Allergy
Classification and external resources
Hives are a common allergic symptom.
ICD-10	T78.4
ICD-9	995.3
DiseasesDB	33481
MedlinePlus	000812
eMedicine	med/1101
MeSH	D006967

An allergy is a hypersensitivity disorder of the immune system.^[1] Allergic reactions occur when a person's immune system reacts to normally harmless substances in the environment. A substance that causes a reaction is called an allergen. These reactions are acquired, predictable, and rapid. Allergy is one of four forms of hypersensitivity and is formally called type I (or immediate) hypersensitivity. Allergic reactions are distinctive because of excessive activation of certain white blood cells called mast cells and basophils by a type of antibody called Immunoglobulin E (IgE). This reaction results in an inflammatory response which can range from uncomfortable to dangerous.

Mild allergies like hay fever are very common in the human population and cause symptoms such as red eyes, itchiness, and runny nose, eczema, hives, or an asthma attack. Allergies can play a major role in conditions such as asthma. In some people, severe allergies to environmental or dietary allergens or to medication may result in life-threatening reactions called anaphylaxis. Food allergies, and reactions to the venom of stinging insects such as wasps and bees are often associated with these severe reactions.^[2]

A variety of tests exist to diagnose allergic conditions. These include placing possible allergens on the skin and looking for a reaction such as swelling. Blood tests can also be done to look for an allergen-specific IgE.

Treatments for allergies include avoiding known allergens, use of medications such as anti-histamines that specifically prevent allergic reactions, steroids that modify the immune system in general, and medications such as decongestants that reduce the symptoms. Many of these medications are taken by mouth, though epinephrine, which is used to treat anaphylactic reactions, is injected. Immunotherapy uses injected allergens to desensitize the body's response.

Signs and symptoms[link]

Many allergens such as dust or pollen are airborne particles. In these cases, symptoms arise in areas in contact with air, such as eyes, nose, and lungs. For instance, allergic rhinitis, also known as hay fever, causes irritation of the nose, sneezing, itching, and redness of the eyes.^[3] Inhaled allergens can also lead to asthmatic symptoms, caused by narrowing of the airways (bronchoconstriction) and increased production of mucus in the lungs, shortness of breath (dyspnea), coughing and wheezing.^[4]

Aside from these ambient allergens, allergic reactions can result from foods, insect stings, and reactions to medications like aspirin and antibiotics such as penicillin. Symptoms of food allergy include abdominal pain, bloating, vomiting, diarrhea, itchy skin, and swelling of the skin during hives. Food allergies rarely cause respiratory (asthmatic) reactions, or rhinitis.^[5] Insect stings, antibiotics, and certain medicines produce a systemic allergic response that is also called anaphylaxis; multiple organ systems can be affected, including the digestive system, the respiratory system, and the circulatory system.^[6][7][8] Depending on the rate of severity, it can cause cutaneous reactions, bronchoconstriction, edema, hypotension, coma, and even death. This type of reaction can be triggered suddenly, or the onset can be delayed. The severity of this type of allergic response often requires injections of epinephrine, sometimes through a device known as the EpiPen or Twinject auto-injector. The nature of anaphylaxis is such that the reaction can seem to be subsiding, but may recur throughout a prolonged period of time.^[8]

Substances that come into contact with the skin, such as latex, are also common causes of allergic reactions, known as contact dermatitis or eczema.^[9] Skin allergies frequently cause rashes, or swelling and inflammation within the skin, in what is known as a "wheal and flare" reaction characteristic of hives and angioedema.^[10]

Cause[link]

Risk factors for allergy can be placed in two general categories, namely host and environmental factors.^[11] Host factors include heredity, gender, race, and age, with heredity being by far the most significant. However, there have been recent increases in the incidence of allergic disorders that cannot be explained by genetic factors alone. Four major environmental candidates are alterations in exposure to infectious diseases during early childhood, environmental pollution, allergen levels, and dietary changes.^[12]

Foods[link]

One of the most common food allergies is a sensitivity to peanuts. Peanut allergies may be extremely severe, but can sometimes be outgrown by children school-age.^[13] Tree nuts, including pecans, pistachios, pine nuts, and walnuts, are another common allergen. Sufferers may be sensitive to one, or many, tree nuts.^[14] Also seeds, including sesame seeds and poppy seeds, contain oils where protein is present, which may elicit an allergic reaction.^[14]

Egg allergies affect one to two percent of children but are outgrown by about two-thirds of children by the age of 5.^[15] The sensitivity is usually to proteins in the white rather than the yolk.^[14]

Milk, from cows, goats, or sheep, is another common allergy-causing food, and many sufferers are also unable to tolerate dairy products such as cheese. Lactose intolerance, a common reaction to milk, is not in fact a form of allergy. A small portion of children with a milk allergy, roughly ten percent, will have a reaction to beef. Beef contains a small amount of protein that is present in cow's milk.^[16]

Other foods containing allergenic proteins include soy, wheat, fish, shellfish, fruits, vegetables, spices, synthetic and natural colors, chicken, and chemical additives.^{[citation needed]}

Non-food proteins[link]

