The Riddle of Red-Eyes and Runny-Noses

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Penultimate Show, this series, Curios, and this one's it's a real snoozy diesel.

Snoozy Deezer.

Yep, that's what I'm going with.

Okay, make it happen.

Here we go.

Stop trying to make sneezy doozo happen.

It's now a thing.

Snoozy doozings is a thing.

Let me have it.

Okay.

Sneezes, wheezes, runny noses and red eyes.

Today's episode is apparently all about the seven dwarfs.

No, it's about allergies.

We have got an inbox full of questions about these debilitating symptoms brought on by everyday stuff like pet hair, peanuts and pollen.

I don't think I've ever asked you actually Adam if you're allergic to anything.

Well, for the longest time, there's been an assumption in my family that I'm allergic to penicillin.

But I've no idea whether that's true or not.

Well, guess there's only one way to find out.

You know what?

I'm not super keen to actually do that.

But I'm not the only one.

Our inbox was absolutely crammed full of these questions.

Jess Newell wrote to us because she suddenly developed a severe allergy to banana and kiwi fruit at the age of 21.

Wants to know why that happened.

Meanwhile, Ali Thomas, who is a mum of two young'uns who both have allergies, she's wondering if allergies really are on the increase or whether we're just better at diagnosing them.

And Anita Desar is interested in whether allergies result from some kind of evolutionary advantage that they once provided.

Well, thankfully we have two experts in to help us.

In the studio we have Adam Fox, Professor of Pediatric Allergy at Everline and London Children's Hospital.

And we also have Judith Holloway, Professorial Fellow in Allergy at the University of Southampton.

Okay, Judith, so let's assume for a moment that Adam is allergic to penicillin.

What does it actually mean to be allergic to something?

What's happening inside your body

when you have an allergic

So when you're having an allergic response to something, it means that your immune system is seen something that's foreign and something that's harmless and made a response to it as if it's something that's foreign and harmful, like a bacteria or a virus or a parasite or something like that.

So your immune system will then see, let's say, peanut, egg, milk, and mount an immune response.

And that means that for the very quick thing like the anaphylaxis like the very quick immune response cells are degranulating which means they're kind of popping and bursting and releasing all their goodies which are the things that cause you to have the symptoms the swelling the wheezing the runny nose but your immune system will have seen whatever it is you're allergic to before it can't have that immune response the very first time you see it so before that it will have laid the ground and it will take you know a couple of weeks in order to be able to make that immune response the second time you see something.

Why does it get confused though?

Why does it mistake something that's harmless for something that's harmful?

Yeah, and this is just about the million dollar question.

It's partly down to two things.

So it's partly your genetics.

So if you have a family history of being allergy, like your mum has allergies, your grandparents, your siblings and so on, then you have a genetic makeup that makes you more susceptible to have allergies.

It doesn't mean you're going to become allergic, but you have that likelihood, that background genetic makeup.

And then the second thing that will happen is that, let's say when you come across that peanut, that grass pollen, that house dust mite, whatever it might be, there's...

Something that happens that confuses your immune system.

So let's say there's a little bit of danger around.

Perhaps at the time that you come across grass pollen, you might have a little bit of a virus in your chest.

And so your immune system gets confused because it sees the danger signals coming from the virus and it sees the grass pollen and it thinks aha that's the foreign dangerous thing and I need to mount an immune response so I better do something.

It's like a bit of a case of mistaken identity.

Yeah, it's all your brilliant immune system that works fantastically most of the time.

Just getting slightly confused and just going slightly wrong.

Okay, Adam Fox, not Adam Rutherford, because that's me speaking.

This is going to get confusing.

It'll be weird for me to address the question to myself, although it does happen.

Adam, when do we first develop, though?

How do we first develop allergies?

So for a lot of people, it will happen very early on.

And as Jude's already alluded to, if you've got that genetic tendency, patients will often go through what we call the allergic march or the atopic march.

