William Frankland (allergist)

Alfred William Frankland MBE (born 19 March 1912) is a British allergist whose achievements include the popularisation of the pollen count as a piece of weather-related information to the British public, and the prediction of increased levels of allergy to penicillin. He continues to work, some years after turning 100.

Early life and education
Frankland was born in Battle, Sussex, England, to a "comfortably off" family, his mother's maiden name is West. He was born an identical twin; his brother, John Ashlin Frankland, died in 1995 at age 83. Frankland reports that the family doctor was ineffective, and this motivated him to do better himself. His childhood was spent in the Lake District and he attended St Bees School. He subsequently read medicine at The Queen's College, Oxford and St Mary's Hospital Medical School, now part of Imperial College London.

Military service
Frankland spent the war years 1939–45 in the Royal Army Medical Corps; three and a half were spent as a prisoner of war in Singapore. He was struck by how desensitised the Japanese prison guards were to native insect bites, later recalling that "Medically, as a prisoner of war, we saw conditions which are now unknown".

Post-war academic career
In 1946, Frankland began full-time work in the Allergy Department of St Mary's Hospital, London. He and his colleagues undertook a series of trials on between 25,000 and 30,000 patients, which proved that antihistamine tablets neither reduced nor increased the incidence of pollen asthma. Frankland has continued to contribute articles to academic journals beyond his official retirement and his 100th birthday.

Hygiene theory
Frankland believed that the rise in allergies results from increased cleanliness and the levels of hygiene in modern life; the so-called hygiene theory. He has said that "We don't set off our immune system early on, we are too clean. In the former East Germany for instance, with very poor work and housing conditions, people were less allergic".

Pollen count
Frankland was keen to provide patients he saw in London with information about pollens, such as the levels of pollen on any given day, and the times of year when levels would tend to be at their highest. St. Mary's Hospital employed a botanist to assist with collecting this information, and to complement the work on pollen counts already being measured in Cardiff. Weekly London pollen counts were sent to members of the British Allergy Society from 1953 and shared publicly, through daily news outlets, from 1963.

Self-experimentation
He was also a supporter of the idea of desensitisation, a technique which aims to reduce the level of immune response to allergens by repeated low doses of the substance to which the patient has an allergy. In 1955, Frankland experimented on himself by being bitten each day by the blood-sucking insect Rhodnius prolixus. He was assisted in this work by the London School of Hygiene & Tropical Medicine, which was able to supply insects which Frankland could be sure he had never previously been exposed to. The bites eventually provoked a severe anaphylactic reaction.

This research contributed to an understanding of how long injections of allergens would need to be given to achieve desensitisation. Results varied by individual, but immunity to pollen was found on average after three years. Immunity to venom-based allergens took longer, and immunity was found on average after five years.

Collaboration with Alexander Fleming
During the 1950s, Frankland served as a registrar to Alexander Fleming in the development of penicillin. The two had a daily meeting, but due to Fleming's lack of interest in clinical medicine, Frankland has said that he cannot recall a patient ever being discussed. Later, Frankland wrote a chapter on penicillin for a book edited by Fleming. Although largely content with the initial draft, Fleming is reported to have replaced Frankland's closing comment that "due to increased use, allergy to penicillin is expected to increase" with "due to increased purity [of production], allergy to penicillin is likely to decrease."

Frankland has since acknowledged that Fleming may have been "partly right" because the quality of penicillin production at the time was poor. In 1954, Frankland published "Prophylaxis of summer Hay-fever and Asthma". The article reported the results of a trial involving 200 patients with previous histories of grass pollen sensitivity half treated with active vaccines, and half with inactive 'control' vaccines.

The results suggested that the active vaccines were much more effective in reducing allergy symptoms than the controls. The study was notable for being the first in the field which used randomised, controlled methods and a standardised approach to every patient. The trial, along with his work on the pollen count, was one of the contributing factors to Frankland being awarded the EAACI Noon Award for significant contributions to immunotherapy.

Saddam Hussein
In 1979 Frankland treated Iraq’s then president Saddam Hussein. Contacted to visit a VIP in Baghdad having trouble with asthma, Frankland advised Hussein this was not the case and to give up his habit of 40 cigarettes a day. Frankland has said “To my lasting regret, I told him that was his trouble and that if he carried on, in another two years he wouldn’t be head of state. I heard some time later that he had had a disagreement with his secretary of state for health, so he took him outside and shot him. Maybe I was lucky.” Hussein was executed in Baghdad 30 December 2006 following the 2003 invasion of Iraq.

Retirement
Frankland retired from his job at St Mary's Hospital at 65, but was then offered an unpaid consultancy role in the Department of Medicine at Guy's Hospital. He worked at Guy's on this basis for twenty years on peanut anaphylaxis and paediatric allergies. After retiring from Guy's he continued to participate in academic life by attending conferences and publishing articles in journals.

In February 2012, Frankland appeared as an expert witness in a British court. The accused had claimed that a vehicle crash in which he was involved was caused by his losing control following a bee sting. Although Frankland agreed with the defence that such a scenario was possible, he gave an opinion that delayed-response reactions to bee stings only occurred after there had been initial symptoms following the sting. In this case there had not been such symptoms, and the accused was found guilty.

In 2015, he appeared in an episode of the BBC 2 TV series Britain's Greatest Generation and as a guest on BBC Radio 4's Desert Island Discs. In June 2015, at the age of 103, he was awarded an MBE for services to allergy research. In July 2015 he was the oldest recipient of the badge of the Order of Mercy.

Frankland continues to publish; at age 100 he authored "100 years of allergen immunotherapy", and most recently co-authoring, "Flight Lieutenant Peach's observations on Burning Feet Syndrome in Far Eastern Prisoners of War 1942–45" in the journal QJM in 2016.

British Society for Allergy and Clinical Immunology
In 1948, Frankland was instrumental in the creation of the British Association of Allergists. The speakers at the Association's inaugural meeting included Sir Henry Dale, pharmacologist and chairman of the board at the Wellcome Trust, and Dr. John Freeman. In 1962 the Association became the British Allergy Society, and Frankland served as president between 1963 and 1966. The society became the British Society for Allergy and Clinical Immunology (BSACI) in 1973.

International Association of Aerobiology
Frankland is a founder member (in 1970) and president.

Anaphylaxis Campaign
Frankland is president of the Anaphylaxis Campaign, the UK charity for severe allergy issues.

Legacy
The William Frankland Award for Outstanding Services in the field of Clinical Allergy is awarded each year at the annual meeting of the BSACI. The allergy clinic at St Mary's Hospital is named after Frankland.