Latex can trigger an IgE-mediated cutaneous, respiratory, and systemic reaction. The prevalence of latex allergy in the general population is believed to be less than one percent. In a hospital study, one in 800 surgical patients (0.125 percent) report latex sensitivity, although the sensitivity among healthcare workers is higher, between seven and ten percent. Researchers attribute this higher level to the exposure of healthcare workers to areas with significant airborne latex allergens, such as operating rooms, intensive-care units, and dental suites. These latex-rich environments may sensitize healthcare workers who regularly inhale allergenic proteins.^[17]

The most prevalent response to latex is an allergic contact dermatitis, a delayed hypersensitive reaction appearing as dry, crusted lesions. This reaction usually lasts 48 to 96 hours. Sweating or rubbing the area under the glove aggravates the lesions, possibly leading to ulcerations.^[17] Anaphylactic reactions occur most often in sensitive patients, who have been exposed to the surgeon's latex gloves during abdominal surgery, but other mucosal exposures, such as dental procedures, can also produce systemic reactions.^[17]

Latex and banana sensitivity may cross-react; furthermore, patients with latex allergy may also have sensitivities to avocado, kiwifruit, and chestnut.^[18] These patients often have perioral itching and local urticaria. Only occasionally have these food-induced allergies induced systemic responses. Researchers suspect that the cross-reactivity of latex with banana, avocado, kiwifruit, and chestnut occurs because latex proteins are structurally homologous with some plant proteins.^[17]

Toxins interacting with proteins[link]

Another non-food protein reaction, urushiol-induced contact dermatitis, originates after contact with poison ivy, eastern poison oak, western poison oak, or poison sumac. Urushiol, which is not itself a protein, acts as a hapten and chemically reacts with, binds to, and changes the shape of integral membrane proteins on exposed skin cells. The immune system does not recognize the affected cells as normal parts of the body, causing a T-cell-mediated immune response.^[19] Of these poisonous plants, sumac is the most virulent.^[20] The resulting dermatological response to the reaction between urushiol and membrane proteins includes redness, swelling, papules, vesicles, blisters, and streaking.^[21]

Estimates vary on the percentage of the population that will have an immune system response. Approximately 25 percent of the population will have a strong allergic response to urushiol. In general, approximately 80 percent to 90 percent of adults will develop a rash if they are exposed to .0050 milligrams (7.7×10⁻⁵ gr) of purified urushiol, but some people are so sensitive that it takes only a molecular trace on the skin to initiate an allergic reaction.^[22]

Genetic basis[link]

Allergic diseases are strongly familial: identical twins are likely to have the same allergic diseases about 70% of the time; the same allergy occurs about 40% of the time in non-identical twins.^[23] Allergic parents are more likely to have allergic children,^[24] and their allergies are likely to be more severe than those from non-allergic parents. Some allergies, however, are not consistent along genealogies; parents who are allergic to peanuts may have children who are allergic to ragweed. It seems that the likelihood of developing allergies is inherited and related to an irregularity in the immune system, but the specific allergen is not.^[24]

The risk of allergic sensitization and the development of allergies varies with age, with young children most at risk.^[25] Several studies have shown that IgE levels are highest in childhood and fall rapidly between the ages of 10 and 30 years.^[25] The peak prevalence of hay fever is highest in children and young adults and the incidence of asthma is highest in children under 10.^[26] Overall, boys have a higher risk of developing allergies than girls,^[24] although for some diseases, namely asthma in young adults, females are more likely to be affected.^[27] Sex differences tend to decrease in adulthood.^[24] Ethnicity may play a role in some allergies; however, racial factors have been difficult to separate from environmental influences and changes due to migration.^[24] It has been suggested that different genetic loci are responsible for asthma, to be specific, in people of European, Hispanic, Asian, and African origins.^[28]

Hygiene hypothesis[link]

Allergic diseases are caused by inappropriate immunological responses to harmless antigens driven by a TH2-mediated immune response. Many bacteria and viruses elicit a TH1-mediated immune response, which down-regulates TH2 responses. The first proposed mechanism of action of the hygiene hypothesis was that insufficient stimulation of the TH1 arm of the immune system leads to an overactive TH2 arm, which in turn leads to allergic disease.^[29] In other words, individuals living in too sterile an environment are not exposed to enough pathogens to keep the immune system busy. Since our bodies evolved to deal with a certain level of such pathogens, when they are not exposed to this level, the immune system will attack harmless antigens and thus normally benign microbial objects — like pollen — will trigger an immune response.^[30]

The hygiene hypothesis was developed to explain the observation that hay fever and eczema, both allergic diseases, were less common in children from larger families, which were, it is presumed, exposed to more infectious agents through their siblings, than in children from families with only one child. The hygiene hypothesis has been extensively investigated by immunologists and epidemiologists and has become an important theoretical framework for the study of allergic disorders. It is used to explain the increase in allergic diseases that have been seen since industrialization, and the higher incidence of allergic diseases in more developed countries. The hygiene hypothesis has now expanded to include exposure to symbiotic bacteria and parasites as important modulators of immune system development, along with infectious agents.