And this is a progression of conditions that you see commonly in people with allergic genes.

So the first sign will be in early infancy developing eczema.

Now, if you've got eczema in early childhood, that very much predisposes you to developing food allergies.

And whilst as those kids get a little bit older, the eczema will often get better.

If they're lucky, they'll outgrow their food allergies.

Sometimes they do, sometimes they don't.

But it's those same kids who will then present a few years later to the clinic with wheezy episodes, hay fever, cat allergies, dust mite allergies, and asthma.

And the numbers on that?

What sort of proportion of people on average?

In the UK, 20% of kids will get a degree of eczema, but then, of course, it's a much smaller group who get significant eczema.

5% of kids will get food allergies.

Most of them are outgrown during early childhood, so the common things like allergy to to milk and egg get better usually.

So in adulthood, food allergies are less common.

But asthma is as common as 20%, hay fever, allergic rhinitis, 25%.

These are really, really common chronic conditions.

Okay, now, look, I'm absolutely terrible at immunology.

I'm not bad at genetics, though.

And so you mentioned that there's

an underlying genetic cause.

Do we know the actual biochemical pathways that are being triggered here and the genes involved?

I think we're at the beginning of that journey.

So there are genes emerging that clearly contribute to things like asthma and eczema, but it's way more complex than that.

And I think increasingly over time we're moving away from the hygiene hypothesis, which is one that always gets trotted out.

And everybody says, you know, you can imagine being an allergist, going out to dinner parties.

It's the same questions every week.

Why is there more allergy around?

And everybody thinks they know.

They think it's because, oh, we're a lot...

cleaner than we used to be and so now that our immune systems aren't challenged they've got to find something else to do so you become more allergic.

It's got big holes in that theory.

So essentially it comes from a finding in the 1980s in large birth cohort studies that suggested that the older kids, the first child, was more likely to get hay fever.

And so the idea is, is that he has less immunological challenge because he's not got older siblings bringing all the germs and bugs back home.

The younger kids do because their older siblings are bringing nasty things back from nursery and hence the younger kids, more mature immune systems, less likely to get allergy.

But it falls down when you notice that actually in other birth cohorts, the older child isn't the one that's most likely to have hay fever.

It's yeah, it's not a consistent finding and we've really moved on from that, although it's just entered the public consciousness and it's just not moving.

We're now far more interested in microbiomes, in the impact of our gut flora, for example, in the way that we develop our relationship with the outside world.

It clearly has an important role to play together with genetics and numerous other factors and environmental exposures with what you end up becoming allergic to.

It's an interesting and attractive idea that, you know, it's sort of associated with the idea that, you know, kids are stuck in front of their screens, they're not going out enough, they're not going playing in the mud enough, so they're not being exposed.

And is that, do you think, one of the reasons why people really latched onto the I think it just plays to a very simplistic view of the world.

So, for example, there was always this sense that it was a Western phenomenon, which it's not.

Actually, people just weren't doing studies in Southeast Asia to look for food allergies, hence they weren't finding it.

So there's this perception that you only get, you know, it's only in the US, Australia, and the UK that you get lots of food allergies, they don't get them in China.

Well, they do.

Actually, the prevalence isn't far off what it is here.

Likewise, you only have to look at places in the world, Switzerland, for example, where infant mortality and infections are very, very low, very clean place to live.

Where are they on the allergy table?

They should be top by a mile, but they're not.

They're nowhere near.

In fact, it's interestingly, it's English-speaking countries that seem to be leading the way.

Canada, New Zealand, Australia, UK, US.

I think it's the language which is causing this.

Have I misinterpreted what you're saying?

I suspect as a scientist, you'll know that we're talking about confounding factors here.

That is an important point, though, actually.

I know that Adam was joking there about being allergic to allergy.

But can you be allergic to anything?

I mean, can you be allergic to...

There are people who are allergic to sunlight, aren't there?

That's vampires.

Ignore this, man.

