuing Medical Education and provides American Medical Association Physician Recognition Award Category 1 CreditsTM. AAEM physicians have earned a recognized MD or DO degree by an accredited medical school in the United States, Canada or other countries and maintain current licensure to practice medicine. Most AAEM physician members are board certified by one or more of the 24 medical specialty boards of the American Board of Medical Specialties.

History of Environmental Medicine - An Evolution in Process


Theron G. Randolph, M.D., is probably the physician who will be remembered as the greatest pioneer in the field of Environmental Medicine.  The best source of information tracing the roots of Environmental Medicine is found in Environmental Medicine – Beginnings and Bibliographies of Clinical Ecology by Theron Randolph, M.D.1

One of the first physicians to record his observations on the effects of food on his patients was Francis Hare, M.D. an Australian who wrote, The Food Factor and Disease2 in 1905.  In 1889 Dr. Hare began treating obesity with a diet consisting mostly of protein foods and largely excluding fats, carbohydrates, saccharine, alcoholic drinks.  Much to his surprise, when patients followed this regimen of dietary restriction, they noted relief of many of their chronic symptoms such as migraine headaches, catarrhal conditions of the mucus membranes, epilepsy, angina, diarrhea, and vomiting.  He stated that the temporary abstention from food (fasting) may be the shortest route to relief of all these afflictions.  In respect to obesity, Hare noted that the majority of such patients have hearty appetites for the more highly carbonaceous food stuffs, such as sugars and starches. He refers to sugar as perhaps the worst article of the diet and likened sugar gluttony to alcoholism. He noted that two or three lumps of cane sugar, an ounce of butter, an extra pint of milk, a small plate of porridge, an extra ounce of bread or toast, etc. may suffice to bring on typical migraine paroxysms.  He emphasized that although there were beneficial effects from reduction of carbohydrates, he pointed out that sometimes reduction of protein relieved migraine.

Hare had an interest in mental illnesses and described a case study of a man who had been committed to an asylum for the greater part of his life.  At times he refused food and was force-fed by a stomach tube. His health failed to the point that his physicians felt it was useless to force food any longer upon him, and he was left to die in peace.  He did not die in peace, and in fact, recovered his sanity and was able to leave the asylum.  Hare noted the alternation of psychosis with what were later referred to as allergies (rhinitis, asthma, eczema and headache).  He also noted that it was quite common to see cases of arthritis, stiff neck, and lumbago rapidly improve concurrently along with weight loss when patients were placed on mainly a protein diet.

Hare had a strong interest in alcoholism, as did Randolph.  In respect to alcoholic beverages, Hare pointed out that substances undergoing rapid absorption such as wine or alcohol may produce asthma within a minute or two. He commented that sugar and sweet things generally had a special inverse relation to alcoholism, pointing out the well-known observation that alcoholism usually killed the desire for sweets – the taste for which nearly always returned within two to three weeks after the final withdrawal of alcoholic beverages.  He apparently regarded this recurrence as evidence of “improvement” stating that obvious enjoyment of the sweets was acceptable in the sanitarium as “satisfactory index of recovery” from alcoholism. Hare contributed 65 publications to the medical literature.

Hare agreed with the work of George M. Savage3 who in 1896 apparently was the first to point out the alternation of mental and physical symptoms.  Dr. Savage stated “ I have met with several cases in which insanity has alternated with spasmodic asthma in patients who have for years been subject to recurrent attacks of asthma, and would become almost suddenly well, as far as the asthma was concerned, but would at the same time develop insanity and as long as the insanity was present the asthma was absent.

In his day, Arthur Coca was considered to be the Dean of American Immunologists.  Randolph became familiar with Coca after he heard his presidential address to the American Association of Immunologists in 1933. Dr. Coca had been on the faculty of Cornell University Medical Center since 1910 (age 35), and founded the Journal of Immunology in 1915 where he served as editor for many years. During this period of time he remained the leading theoretician in the field of allergy, carrying on a long debate with Dr. Robert Doerr of Switzerland in regard to the definition of the term allergy. Coca objected to the redefinition of allergy in the limited terms of antigen-antibody reactions.  Unfortunately there is very little documentation in the readily available medical literature about the controversy over the definition of allergy.  One available account in 1925 states “Under the leadership of Doerr, immunologists and allergists abroad united in recognizing as truly allergic only such reactions as are based on an antigen-antibody reaction.”4  Coca’s definition of allergy as a condition of hypersensitivity in which an antigen-antibody response has not been shown to be the underlying cause of symptoms that characterizes it, was the opposite of Doerr’s.  Doerr’s viewpoint was finally accepted by academicians in this country.