Epidemiological data support the hygiene hypothesis. Studies have shown that various immunological and autoimmune diseases are much less common in the developing world than the industrialized world and that immigrants to the industrialized world from the developing world increasingly develop immunological disorders in relation to the length of time since arrival in the industrialized world.^[31] Longitudinal studies in the third world demonstrate an increase in immunological disorders as a country grows more affluent and, it is presumed, cleaner.^[32] The use of antibiotics in the first year of life has been linked to asthma and other allergic diseases.^[33] The use of antibacterial cleaning products has also been associated with higher incidence of asthma, as has birth by Caesarean section rather than vaginal birth.^[34][35]

Other environmental factors[link]

International differences have been associated with the number of individuals within a population that suffer from allergy. Allergic diseases are more common in industrialized countries than in countries that are more traditional or agricultural, and there is a higher rate of allergic disease in urban populations versus rural populations, although these differences are becoming less defined.^[36]

Exposure to allergens, especially in early life, is an important risk factor for allergy. Alterations in exposure to microorganisms is another plausible explanation, at present, for the increase in atopic allergy.^[12] Endotoxin exposure reduces release of inflammatory cytokines such as TNF-α, IFNγ, interleukin-10, and interleukin-12 from white blood cells (leukocytes) that circulate in the blood.^[37] Certain microbe-sensing proteins, known as Toll-like receptors, found on the surface of cells in the body are also thought to be involved in these processes.^[38]

Gutworms and similar parasites are present in untreated drinking water in developing countries, and were present in the water of developed countries until the routine chlorination and purification of drinking water supplies.^[39] Recent research has shown that some common parasites, such as intestinal worms (e.g., hookworms), secrete chemicals into the gut wall (and, hence, the bloodstream) that suppress the immune system and prevent the body from attacking the parasite.^[40] This gives rise to a new slant on the hygiene hypothesis theory — that co-evolution of man and parasites has led to an immune system that functions correctly only in the presence of the parasites. Without them, the immune system becomes unbalanced and oversensitive.^[41] In particular, research suggests that allergies may coincide with the delayed establishment of gut flora in infants.^[42] However, the research to support this theory is conflicting, with some studies performed in China and Ethiopia showing an increase in allergy in people infected with intestinal worms.^[36] Clinical trials have been initiated to test the effectiveness of certain worms in treating some allergies.^[43] It may be that the term 'parasite' could turn out to be inappropriate, and in fact a hitherto unsuspected symbiosis is at work.^[43] For more information on this topic, see Helminthic therapy.

Pathophysiology[link]

This is a summary diagram that explains how allergy develops.

Tissues affected in allergic inflammation.

Acute response[link]

Degranulation process in allergy. Second exposure to allergen.1 - antigen; 2 - IgE antibody; 3 - FcεRI receptor; 4 - preformed mediators (histamine, proteases, chemokines, heparine); 5 - granules; 6 - mast cell; 7 - newly formed mediators (prostaglandins, leukotrienes, thromboxanes, PAF)

In the early stages of allergy, a type I hypersensitivity reaction against an allergen encountered for the first time and presented by a professional Antigen-Presenting Cell causes a response in a type of immune cell called a T_H2 lymphocyte, which belongs to a subset of T cells that produce a cytokine called interleukin-4 (IL-4). These T_H2 cells interact with other lymphocytes called B cells, whose role is production of antibodies. Coupled with signals provided by IL-4, this interaction stimulates the B cell to begin production of a large amount of a particular type of antibody known as IgE. Secreted IgE circulates in the blood and binds to an IgE-specific receptor (a kind of Fc receptor called FcεRI) on the surface of other kinds of immune cells called mast cells and basophils, which are both involved in the acute inflammatory response. The IgE-coated cells, at this stage are sensitized to the allergen.^[12]

If later exposure to the same allergen occurs, the allergen can bind to the IgE molecules held on the surface of the mast cells or basophils. Cross-linking of the IgE and Fc receptors occurs when more than one IgE-receptor complex interacts with the same allergenic molecule, and activates the sensitized cell. Activated mast cells and basophils undergo a process called degranulation, during which they release histamine and other inflammatory chemical mediators (cytokines, interleukins, leukotrienes, and prostaglandins) from their granules into the surrounding tissue causing several systemic effects, such as vasodilation, mucous secretion, nerve stimulation, and smooth muscle contraction. This results in rhinorrhea, itchiness, dyspnea, and anaphylaxis. Depending on the individual, allergen, and mode of introduction, the symptoms can be system-wide (classical anaphylaxis), or localized to particular body systems; asthma is localized to the respiratory system and eczema is localized to the dermis.^[12]

Late-phase response[link]

After the chemical mediators of the acute response subside, late phase responses can often occur. This is due to the migration of other leukocytes such as neutrophils, lymphocytes, eosinophils and macrophages to the initial site. The reaction is usually seen 2–24 hours after the original reaction.^[44] Cytokines from mast cells may also play a role in the persistence of long-term effects. Late phase responses seen in asthma are slightly different from those seen in other allergic responses, although they are still caused by release of mediators from eosinophils, and are still dependent on activity of T_H2 cells.^[45]

Diagnosis[link]

An allergy testing machine being operated in the diagnostic immunology lab at Lackland Air Force Base

Before a diagnosis of allergic disease can be confirmed, the other possible causes of the presenting symptoms should be carefully considered.^[46] Vasomotor rhinitis, for example, is one of many maladies that shares symptoms with allergic rhinitis, underscoring the need for professional differential diagnosis.^[47] Once a diagnosis of asthma, rhinitis, anaphylaxis, or other allergic disease has been made, there are several methods for discovering the causative agent of that allergy.