There are people who are allergic to sunlight.

Well, no, there's people who will come out in hives when they go out in the sunlight and have got a rare condition called solar reticaria that's not allergic in nature.

Allergy just, you know,

it gets banded around a lot for things that it doesn't relate to.

This is absolutely crucial to this discussion because we spent a lot of time when we were prepping for this program

well discussing whether I'm allergic to penicillin whether Hannah has any allergies can you be allergic to anything Hannah talks about how she is allergic to orange juice and mosquito bites and I intuitively having a tiny bit of knowledge about this thought I'm not sure that's correct he's he's gaslighting me on my on my allergies they allergies well

Okay, putting me in a different...

I've got these two guys looking at me here, and I know they both want me to agree with each of them.

It would want to hear the full stories, but chances are, I'm going to stick my neck out and guess that you've probably got papillarticaria, which is a condition where when you get bitten by mosquitoes or other insects, you get these enormous, unpleasant bumps very, very quickly that do get better with antihistamine.

And yes, they are a hypersensitivity reaction of sorts, but we wouldn't really call them classic allergy.

I wouldn't say you are allergic to mosquitoes, and there's certainly not risk of anything nasty happening.

Okay, though, hang on, Judith, you need to back me up on this.

Because if you're taking antihistamines, aren't antihistamines supposed to be for when you have an allergic reaction to something?

So the cells that I was talking about earlier on that burst and release their granules and release their pre-formed mediators, in those pre-formed mediators, one of the mediators that they have in them is histamine.

And so that's why when they release their goodies, that's why antihistamine is so effective because it's calming down that histamine and it's taking that out of the equation.

Antihistamine is working, but it's not working on the allergy.

It's working on the cell that released the goodies and the goodies contained the histamine.

Adam's pointing to his own smug face right now.

He is.

So, look, peanuts create an anaphylactic shock if you are allergic to them, but not orange juice, Hannah, although it is only on a technicality.

Judy, can I stick my aura in here?

Yes.

So, the technical point here.

Is this in my favour?

Because I'm not going to be able to do that.

It's so in your favour.

I think you might have got a really bum deal here.

I always do.

We might be missing a genuine life-threatening allergy here.

So interesting concept, cross-reactivity.

So sometimes you can be allergic to one thing, and as a consequence, when your immune system sees something else that looks a bit like it, you can react to that as well.

I've got patients with cashew nut allergies.

That's the most common tree nut allergy.

About one in 50 kids will have tree nut allergies.

If you're allergic to cashew and pistachio, a significant number of those kids are also allergic to the pips of citrus fruits.

And so I have had kids who have had full-on anaphylaxis after having some fresh orange juice that contained one of those pips and it turned out it was due to cross-reactivity so this could be a thing i think we might have dismissed that a little early how do you feel about cashew nuts eat them all day every day

you've missed that

what hannah just said about the cashew nuts eating them all day every day that's really important for your immune system because um we talked about how your immune system can be sensitized to something.

So the first time you see it, your immune system takes two weeks and it starts making your allergic antibody and you're sensitized to it and that's very very different from actually having clinical symptoms to allergy so some people are sensitized but their immune system then doesn't get triggered by it and if you're sensitized to something but you can eat it safely and you don't get any clinical symptoms it's really important to keep on eating it keep your immune system kind of schooled almost that your immune system knows to ignore it if you stop coming across that, actually your immune system then can then forget that it's safe.

And I'm one of those people that

in the early days of allergy, not really understanding it, got that advice because I was sensitized to peanut, but I ate it every day, a bit like Hannah eats the cashew.

And I was told to stop eating it.

This is 20, 30 years ago.

Stop eating it and your eczema will clear up.

So I did.

And my eczema didn't change, nothing happened.

And then three months later, I thought I'd have a little chocolate bar with peanuts in it and nobody would notice.

And I would just have that because I love peanuts.

And then I had full-on anaphylaxis.