In 1932, at the age of 57, Dr. Coca retired from Cornell and became Medical Director of Lederle Laboratories.  In 1935, at the age of 60, Dr. Coca started the Allergy Discussion Group consisting of physicians and scientists interested in immunology.  By 1940 his major interests had changed from theoretical immunology to food allergy and allergy related migraine and hypertension — to the utter consternation and dismay of many of his scientist friends.

Coca’s interest in allergic reactions to foods and other environmental exposures not associated with immunologically measurable parameters led to the publication of his book in 1943, Familial Nonreagenic Food Allergy5 which was bitterly criticized by his contemporaries.  Although headache, fatigue, rheumatism and arthritis had been described as systemic syndromes of allergy previously, Coca confirmed these findings and reported additionally on food related manifestations of hypertension, psychosis, and seizures.  He made the observation that an elevated pulse rate commonly occurred after ingestion of allergic foods.6 In addition to his interest in foods, Dr. Coca was the first to note that such environmental chemicals as fumes from natural gas, gasoline, automotive exhaust, perfumes, and other hydrocarbon exposures were often responsible for precipitating acute reactions in highly susceptible allergy patients.  Dr. Randolph states that Dr. Coca is to be commended for having the courage of his convictions despite intense criticism from his contemporaries and former admirers.  Dr. Coca retired from Lederle Laboratories in 1948 at the age of 73 and went into the private practice of allergy in his home in Oradall, New Jersey. Arthur Coca’s published bibliography includes 112 articles.

Albert Holmes Rowe, M.D. was a clinical observer far ahead of his time. Dr. Rowe functioned as a lecturer in allergy at the University of California Medical School (San Francisco) for a period of thirty years and also served as the chief of the Medical Center Allergy Society. Rowe alongwith Grant L. Selfridge and George Piness was a co-founder of the Western Society for the Study of Hay Fever, Asthma, and Allergic Diseases in 1923.  This original national allergy society later merged with the Society for the Study of Asthma and Allied Conditions to form what later became known as the American Academy of Allergy and Immunology.  Dr. Rowe’s first major book, Food Allergy:  It’s Manifestations, Diagnosis and Treatment 7 was published in 1931.  Dr. Rowe’s opening preface in this remarkable book is as appropriate today as it was when written.

“Food allergy as a common cause of human symptomology is gaining increasing recognition, as emphasized in the literature of the last decade and in my experience as an internist as well as an allergist.  Such allergy not only enters into the etiology of many conditions necessarily treated by general practitioner, but also into the causes of symptoms demanding relief by all specialists.  Food allergy may produce localized symptoms in any tissue or parts of the body.  In this it differs from inhalant types of allergy whose main manifestations occur in tissues with which those allergens have more or less definite contact.  Thus food sensitization is one of the most important etiological agents known.”

Rowe’s recognized that food allergy was a factor to be considered in all cases of headache, fatigue, bronchitis, bronchiectasis, emphysema, ulcerative colitis, regional ileitis, as well as many other cerebral, neural, musculoskeletal, and other acute and chronic manifestations.is view represented relatively new interpretations when these reports were first published. Rowe’s accomplishments did not neglect other environmental factors contributing to the allergic state.   His contributions in the areas of pollens, fungi, infections and many other exposures attest to his comprehensive coverage of the subject. Rowe was best known for his development of elimination diets, probably the most widely used technique for diagnosing food allergy and one of the most effective.  According to Dr. Randolph, Albert Rowe deserves the accolade as the father of food allergy in this country as well as the world.  Dr. Rowe was recognized for his accomplishments at the first International Congress of Food and Digestive Allergy in Vichy, France in 1963 when he received an award for his contribution.

According to Dr. Randolph, one of Albert Rowe’s most outstanding characteristics was his ability to absorb criticism, yet to remain steadfast in his endeavors.  Rowe told Randolph that in this field one must learn how to take criticism.  He said, “Criticism rolls off me like water off a duck.”  Indeed, for about half a century he received the bulk of the criticism from the medical establishment concerning his views on  concepts and techniques related to food allergy. Dr. Rowe’s bibliography includes 134 publications.