Effective management of allergic diseases relies on the ability to make an accurate diagnosis.^[48] Allergy testing can help confirm/rule out allergies and consequently reduce adverse reactions and limit unnecessary avoidance and medications.^[49][50] Correct diagnosis, counseling and avoidance advice based on valid allergy test results will help reduce the incidence of symptoms, medications and improve quality of life.^[49] For assessing the presence of allergen-specific IgE antibodies, you can use two different methods—a skin prick test or an allergy blood test. Both methods are recommended by the NIH guidelines and have similar diagnostic value in terms of sensitivity and specificity.^[50][51]

A healthcare provider can use the test results to identify the specific allergic triggers that may be contributing to the symptoms. Using this information, along with a physical examination and case history, the doctor can diagnose the cause of the symptoms and tailor treatments that will help the patient feel better. A negative result can help the doctor rule out allergies in order to consider other possible.

NIH Guidelines state that: “sIgE tests are useful for identifying foods potentially provoking IgE-mediated food-induced allergic reactions, and specified ‘‘cutoff’’ levels, defined as 95% predictive values, may be more predictive than skin prick tests of clinical reactivity in certain populations.” It further states, “sIgE tests are very useful for detecting the presence of sIgE antibodies, which indicates the presence of allergic sensitization. Fluorescence-labeled antibody assays have comparable sensitivity to that of skin prick tests, and the absolute levels of sIgE antibodies may directly correlate with the likelihood of clinical reactivity when compared with oral food challenges for the identification of foods provoking IgE mediated FA.”^[52]

According to NICE Guidelines, skin prick tests and blood tests are equally cost-effective and health economic evidence show that both the IgE antibody test and the skin prick test were cost effective compared with no test.^[49] Also, earlier and more accurate diagnoses save cost due to reduced GP consultations, referrals to secondary care, misdiagnosis and emergency admissions.^[53]

Allergy undergoes dynamic changes over time. Regular allergy testing of relevant allergens provides information on if and how patient management can be changed, in order to improve health and quality of life. Annual testing is often the practice for determining whether allergy to milk, egg, soy, and wheat have been outgrown and the testing interval is extended to 2 to 3 years for allergy to peanut, tree nuts, fish, and crustacean shellfish.^[50] Results of follow-up testing can guide decision-making regarding whether and when it is safe to introduce or re-introduce allergenic food into the diet.^[52]

Skin testing[link]

Skin testing on arm

Skin testing on back

Skin testing is also known as "puncture testing" and "prick testing" due to the series of tiny puncture or pricks made into the patient's skin. Small amounts of suspected allergens and/or their extracts (pollen, grass, mite proteins, peanut extract, etc.) are introduced to sites on the skin marked with pen or dye (the ink/dye should be carefully selected, lest it cause an allergic response itself). A small plastic or metal device is used to puncture or prick the skin. Sometimes, the allergens are injected "intradermally" into the patient's skin, with a needle and syringe. Common areas for testing include the inside forearm and the back. If the patient is allergic to the substance, then a visible inflammatory reaction will usually occur within 30 minutes. This response will range from slight reddening of the skin to a full-blown hive (called "wheal and flare") in more sensitive patients similar to a mosquito bite. Interpretation of the results of the skin prick test is normally done by allergists on a scale of severity, with +/- meaning borderline reactivity, and 4+ being a large reaction. Increasingly, allergists are measuring and recording the diameter of the wheal and flare reaction. Interpretation by well-trained allergists is often guided by relevant literature.^[54] Some patients may believe they have determined their own allergic sensitivity from observation, but a skin test has been shown to be much better than patient observation to detect allergy.^[55]

If a serious life threatening anaphylactic reaction has brought a patient in for evaluation, some allergists will prefer an initial blood test prior to performing the skin prick test. Skin tests may not be an option if the patient has widespread skin disease or has taken antihistamines sometime the last several days.

Blood testing[link]

An allergy blood test is quick and simple and can be ordered by a licensed health care provider e.g. an allergy specialist, GP or PED. Unlike skin-prick testing, a blood test can be performed irrespective of age, skin condition, medication, symptom, disease activity and pregnancy. Adults and children of any age can take an allergy blood test. For babies and very young children, a single needle stick for allergy blood testing is often more gentle than several skin tests.

An allergy blood test is available through most laboratories, and a sample of the patient’s blood is sent to a laboratory for analysis and the results are sent back a few days later. Multiple allergens can be detected with a single blood sample.

Allergy blood tests are very safe, since you are not exposed to any allergens during the testing procedure.

How does the test work?