And that is because my immune system, because I wasn't exposing it to it, it had forgotten that my peanut was safe.

So Hannah, keep eating the cashew nuts.

I'm going to eat nothing else now.

Can you eat peanuts now?

Or is it gone forever?

No, now I have EpiPens.

And actually, going back to what Anna said about cross-reactivity, I also have anaphylaxis to latex.

And that cross-reacts with various foods like avocados.

So for example, there are some foods I can't eat because of that.

It's very frightening.

I can only imagine walking around and knowing that that's

a potential event.

The allergies that we've been talking about so far in terms of latex and peanut allergy, I think these are ones that are all sort of in the public consciousness.

But Adam, are there slightly more unusual ones?

You sort of become allergic to what's going on around you.

So if you're brought up in an Indian household, you're more likely to be allergic to chickpeas than you are to be allergic to peanuts.

In the Middle East sesame allergy is really common.

In Singapore one of the most common reasons for food causing anaphylaxis is bird's nest and it's because those are the allergens that are around.

From bird's nest soup, the one that's that's made with real bird's live, eh?

Yeah, that's right.

I think it's swallows that make these little nests that then get collected and it's a delicacy and

yeah, eaten pretty widely in Southeast Asia.

It's delicious.

Are there any others that you've come across?

Most people are allergic to the usual suspects, but I had a kid who I I saw not so long ago, actually, who was allergic to caviar,

which seemed slightly remarkable.

I was impressed with it.

And I had to have had it twice.

And had it at least twice, but then actually, the story that ended with the allergic reaction did involve a private jet, a yacht.

And yeah, it was a remarkable story.

That is the most middle-class allergy I've ever come across.

I'd say if it's private jets, a monocle, it's more upper class.

Yes, I completely agree.

I don't know what sort of middle class you are.

Now, listen, I just want to bring us back to one of the original questions, which was from Jess, which is that she was particularly upset that she developed an analogy to pretty common fruits, banana and kiwi, but only at the age of 21.

So why does that happen spontaneously at a moment in your life when you're, you know, a grown-up?

So this reflects nicely actually what Jude was saying earlier about the possibility of cross-reactivity, because that's likely what's happening here.

So, there's different windows during your,

I guess, immune evolution where allergies can develop.

So, the first will be when you're very little, and that's when you're most likely to develop allergy to milk, and egg, and peanut, and foods like that.

Then, as you get older, it's more about respiratory allergens, and you might very commonly become allergic to pollen, and then you start getting this risk of cross-reactivity to pollens.

And this is much more common than I think people realise.

I see this all the time in my clinic.

So, people that have had pollen allergies, so hay fever for a couple of years, they start to notice that foods that they were absolutely fine with for years on end classically stone fruit so apples pears peaches plums kiwi but sometimes nuts hazelnuts and almonds suddenly are giving them symptoms but only in the raw form so if they have an apple pie absolutely fine but if they have raw apple there are pollen that proteins in there that look identical to birch pollen for example and if you're allergic to birch pollen when you put them in your mouth your immune system will think oh we've just had a mouthful of pollen and it will cause a reaction it's very very rare for it to cause severe reactions.

It's usually a mild tingling sensation, but it's unpleasant and it starts taking things off the menu.

And actually that list of things can start becoming really problematic.

Loads of fruits and vegetables start becoming an issue.

So we call it pollen food syndrome and pretty common in people with hay fever.

Do you know what?

My dad, this, my dad, he's had hay fever all his life at the age of 65.

being a great banana lover develops an allergy to bananas he was heartbroken and you've just explained it sorry dad it's your immune system.

But it's another case of mistaken identity, though, right?

But it's like layers and on layers and layers of mistaken identity.

That's exactly what it is.

Turns out the immune system is wickedly complex.

Who'd have thought it?

Okay, then, so allergies are specifically caused by the immune system producing a whole cascade of molecules in response to actually harmless substances, and that cascade includes all sorts of things like immunoglobulin E, which I can't say because it turns out I am allergic to immunology.

