History of Allergy Shots: The 1911 Experiment That Started Immunotherapy

Most medical ideas begin by asking what a disease is. The history of allergy shots begins with a bolder question: what if the treatment for a pollen allergy was the pollen itself — measured, diluted, and injected in rising doses until the body stood down? In 1911, at St Mary's Hospital in Paddington, London, two physicians turned that question into the first systematic attempt at what the world now calls allergen immunotherapy. Their names were Leonard Noon and John Freeman, and the century of practice that followed is, in large part, a footnote to one short paper.

The timing matters. In 1911 there were no antihistamines — that story starts in the 1930s, and is told in our history of antihistamines. For a hay-fever sufferer of the Edwardian era, the medical cupboard held little beyond sympathy and a ticket to the seaside. Noon's idea was not a drug. It was a negotiation with the immune system, conducted one injection at a time.

Key takeaways

• In 1911, at St Mary's Hospital in London, Leonard Noon tested sensitivity with a conjunctival challenge, standardised doses in a unit of his own devising — the extract of a thousandth part of a milligram of pollen — and injected rising doses of grass pollen extract.
• Noon's theory — a soluble toxin in grass pollen — did not survive the decade, but his method did: test, measure, inject the allergen itself in graded doses.
• John Freeman, himself a hay-fever sufferer, carried the work after Noon's death in 1913, noting that relief could persist at least a year after injections stopped and publishing the first rush protocol in 1930.
• The proof took four decades: Frankland and Augustin's controlled trial in 1954, then Lowell and Franklin's double-blind ragweed study in 1965.
• In April 2014, the FDA approved the first sublingual immunotherapy tablets — the same allergen and graded logic, in a new delivery.

The history of allergy shots begins with a toxin that wasn't

Noon's reasoning was wrong in its detail and right in its direction. He believed hay fever was caused by a soluble toxin in grass pollen, poisonous to susceptible people in a way it was not to others. So he proceeded like a vaccinologist: he measured sensitivity by challenging the eye with pollen extract — the conjunctival test — and he standardised his doses in a unit of his own devising, the Noon unit, defined by the extract of a thousandth part of a milligram of pollen. Then, before the season, he injected patients under the skin with rising doses of the same extract.

In June 1911 — as the centenary review in the World Allergy Organization Journal records — "Leonard Noon demonstrated that prophylactic subcutaneous inoculation with a grass pollen extract was effective in suppressing immediate conjunctival sensitivity to grass pollen." His paper in The Lancet, "Prophylactic inoculation against hay fever," ran to barely two pages. The toxin theory would not survive the decade. The method — test, measure, inject the allergen itself in graded doses — is recognisably the ancestor of every allergy shot given since.

The idea had scattered precedents, and they sharpen what Noon actually contributed. Holbrook Curtis had written of an "immunizing cure" of hay fever in New York in 1900; in Paris, Alexandre Besredka experimented on animals with what he called anti-anaphylactic vaccination; in New Orleans, William Scheppegrell tried dried pollen powder in the nose in 1909. What none of them had was Noon's combination: a measured test, a defined unit, and a published series. The history of allergy shots is the history of that combination becoming a discipline.

Freeman carries it: the season of 1911, and after

Noon did not live to build the field he opened. Tuberculosis forced his withdrawal from practice, and he died in 1913. The work passed to his colleague John Freeman — himself a hay-fever sufferer — who reported on the 1911 season's treated patients in The Lancet the same year Noon published, and kept the clinic at St Mary's going for decades. Freeman's observations were the field's first lessons in its own limits: he noted that relief could persist at least a year after the injections stopped, and he was among the first to warn that apparent improvement might be the placebo effect or simply a light pollen season — a caution every allergy trial since has had to answer.

Under Freeman the practice grew up. The pollen extract was produced commercially, by the Parke-Davis firm, turning a hospital preparation into a distributable medicine. Freeman published a three-year follow-up in The Lancet in 1914, extended the method beyond grass to other pollens and animal danders, and in 1930 published the first rush protocol — injections every hour or two across a single long day to reach maintenance doses in days rather than months.

The case reports of those decades show a clinic steadily widening its net: alongside the grass extracts of 1911, Freeman's reports took in horse dander, house dust and even cod fish — the practice generalising from one man's hay fever into a method applied wherever an offending substance could be named, extracted and dosed. Not all of those extensions survived later scrutiny, but the pattern was set within the founder's own tenure: immunotherapy was never going to remain a grass-pollen procedure. What St Mary's had built was a platform — test for the trigger, extract the trigger, dose the trigger — and platforms get applied to everything. Across the Atlantic, New York's Robert Cooke took up the method early and built a leading allergy practice on it; in 1935 his group published serological evidence that treated patients developed a second, "blocking" antibody alongside the sensitising one — the first laboratory footprint of why the treatment worked, decades before the antibody that starts the reaction was itself identified in the story told in our discovery of IgE.