The test measures the concentration of specific IgE antibodies in the blood. Quantitative IgE test results increases the possibility of ranking how different substances may affect your symptoms. A general rule of thumb is that the higher the IgE antibody value, the greater the likelihood of symptoms. Allergens found at low levels that today do not result in symptoms can nevertheless help predict future symptom development. The quantitative allergy blood result can help determine what a patient is allergic to, help predict and follow the disease development, estimate the risk of a severe reaction and explain cross-reactivity.^[56][57]

A low total IgE level is not adequate to rule out sensitization to commonly inhaled allergens.^[58] Statistical methods, such as ROC curves, predictive value calculations, and likelihood ratios have been used to examine the relationship of various testing methods to each other. These methods have shown that patients with a high total IgE have a high probability of allergic sensitization, but further investigation with allergy tests for specific IgE antibodies for a carefully chosen of allergens is often warranted.

History

Radiometric assays include the radioallergosorbent test (RAST) test method, which uses IgE-binding (anti-IgE) antibodies labeled with radioactive isotopes for quantifying the levels of IgE antibody in the blood.^[59] Other newer methods use colorimetric or fluorescence-labeled technology in the place of radioactive isotopes.

The market-leading RAST methodology was invented and marketed in 1974 by Pharmacia Diagnostics AB, Uppsala, Sweden, and the acronym RAST is actually a brand name. In 1989, Pharmacia Diagnostics AB replaced it with a superior test named the ImmunoCAP Specific IgE blood test, which uses the newer fluorescence-labeled technology. American College of Allergy Asthma and Immunology (ACAAI) and the American Academy of Allergy Asthma and Immunology (AAAAI) issued the Joint Task Force Report “Pearls and pitfalls of allergy diagnostic testing” in 2008, and is firm in its statement that the term RAST is now obsolete:

“The term RAST became a colloquialism for all varieties of (in vitro allergy) tests. This is unfortunate because it is well recognized that there are well-performing tests and some that do not perform so well, yet they are all called RASTs, making it difficult to distinguish which is which. For these reasons, it is now recommended that use of RAST as a generic descriptor of these tests be abandoned.”^[60] The new version, the ImmunoCAP Specific IgE blood test, is the only specific IgE assay to receive FDA approval to quantitatively report to its detection limit of 0.1kU/l.

Other[link]

Challenge testing: Challenge testing is when small amounts of a suspected allergen are introduced to the body orally, through inhalation, or other routes. Except for testing food and medication allergies, challenges are rarely performed. When this type of testing is chosen, it must be closely supervised by an allergist.

Elimination/Challenge tests: This testing method is utilized most often with foods or medicines. A patient with a particular suspected allergen is instructed to modify his/her diet to totally avoid that allergen for determined period of time. If the patient experiences significant improvement, he/she may then be “challenged” by reintroducing the allergen to see if symptoms can be reproduced.

Patch testing: Patch testing is used to help ascertain the cause of skin contact allergy, or contact dermatitis. Adhesive patches, usually treated with a number of different commonly allergic chemicals or skin sensitizers, are applied to the back. The skin is then examined for possible local reactions at least twice, usually at 48 hours after application of the patch, and again two or three days later.

Some "screening" test methods are intended to provide qualitative test results, giving a "yes" or "no" answer in patients with suspected allergic sensitization. One such method has a sensitivity of about 70.8% and a positive predictive value of 72.6% according to a large study.^[61]

Unreliable tests: There are other types of allergy testing methods that the American Academy of Allergy, Asthma, and Immunology considers to be unacceptable.

These unreliable allergy testing methods are:

Applied kinesiology (allergy testing through muscle relaxation), Cytotoxicity testing, Urine autoinjection, Skin titration (Rinkel method), and Provocative and neutralization (subcutaneous) testing or sublingual provocation^[62]

Management[link]

In recent times, there have been enormous improvements in the medical practices used to treat allergic conditions. With respect to anaphylaxis and hypersensitivity reactions to foods, drugs, and insects and in allergic skin diseases, advances have included the identification of food proteins to which IgE binding is associated with severe reactions and development of low-allergen foods, improvements in skin prick test predictions; evaluation of the atopy patch test; in wasp sting outcomes predictions and a rapidly disintegrating epinephrine tablet, and anti-IL-5 for eosinophilic diseases.^[63]

Traditional treatment and management of allergies consisted simply of avoiding the allergen in question or otherwise reducing exposure. For instance, people with cat allergies were encouraged to avoid them. However, while avoidance of allergens may reduce symptoms and avoid life-threatening anaphylaxis, it is difficult to achieve for those with pollen or similar air-borne allergies. Nonetheless, strict avoidance of allergens is still considered a useful treatment method, and is often used in managing food allergies.

New technology approaches to decreasing IgE overproduction, and regulating histimine release in allergic individuals have demonstrated statisitically significant reduction on Total Nasel Symptom Scores.^[64][65]

Medication[link]

Several antagonistic drugs are used to block the action of allergic mediators, or to prevent activation of cells and degranulation processes. These include antihistamines, glucocorticoids, epinephrine (adrenaline), theophylline and cromolyn sodium. Anti-leukotrienes, such as Montelukast (Singulair) or Zafirlukast (Accolate), are FDA approved for treatment of allergic diseases.^{[citation needed]} Anti-cholinergics, decongestants, mast cell stabilizers, and other compounds thought to impair eosinophil chemotaxis, are also commonly used. These drugs help to alleviate the symptoms of allergy, and are imperative in the recovery of acute anaphylaxis, but play little role in chronic treatment of allergic disorders.