Okay, and you were the one who was pedantic about my orange juice.

Okay,

if we go back to Ali's question at the beginning, it brings up something that you were talking about, Adam Fox, which this idea that we all accept that allergies are now much more common.

Is that definitely true?

Are we just better at diagnosing them?

I think it depends on your time scale.

Are there more allergies now than there were 100 years ago?

Yeah, absolutely.

I think we could be confident.

In fact, if you look at the history of hay fever, it's remarkable.

So if you go back to, I think it's the beginning of the 19th century, there was a pediatrician called Jonathan Bostock who had what turned out to be hay fever.

So he realized that he got these reproducible symptoms consistent with the pollen season.

It took him nine years to find the other 28 cases that he wrote up in the Lancet.

Now, average group of UK adults, 25% of them, have got a pollen allergy.

So something has changed dramatically.

It can't just be genetics in that space of time.

So yes, over the course of decades, we're seeing more eczema, we're seeing more asthma, hay fever, all of that.

But a lot of people seem to be under the impression that we're on this steep incline of allergy prevalence that is still going on.

And I don't think there's any evidence for that at all.

If you look over the past 10 years, I don't really think I've seen anything that convinces me that there's more food allergy now than there was a decade ago.

And I think there is better perception of it.

This seems to be one of those situations, Judith, in science where we can observe that something is happening, but we're not quite at the point where we are certain of the reason why.

Are there other theories as to what might be going on?

I mean, to be honest, I've been working on the immunology of allergy for 20, 30 years now.

And the more I feel I know, the less I feel I understand it, the more complex it gets.

And like Adam was alluding to, the hygiene hypothesis, the allergic march, all of these sort of theories come along and we explore them all.

And I don't think there's one thing that is ever going to explain allergy.

It is just so complex.

We talked about the genetics earlier on.

It's not simple because there's not one allergy gene.

It's a complex disease with loads of genes involved.

So I don't think there's ever going to be one theory that fits what's happening with allergy.

Okay, Adam Fox.

It sounds like that, you know, the immune system is wickedly complex and the environment is wickedly complex and you combine the two things together and it's wickedly complex squared.

What other factors might be involved?

I'm pretty sure that there are a whole raft of these sorts of things.

And I think a good analogy here would be around infant feeding practices and food allergy.

We know, for example, from very robust studies now that early introduction of specific food allergens such as peanut into the infant weaning diet can markedly reduce the risk of peanut allergy developing.

Whereas what had happened previously is these allergens were finding their way into the infant diet later and later.

We were doing less breastfeeding, which of course is a disaster immunologically.

Babies are designed to develop their immune system alongside that exposure to all the immune factors that are present in breast milk.

So there's a whole range of different things alongside

countless other environmental factors that are almost certainly interrelating to these genetic components and changing things.

And exactly as Jude said, the more you look at it, just the more complex it gets.

Of course, many women can't breastfeed or choose not to.

What can they do to reduce the risk of increased susceptibility to allergies?

That's an excellent question because, of course, often people find themselves in that situation.

And I think if there is a clear allergic tendency, if your infant has got eczema,

then getting some advice about early introduction of allergenic foods into the diet would probably be a sensible place to start.

I want to come back to that idea about hygiene, though, and about how you need

a whole range of germs and parasites for your body to function properly, and that's a good thing.

But then, okay, so this goes back to Agnitha's question.

Because did these allergy responses evolve in the first place, Judith?

Allergy is a misdirected immune response, and really it is the perfect immune response for parasites.

So if you think about getting a parasite into your gut or your lungs or your nose, I don't know why you'd get one up your nose, but let's say you did.

Like a worm are we talking about here?

Like a worm.

I'm fine with this.

I'm sure at some point in history, somebody has sniffed up a worm or two.

What your immune system is going to do is your mast cells will degranulate, they'll release histamine.

That's going to cause things like swelling, redness, heat.