Herbert J. Rinkel graduated from Northwestern University Medical School in 1925.  He became familiar with the research of Albert Rowe concerning food allergies. Rinkel was the first to confirm and extend observations concerning masked food allergy which had major implications in the area of testing for food allergies.  By avoidance of specific foods four to six days prior to an ingestion test, many previously undetected food allergies were then detected.8   In 1948 Rinkel published his observations on the use of the Rotary Diversified Diet which was considered a major contribution to the field of allergy.Rinkel also helped train Michael Zeller, M.D. who made contributions as to the role of food allergy in rheumatoid arthritis.

In 1959 Dr. Carlton Lee, M.D. of Joplin, Missouri observed that allergic reactions to foods could be treated or “neutralized” by appropriately dosed injections of specific food extracts.  Rinkel postulated that , if true, it might also be possible to provoke acute reactions diagnostically.  The two of them worked out the details of the Provocation-Neutralization technique for food allergy which they published in 1964.10

The demand for teaching the so-called  Rinkel Approach in clinical allergy increased due to the development of the annual Wyoming Post Graduate Course in Allergy and Immunology which was started in 1956 under the direction of Russell L. Williams, M.D. who continued this annual event after Dr. Rinkel’s death in 1963.  Dr. Rinkel had turned his practice over to James W. Willoughby, M.D. in 1962 after he was diagnosed with an inoperable abdominal malignancy.  Dr. Rowe and Rinkel were to be honored for their pioneering work in food allergy at the first International Congress of Food and Digestive Allergy in Vichy, France in 1963.  Unfortunately, Dr. Rinkel died ten days before the meeting.  Dr. Rinkel’s point of view of food and inhalant allergies is still being presented annually through courses sponsored by the American Academy of Environmental Medicine,  the American Academy of Otolaryngology Allergy, and the Pan American Allergy Society.

Dr. Randolph stated that “Herbert J. Rinkel was a technological genius, an innovator, and inventor with a passion for making cause and effect observations of patients and especially for measuring them.  He chose as his main subject for medical observation, allergic responses to foods, pollens, molds, danders, dust, insects, and other inhaled materials.  He is to be credited with having changed the course of both food and inhalant allergy.  Without doubt he was the outstanding clinical investigator of his day as far as the field of allergy is concerned.  Dr. Rinkel’s bibliography includes 52 publications in the medical literature.

Carlton Lee, M.D. is recognized as the discoverer of the Provocative-Neutralization method of allergy testing and treatment.  Dr. Lee began studying variations in wheal sizes produced by intracutaneous injections of different dilutions of a given food extract.  Very soon he noted that he was making some patients temporarily worse with certain dilutions and better with other dilutions of the same extract.  Some dilutions gave rapid relief of the symptoms produced or were intensified by other dilutions.   In addition, his patients began to report to him that for about four days after each test they were able to eat their allergic foods and yet remain virtually free of symptoms.  Dr. Lee next found that if he gave the neutralizing dose prophylactically every four days, most patients could eat their allergic foods regularly with few or no symptoms.10

Dr. Miller was a conventional allergist who heard Carlton Lee deliver a paper on provocative testing in 1965 at a meeting of the American College of Allergists in Chicago.  Although he was initially skeptical, Dr. Miller was favorably pleased to discover that Lee’s techniques were quite effective.  Dr. Miller refined and extended many of the points of this technique for teaching and research purposes.  He found that active viral infections such as influenza and various hormonal problems could also be neutralized using this technique.11

Theron Randolph was born and raised on a farm.  His first encounter with the chemical environment occurred during a cattle drive with his father when they were exposed to the stench from the Dow Chemical Company at Midland, Michigan.  While in college he became an accomplished typist which later contributed to his legendary ability to precisely record a patient’s history.  He graduated from medical school at the University of Michigan in 1933.  After his internship and residency at the University Hospital, he completed an allergy fellowship at Massachusetts General Hospital and Harvard Medical School.  Dr. Randolph began his practice in Milwaukee where he joined the staff at Marquette University Medical School and founded the allergy clinic at Milwaukee Children’s Hospital.  In 1942 he was appointed Chief of the Allergy Clinic at the University of Michigan Medical School.  He later moved to Chicago where he started a private practice in allergy and joined the staff at Northwestern University Medical School.

Early in his career Dr. Randolph developed a strong interest in food allergy which was a very controversial topic at the middle of the century.  He, along with Herbert Rinkel and Albert Rowe, discovered the basic nature of food allergy. At this time Randolph announced that, although he was interested in food allergy, he would no longer perform skin tests for it’s detection since he felt they were unreliable.  He also began the practice of recording medical histories and progress notes directly on the typewriter without an off hand interpretation of their significance.  This routine turned out to be so helpful in dealing with alleged hypochondriacs that he adopted the technique of practicing “poker faced medicine”.