Immunotherapy[link]

Anti-allergy immunotherapy

Desensitization or hyposensitization is a treatment in which the person is gradually vaccinated with progressively larger doses of the allergen in question. This can either reduce the severity or eliminate hypersensitivity altogether. It relies on the progressive skewing of IgG antibody production, to block excessive IgE production seen in atopys. In a sense, the person builds up immunity to increasing amounts of the allergen in question. Studies have demonstrated the long-term efficacy and the preventive effect of immunotherapy in reducing the development of new allergy.^[66] Meta-analyses have also confirmed efficacy of the treatment in allergic rhinitis in children^[67] and in asthma.^[68] A review by the Mayo Clinic in Rochester confirmed the safety and efficacy of allergen immunotherapy for allergic rhinitis and conjunctivitis, allergic forms of asthma, and stinging insect based on numerous well-designed scientific studies.^[69] In addition, national and international guidelines confirm the clinical efficacy of injection immunotherapy in rhinitis and asthma, as well as the safety, provided that recommendations are followed.^[70]

A second form of immunotherapy involves the intravenous injection of monoclonal anti-IgE antibodies. These bind to free and B-cell associated IgE; signalling their destruction. They do not bind to IgE already bound to the Fc receptor on basophils and mast cells, as this would stimulate the allergic inflammatory response. The first agent of this class is Omalizumab. While this form of immunotherapy is very effective in treating several types of atopy, it should not be used in treating the majority of people with food allergies.^{[citation needed]}

A third type, Sublingual immunotherapy, is an orally-administered therapy that takes advantage of oral immune tolerance to non-pathogenic antigens such as foods and resident bacteria. This therapy currently accounts for 40 percent of allergy treatment in Europe.^{[citation needed]} In the United States, sublingual immunotherapy is gaining support among traditional allergists and is endorsed by doctors treating allergy.^[71]

Allergy shot treatment is the closest thing to a ‘cure’ for allergic symptoms. This therapy requires a long-term commitment.

Other[link]

An experimental treatment, enzyme potentiated desensitization (EPD), has been tried for decades but is not generally accepted as effective.^[72] EPD uses dilutions of allergen and an enzyme, beta-glucuronidase, to which T-regulatory lymphocytes are supposed to respond by favouring desensitization, or down-regulation, rather than sensitization. EPD has also been tried for the treatment of autoimmune diseases but is not approved by the U.S. Food and Drug Administration or of proven effectiveness.^[72]

Systematic literature searches conducted by the Mayo Clinic through 2006, involving hundreds of articles studying multiple conditions, including asthma and upper respiratory tract infection, showed no effectiveness of homeopathic treatments and no difference compared with placebo. The authors concluded that, based on rigorous clinical trials of all types of homeopathy for childhood and adolescence ailments, there is no convincing evidence that supports the use of homeopathic treatments.^[73]

Epidemiology[link]

Many diseases related to inflammation such as type 1 diabetes, rheumatoid arthritis, and allergic diseases — hay fever and asthma — have increased in the Western world over the past 2-3 decades.^[74] Rapid increases in allergic asthma and other atopic disorders in industrialized nations, it is estimated, began in the 1960s and 1970s, with further increases occurring during the 1980s and 1990s,^[75] although some suggest that a steady rise in sensitization has been occurring since the 1920s.^[76] The incidence of atopy in developing countries has, in general, remained much lower.^[75]

Although genetic factors fundamentally govern susceptibility to atopic disease, increases in atopy have occurred within too short a time frame to be explained by a genetic change in the population, thus pointing to environmental or lifestyle changes.^[75] Several hypotheses have been identified to explain this increased prevalence; increased exposure to perennial allergens due to housing changes and increasing time spent indoors, and changes in cleanliness or hygiene that have resulted in the decreased activation of a common immune control mechanism, coupled with dietary changes, obesity and decline in physical exercise.^[74] The hygiene hypothesis maintains^[87] that high living standards and hygienic conditions exposes children to fewer infections. It is thought that reduced bacterial and viral infections early in life direct the maturing immune system away from T_H1 type responses, leading to unrestrained T_H2 responses that allow for an increase in allergy.^[41][88]

Changes in rates and types of infection alone however, have been unable to explain the observed increase in allergic disease, and recent evidence has focused attention on the importance of the gastrointestinal microbial environment. Evidence has shown that exposure to food and fecal-oral pathogens, such as hepatitis A, Toxoplasma gondii, and Helicobacter pylori (which also tend to be more prevalent in developing countries), can reduce the overall risk of atopy by more than 60%,^[89] and an increased prevalence of parasitic infections has been associated with a decreased prevalence of asthma.^[90] It is speculated that these infections exert their effect by critically altering T_H1/T_H2 regulation.^[91] Important elements of newer hygiene hypotheses also include exposure to endotoxins, exposure to pets and growing up on a farm.^[91]

History[link]