It's going to stimulate your nerves.

So your nerve endings are going to get itchy.

And it's going to stimulate your cells lining your nose to make mucus.

And that mucus is going to be really runny and it's going to get quite sticky.

And so all of those things are brilliant ways of your body keeping the parasite out.

Because you imagine runny, sticky, itchy nose.

That's a physical way of getting the parasite out.

We now have those very same symptoms causing allergies.

I guess this is particularly important if you think historically when these things were much more common.

Adam, I know that this is Adam Rutherford.

This is, I mean, maybe it's up your street too, Adam Fox, who knows?

But there was a study that I saw in the news recently about some medieval monks and their bodies were like riddled with worms.

And they think that it's because uh they used to use human feces as like garden manure to sort of fertilize the the gardens yes although i i don't think there's any evidence that they actually snorted them as judith was and i bet none of them had peanut allergy and they probably didn't have peanut anyway the point is that worm infections and and and general pathogens were very common in the past and they still are in in some countries now we actually spoke to rick maisels professor of parasitology at university of glasgow and he explained to us how parasitic worms called helminths could potentially help us develop new treatments to prevent allergies.

So helminths are worm parasites which live in various parts of the body.

They can live in the intestinal tract and a classic example there is the hookworm which literally holds on to your the insides and sucks blood and our immune system can eliminate them and it uses a pathway which is very similar to the reaction that causes allergy.

Some Dutch scientists made a fascinating observation that children with these Helmith parasites, they were called schistosomes, these children had lower levels of allergy.

And then when they were treated for their schistosome infections, their allergic propensity increased.

So there was some idea that the parasites were able to switch off the immune system to protect themselves, and by switching off

that immune reaction it dampened allergy.

So our group has really been trying to pin down what the pathway is that could possibly account for parasites being able to block allergic reactions.

Can we find essentially a new drug based on parasites that will switch off the immune system?

And we have found two products, one of which for example seems to intervene at the very first step where the body is sensitized and begins to react to an allergen.

And we found a second one that seems to act later on.

Whether they will work in the human body is a big question and that's probably going to take a five to ten year period but we're way ahead of where we were ten years ago.

Good progress has been made.

I've been reliably informed by my

local friendly evolution expert namely Adam Radford.

Hello.

That when it comes to evolution, parasites and their hosts have a bit of an arms race.

The immune system develops some kind of weapon against them and then they develop something else and so on and so on and so on.

What do you think of this then, Adam?

Do you think that

you can harness this idea to help immune responses?

I think it's a really nice analogy because when it comes to that arms race, I think our immune systems don't know that they've won and that the parasites really don't have a chance anymore because we just don't come across them anything like as often, but it's still trying to act as though they do.

And I often say to patients that, you know, what the purpose of our immune response is, if you imagine you've got scabies, which is those little parasites that burrow onto your skin, they cause the release of histamine.

It makes you really itchy.

And it makes you want to literally dig the parasite out.

So you're doing exactly what you should do.

For years, we've been seeing these studies of people trying to get patients to swallow worms and eat worms and put worms up their noses and do all sorts of things in order to make their allergies better.

It always makes me worry when

if after 50 years of doing it, we still haven't got anything out of it, is their mileage.

But I think we're doing it in a dramatically more scientific way now.

And I think there's legs there.

Okay, well, that brings us to the sort of end sort of idea that we really need to address, which is if you're a parent and if you're worried about your children, that either they have allergies or they're at risk of developing them, what are the things that we should be doing as parents to prevent our kids from getting allergies?

Well, I think the first thing is not worry too much.

One thing you can say about allergies is that they are definitely over-perceived.

Most people who think that they've got allergies, who think their babies have got food allergies, it usually turns out they haven't.

In terms of children who are otherwise very well, but there's a strong family history of allergy, then online you can get really good advice about

introduction of allergenic foods.

The public health guidance is very clear: don't delay the introduction of things like egg and peanut and sesame into the weaning diet.