The history of allergy shots gets its proof: 1954 and 1965

For its first four decades, immunotherapy ran on testimony — patients reported better seasons, and doctors believed them, Freeman's placebo warning notwithstanding. The proof arrived, fittingly, from St Mary's again. A. William Frankland, who had trained under Freeman, joined with Rosa Augustin to run the field's first controlled trial, published in The Lancet in 1954: whole grass-pollen extract and its isolated main protein both outperformed the protein-free ultrafiltrate and the plain diluent. Frankland himself became the living bridge of the whole story, still practising in his ninety-ninth year.

Eleven years later, in Boston, Francis Lowell and William Franklin supplied the rigour and the specificity in a double-blind study in The New England Journal of Medicine: ragweed-sensitive patients on multi-allergen extracts were paired by severity, and for one member of each pair the ragweed was secretly removed from the extract, replaced with caramelised sugar. Only the patients still receiving ragweed did better — proof, about as clean as the era could make it, that the effect belonged to the allergen in the syringe and not the ritual around it.

Standard doses and a tablet: the old idea in modern dress

The post-war decades spread the practice worldwide and slowly professionalised its materials. Where Noon had brewed extracts by weight, regulators in the United States moved through the 1970s and 1980s to standardise allergenic extracts by measured potency, so that a dose in one clinic meant the same as a dose in another. The method also had to survive the arrival of the medicine chest described in our antihistamines history: once a pill could blunt the symptoms, the case for a course of injections had to rest on the one thing the pills never claimed — changing the underlying sensitivity rather than muting its effects. That it kept its place in the clinic, through the whole antihistamine era and into the age of the tablet, is the strongest testimony its first four testimonial-driven decades could have asked for. A second route matured alongside the needle: drops and tablets held under the tongue, developed in Europe from the 1980s and recognised in a 1998 World Health Organization position paper as a legitimate alternative form of the same idea. In April 2014, the US Food and Drug Administration approved the first sublingual immunotherapy tablets — a grass-pollen tablet on April 1, with a second grass tablet and a ragweed tablet following within the same month. The reviews marking the field's 111th year trace a straight line from Paddington to that approval: same allergen, same graded logic, new delivery.

The counts that Noon's patients could only record as ruined days now run daily and numerically for New York, Chicago, Houston and the rest of the map on the Pollen Atlas heatmap. Questions about your own symptoms belong with the allergy specialists who practise at the modern end of this history. This article is general information only and is not medical advice.

Frequently Asked Questions

When were allergy shots invented?

In 1911, at St Mary's Hospital in Paddington, London. Leonard Noon's paper in The Lancet, "Prophylactic inoculation against hay fever," ran to barely two pages; John Freeman reported on the 1911 season's treated patients the same year.

What was the Noon unit?

A unit defined by the extract of a thousandth part of a milligram of pollen. Noon measured sensitivity by challenging the eye with pollen extract — the conjunctival test — and dosed against that standard.

Who first proved allergy shots worked in a controlled trial?

A. William Frankland and Rosa Augustin, at St Mary's, in 1954: whole grass-pollen extract and its isolated main protein both outperformed the protein-free ultrafiltrate and the plain diluent. Lowell and Franklin's 1965 double-blind study added the specificity — only the patients still receiving ragweed did better.

When did under-the-tongue allergy tablets arrive?

The sublingual route was developed in Europe from the 1980s and recognised in a 1998 World Health Organization position paper. In April 2014, the FDA approved the first sublingual immunotherapy tablets — a grass-pollen tablet on April 1, with a second grass tablet and a ragweed tablet following within the month.

The history of allergy shots, in one arc

A wrong theory, a right method, two pages in The Lancet: that is the whole seed. Freeman's persistence made it a practice, Cooke's antibodies made it a mechanism, Frankland's and Lowell's trials made it a proven one, and standardisation and the tablet made it a modern one. The history of allergy shots is the record of an idea surviving its own explanation — the toxin vanished, the injections remained.

**Noon dosed by the thousandth of a milligram; you can check the whole country's count in a glance. Free pollen counts and 5-day forecasts, worldwide: PollenAtlas.com.**