The concept of "allergy" was originally introduced in 1906 by the Viennese pediatrician Clemens von Pirquet, after he noted that some of his patients were hypersensitive to normally innocuous entities such as dust, pollen, or certain foods.^[92] Pirquet called this phenomenon "allergy" from the Ancient Greek words ἄλλος allos meaning "other" and ἔργον ergon meaning "work".^[93] All forms of hypersensitivity used to be classified as allergies, and all were thought to be caused by an improper activation of the immune system. Later, it became clear that several different disease mechanisms were implicated, with the common link to a disordered activation of the immune system. In 1963, a new classification scheme was designed by Philip Gell and Robin Coombs that described four types of hypersensitivity reactions, known as Type I to Type IV hypersensitivity.^[94] With this new classification, the word "allergy" was restricted to type I hypersensitivities (also called immediate hypersensitivity), which are characterized as rapidly developing reactions.

A major breakthrough in understanding the mechanisms of allergy was the discovery of the antibody class labeled immunoglobulin E (IgE) - Kimishige Ishizaka and co-workers were the first to isolate and describe IgE in the 1960s.^[95]

Medical specialty[link]

An allergist is a physician specially trained to manage and treat allergies, asthma and the other allergic diseases. In the United States physicians holding certification by the American Board of Allergy and Immunology (ABAI) have successfully completed an accredited educational program and an evaluation process, including a secure, proctored examination to demonstrate the knowledge, skills, and experience to the provision of patient care in allergy and immunology.^[96] Becoming an allergist/immunologist requires completion of at least nine years of training. After completing medical school and graduating with a medical degree, a physician will then undergo three years of training in internal medicine (to become an internist) or pediatrics (to become a pediatrician). Once physicians have finished training in one of these specialties, they must pass the exam of either the American Board of Pediatrics (ABP) or the American Board of Internal Medicine (ABIM). Internists or pediatricians wishing to focus on the sub-specialty of allergy-immunology then complete at least an additional two years of study, called a fellowship, in an allergy/immunology training program. Allergist/immunologists listed as ABAI-certified have successfully passed the certifying examination of the American Board of Allergy and Immunology (ABAI), following their fellowship.^[97]

In the United Kingdom, allergy is a subspecialty of general medicine or pediatrics. After obtaining postgraduate exams (MRCP or MRCPCH respectively), a doctor works for several years as a specialist registrar before qualifying for the General Medical Council specialist register. Allergy services may also be delivered by immunologists. A 2003 Royal College of Physicians report presented a case for improvement of what were felt to be inadequate allergy services in the UK.^[98] In 2006, the House of Lords convened a subcommittee that reported in 2007. It concluded likewise that allergy services were insufficient to deal with what the Lords referred to as an "allergy epidemic" and its social cost; it made several other recommendations.^[99]

See also[link]

• Allergic inflammation
• List of allergies
• Oral allergy syndrome

References[link]

External links[link]

• American Academy of Allergy, Asthma & Immunology

This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (March 2012)

Paul Simon
Paul Simon performing March 8, 2007
Background information
Birth name	Paul Frederic Simon
Born	(1941-10-13) October 13, 1941 (age 70) Newark, New Jersey, U.S.
Genres	Folk rock, folk-pop, soft rock, world fusion
Occupations	Musician, singer-songwriter, producer
Instruments	Vocals, guitar, bass, piano, percussion, lute, alto saxophone, piccolo
Years active	1957–present
Labels	Columbia, Warner Bros., Hear Music
Associated acts	Simon & Garfunkel
Website	www.paulsimon.com
Notable instruments
Martin OM42PS (Paul Simon) and PS2 Yamaha PS Signature Models

Paul Frederic Simon (born October 13, 1941) is a grammy award winning American singer-songwriter, poet and guitarist.

Simon's international fame and success began as part of the duo Simon & Garfunkel, launched in 1964 with musical partner Art Garfunkel. Simon wrote most of the pair's songs, including three that reached No. 1 on the U.S. singles charts: "The Sound of Silence", "Mrs. Robinson", and "Bridge Over Troubled Water".^[1] The duo split up in 1970 at the height of their popularity, and Simon began a successful solo career, recording three highly acclaimed albums over the next five years.^[2] In 1986, he released Graceland, an album inspired by South African township music. Simon also wrote and starred in the film One-Trick Pony in 1980 and co-wrote the Broadway musical The Capeman in 1998.^[3]

Simon has earned 12 Grammys for his solo and collaborative work, including the Lifetime Achievement Award.^[4] In 2001, he was inducted into the Rock and Roll Hall of Fame^[5] and in 2006 was selected as one of the "100 People Who Shaped the World" by Time magazine.^[6] Among many other honors, Simon was the first recipient of the Library of Congress' Gershwin Prize for Popular Song in 2007.^[7] In 1986 Simon was awarded an Honorary Doctor of Music degree from Berklee College of Music where he currently serves on the Board of Trustees.^{[8] [9]}

Biography[link]

Early years[link]