It doesn't help, and if anything, it may increase the risk of allergies developing.

Well, thank you very much to both of our guests, Judith Holloway and Adam Fox.

So, Dr.

Rutherford, when it comes to the case of the wheezy snoozes, can we say case of?

Yes, Professor Fry, your body can go nuts in response to all sorts of things that should be non-toxic, but an immune reaction is what makes it an allergy.

For most people, allergies are mild irritants, but for some, they can be extremely dangerous.

You can acquire them late in life, which sucks.

And they do appear to be increasing, especially when exacerbated with other pollutants.

Or putting worms up your nose, which we do not advise.

Well, that was a real sneezy doozer of an episode.

It was.

It was snoozy doozings.

I really enjoyed that.

I thought that was a terrific programme.

They're all terrific, but that was a terrificer one.

I

learnt a lot of things that I didn't know.

Yeah, me too.

Mainly about myself.

So it's really interesting that, isn't it?

Because I intuitively, I didn't study immunology much at university, but I did do it.

And

when you were telling me about your reaction to mosquito bites and orange juice, I was thinking, I don't think that's technically an allergic reaction, but I didn't want to totally gaslight you on a very popular Radio 4 programme.

You didn't want to, and yet you did.

You know, that thing you've got, it's not an allergy.

It's not even a problem.

I, I, like, allergy smells.

I mean, I don't really, I think I really take the point about

intolerances not being allergies.

But I think if you are, if you are, if you have a massive welt on the side of your face,

you don't want some guy coming up and saying, actually, I think you'll find that's not an allergy.

Excuse me, that wasn't mediated by the immune system.

Oh, people will write in.

They will.

No, I accept that.

And I'm sorry for apparently gaslighting you because you were wrong about something.

No, no, it's absolutely fine.

I mean, I'm used to it.

Yeah, sure.

No, it is a really serious, you know, allergies are really serious.

And we do, you know, we have to tread the line between trivializing a bit of an itchy runny nose.

A friend of mine, his son is severely allergic to peanuts and has gone through a huge clinical process of

relieving him of this, which involved sort of weaning onto peanuts.

As in teeny, tiny bits of micro-dosing peanuts.

Yeah, which

seems so straightforward, but actually it's really worked.

And now

he's not allergic to peanuts anymore.

But it did involve him going to a clinical practice and being given M ⁇ Ms.

You know, you want some sort of high-tech drug, but actually it's like, try half an M ⁇ M this week.

Next week, come back, you get a whole one.

It's like, ooh, this is great.

Adam Fox, our guest in today's programme, told us about how he'd had a patient or parents who'd claimed that their children were allergic to mobile phones.

But not like contact allergy, not like they were talking on a mobile phone and there was nickel in the phone and it like allergic to their skin.

It was the

they came out in hives whenever a phone call was made.

I mean he didn't do the randomized control study where he got a thousand phones and placed them near the poor child's head.

But that neatly brings us on to Curio of the week.

Does it?

Oh yes it does.

I have the slight advantage that I read the next line.

Oh, no, wait, no, no, no, no, no.

I've got something else.

I've got something else to talk about, another agenda item before we get to cure of the week.

Because you've got a new job, haven't you, Adam?

I have.

I took up a position as lecturer in my department, in the genetics department at UCL.

And you think this would be a moment of me congratulating you, wouldn't you?

It's not.

It's a moment of me telling a story about something that happened in your

department.

Oh, what?

So what you should know, listeners, is that when you work for an academic institution, they try and keep an a

track of all of the public engagement that you're doing right every time you go out and you speak to an audience of 10 people or 100 people

you're supposed to kind of record it so that they can tell that you're out there engaging with people.

And I told you this in private.

This wasn't to be shared to our 1.2 million listeners per episode because that's the problem.

Okay, so Adam got sent an email when he joined his news department.

He got sent an email saying, as everybody did, saying,

please, can you send us a list of all of the public engagement activity that you did over the last year, including the audience size?