Randolph testified in Washington, D.C. before the Food and Drug Administration concerning the prevalence of corn allergy and the extensive use of corn products in processed foods.  Following his testimony, five other allergists, who were introduced by the Corn Products Research Foundation negated his testimony by stating they had never seen a case of corn allergy.  Criticism of food allergy from both within and from outside the medical profession continued to increase, especially when Randolph described food allergy as a cause of mental illness.  Dr. Randolph’s tenure at Northwestern University Medical School was terminated on the charge that he was “a pernicious influence for medical students”.

Randolph was not deterred by these events.  On the contrary, his contributions to the medical literature was prodigious, publishing close to 400 articles in scientific journals.  The breadth of Randolph’s published research was extraordinary and covered such diverse topics as calculating diet prescriptions for diabetics, histamine levels in asthma, eosinophil counting chambers, house dust allergy, and mold spore counts.  His ground-breaking research demonstrated the role of allergy in migraine headaches, seizure disorders, addiction12, myalgia, psychosis13,14, acute torticolis, arthritis, and fatigue.  His interests in Hans Selye’s General Adaptation Syndrome led him to publish research on the relationship between adaptation and allergy.  He also authored articles on allergy to monosodium glutamate, inert ingredients in medications, and the acid-anoxia-endocrine theory of allergy.  Randolph developed the comprehensive environmental control unit in order to more effectively diagnose and treat complex allergy patients.

Perhaps Randolph’s greatest achievement was his recognition almost fifty years ago of the adverse effects of the chemical environment and indoor air pollution on his patients.15  In 1965, he and a small number of colleagues founded the Society for Clinical Ecology which later became the American Academy of Environmental Medicine.  He was President of this organization in 1970 and has been recipient of both the Jonathan Foreman and Herbert J. Rinkel awards.

Dr. Randolph’s accomplishments were based on his keen intelligence, observation skills, and ability to truly listen to more than 20,000 patients and directly type their histories verbatim without editing their complaints.  He taught thousands of physicians and was always a generous and patient teacher and he was totally devoted to medicine.

The pioneers in the area of food allergy quickly became aware that their clinical findings were at considerable variance with many accepted views in the field of allergy.  These newer ecological concepts and techniques in the field of allergy not only differed from allergy as usually considered, but were spilling over and involving several other medical specialties, especially the fields of otolaryngology and gastroenterology. Otolaryngologists welcomed these concepts as their field had been changing since the advent of the widespread application of antibiotic therapy and decreased indications for surgical intervention.  These trends towards less surgery and more medical management in otolaryngology were especially fostered by French K. Hansel, M.D. and George E. Shambaugh, Jr., M.D.,  the two physicians most responsible for the development of the application of allergy in the field of otolaryngology.

There are numerous other researchers who have contributed to the progress of Environmental Medicine in the world.  More details of these contributions can be seen in Environmental Medicine, Beginnings and Bibliographies of Clinical Ecology.  The field of Environmental Medicine has continued to be advanced by many other physicians such as Lawrence D. Dickey, M.D., who prepared and edited the textbook Clinical Ecology.

The Academy of Firsts


The founders and members of the American Academy of Environmental Medicine are recognized as the first to describe or the first organization to acknowledge…

  • Serial Dilution Endpoint Titration
  • Sublingual Immunotherapy
  • Optimal Dose Immunotherapy
  • Food Allergy/Addiction
  • Provocation/Neutralization
  • Avoidance/Reintroduction Challenge Testing
  • Rotary Diversified Diet
  • Chemical Sensitivity
  • Environmental Control in the Home, Workplace, and Hospital
  • Total Load Phenomenon
  • Chemically Less-Contaminated Foods
  • Sauna Depuration
  • Hepatic Detoxication Enhancement
  • Gulf War Syndrome
  • Endocrine Mimicry Disorders
  • The Role of Mold in the Development of Systemic Illness
  • Yeast Syndrome
  • CFID/FMS

Fellowship


The Fellowship process is designed to help prepare members to honorably promote, practice and defend the ideals of the American Academy of Environmental Medicine. To receive the designation of Fellow, a three-year pathway involving specified training, competent clinical application, and both written and oral examinations must be successfully completed. The AAEM member must finally be nominated and voted in by the AAEM membership as an indication of recognition by peers.

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