And Adam replied saying,

okay.

I mean, okay.

Do you seriously want me to do this?

Is this really what you want me to do?

The Excel spreadsheet that they sent over had 10 lines on it.

And they replied to Adam saying, yes, no, no, you really need to do this.

All staff need to do this.

So Adam was like, okay, rolls up his sleeve and goes through, writes this list of every every single radio appearance that he's done, every single episode of Curious Cases, all of the audience numbers.

How many per episode?

Over a million an episode.

Every episode of Six Music, the slot that Adam and I share over there, and

every episode of Start the Week, which Adam now presents.

Our professional science communities, we do this a lot.

We do.

I mean, there's a lot, right?

Totes it all up over the course of an entire year, comes to hundreds of millions of people.

That is like, okay, sure, fine.

I mean, well done you.

When Adam sends this back to the departmental administrator, as he was requested to do, would you like to know what he did?

He hit reply all.

Reply all.

Accidentally, it was the moment of, I mean, the moment I'd done it, I thought, oh, God, what have I done?

I look like such a

colossal jerk doing this.

Yep.

But it was too late.

Because I put in the note, are you shocked?

You know, I didn't know how to assess the audience numbers because Start of the Week has 4 million listeners per episode.

right?

Send it to all the professors of the department.

I mean,

I really like that story.

Of all the reply-alls you could get wrong.

So, there you go, basically, started a new job, and one of the first things I did was

demonstrate quite what a jerk I am.

Really pleased with that.

Look, if they were among the hundreds of millions of your listeners, they would have known already.

And now we've further, further, the circle continues now that we've advertised this in another show which has millions of listeners.

Let's do Curia of the Week.

Dear Dr.

Rutherford and Professor Fry, in the episode Aural Voyeur, you mentioned creating your own 21st century phone etiquette handbook.

Do you remember this?

Because they want, we need this, we desperately need this.

And Megan Bridges, age 12, wrote in and she said, so I thought I could try and make one for you.

Hope you like it.

I've attached some images from the page.

Your avid listener.

P.S.

I listen to your podcast every night and I love it so much.

Well, this is absolutely brilliant.

So Rutherford and Fry's 21st Century Phone Etiquette Handbook.

That's the cover.

Do you want to know what rule number one is?

One must be trousered while on the phone.

It is impolite to go out and talk to people with no trousers on, so why would it be any different on the phone?

Trousers will be required at all times whilst on the phone, and anyone found disobeying this rule will face serious consequences.

Rule number seven is interesting and relevant to today's discussion.

Don't worry about catching diseases over the phone.

It's impossible.

Correct?

She's good.

She's good.

There are, I mean, there's lots of, there's rule number two is one must not eat when on the phone.

Rule number three, one must not drink when on the phone uh and

rule number four which frankly should have been rule number one was you one must not call people when on the toilet yeah that is a rule megan that doesn't need to be expanded on there's two paragraphs following that and whilst you're absolutely right i just think it's such a fundamental law

don't be on the loo whilst on the phone i think it depends who you're on the phone to i do not and i'm putting my foot down on this i think this is a cast iron absolute rule that needs no further qualification.

Don't speak to people on the phone whilst on the loo.

Yes,

I think that's probably fair.

Well, that was wonderful.

Thank you very much for sending that in, Megan.

We enjoyed it enormously.

You are Curie of the Week.

Thanks to all the listeners at Curios.

This is the Penultimate episode in this current series.

We will be back in January.

We have been reliably informed, although we have no idea what's going to be in that program, that series at all.

Next week, we're doing nuclear fusion.

So, all that remains is for us to invite you to send in your Kyrios to Curios Cookie because we're going to go ahead and give a doo-boo.

I mean, if they don't know it by now, they're never going to, are they?

Exactly.

And we will see you next time.

Hey, if you listen to iHeart K-pop with JoJo, let me say thank you and turn you on to something.

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