Simon was born in Newark, New Jersey. His father, Louis (1916–1995), was a college professor, upright bass player, and dance bandleader who performed under the name "Lee Sims". His mother, Belle (1910–2007), was an elementary school teacher. In 1941, his family moved to Kew Gardens Hills, Queens, in New York City. Donald Fagen has described Simon's childhood as that of "a certain kind of New York Jew, almost a stereotype, really, to whom music and baseball are very important. I think it has to do with the parents. The parents are either immigrants or first-generation Americans who felt like outsiders, and assimilation was the key thought — they gravitated to black music and baseball looking for an alternative culture."^[10] Simon, upon hearing Fagen's description, said it "isn't far from the truth."^[10] Simon says about his childhood, "I was a ballplayer. I'd go on my bike, and I'd hustle kids in stickball." He adds that his father was a Yankee fan:

I used to listen to games with my father. He was a nice guy. Fun. Funny. Smart. He didn't play with me as much as I played with my kids. He was at work until late at night. . . Sometimes [until] two in the morning."^[10]

Simon's musical career began at Forest Hills High School after meeting Art Garfunkel when they were both 11. They performed in a production of Alice in Wonderland for their sixth grade graduation, and began singing together when they were 13,^[11] occasionally performing at school dances. Their idols were the Everly Brothers, whom they imitated in their use of close two-part harmony. Simon also developed an interest in jazz, folk and blues, especially in musical legends Woody Guthrie and Lead Belly.

Simon's first song written for himself and Garfunkel, when he was 12 or 13, was called "The Girl for Me," and according to Simon became the "neighborhood hit." His father wrote out the words and chords on paper by hand for the boys to use. That paper became the first officially copyrighted Paul Simon and Art Garfunkel song, and is now in the Library of Congress. In 1957, still in their mid-teens, they recorded the song "Hey, Schoolgirl" under the name Tom and Jerry, given to them by their label Big Records. The single reached No. 49 on the pop charts.

After graduating from high school, Simon majored in English at Queens College, while Garfunkel studied mathematics at Columbia University in Manhattan.^[10] Simon was a brother in the Alpha Epsilon Pi fraternity, earned a degree in English literature, and briefly attended Brooklyn Law School after graduation, but his real passion was rock and roll.

Early career[link]

Between 1957 and 1964, Simon wrote, recorded, and released more than 30 songs, occasionally reuniting with Garfunkel as Tom & Jerry for some singles, including "Our Song" and "That's My Story". Most of the songs Simon recorded during that time were performed alone or with musicians other than Garfunkel. They were released on several minor record labels, such as Amy, Big, Hunt, King, Tribute, and Madison. He used several pseudonyms for these recordings, including Jerry Landis, Paul Kane and True Taylor. Simon enjoyed some moderate success in recording a few singles as part of a group called Tico and the Triumphs, including a song called "Motorcycle" which reached No. 97 on the Billboard charts in 1962. Tico and the Triumphs released four 45s. Marty Cooper, known as Tico, sang lead on several of these releases. A childhood friend, Bobby Susser, children's songwriter, record producer, and performer, co-produced the Tico 45s with Simon. That year, Simon reached No. 99 on the pop charts as Jerry Landis with the hit "The Lone Teen Ranger." Both chart singles were released on Amy Records.

Simon & Garfunkel[link]

In early 1964, Simon and Garfunkel got an audition with Columbia Records, whose executive Clive Davis was impressed enough to sign the duo to a contract to produce an album. Columbia decided that the two would be called simply "Simon & Garfunkel", a replacement for the group's previous name "Tom and Jerry". Simon said in 2003 that this renaming as "Simon & Garfunkel" was the first time that artists' ethnic names had been used in pop music.^[12] Simon and Garfunkel's first LP, Wednesday Morning, 3 A.M., was released on October 19, 1964; it consisted of 12 songs in the folk vein, five written by Simon. The album initially flopped.

So Simon moved to England to pursue a solo career by touring folk clubs and coffee houses. At the first club he played, the Railway Inn Folk Club in Brentwood, Essex, he met Kathy Chitty who became his girlfriend and inspiration for "Kathy's Song", "America" and others. He performed at Les Cousins in London and toured provincial folk clubs where he was exposed to a wide range of musical influences. In 1965, he recorded his solo LP The Paul Simon Songbook in England.

During his time in the UK, Simon co-wrote several songs with Bruce Woodley of the Australian pop group The Seekers including "I Wish You Could Be Here," "Cloudy", and "Red Rubber Ball"; Woodley's co-author credit was omitted from "Cloudy" on the Parsley, Sage, Rosemary and Thyme album. The American group The Cyrkle recorded a cover of "Red Rubber Ball", which reached No. 2 in the US. Simon also contributed to The Seekers catalogue with "Someday One Day," which was released in March 1966, charting at around the same time as Simon and Garfunkel's Homeward Bound.

Back on the American East Coast, radio stations began receiving requests for one of the Wednesday Morning tracks, Simon's "The Sounds of Silence". Their producer, Tom Wilson, overdubbed the track with electric guitar, bass, and drums, releasing it as a single that eventually went to No. 1 on the U.S. pop charts.^{[citation needed]}

The song's success drew Simon back to the United States to reunite with Garfunkel. Together they recorded four more influential albums: Sounds of Silence; Parsley, Sage, Rosemary and Thyme; Bookends; and the hugely successful Bridge over Troubled Water. Simon and Garfunkel also contributed extensively to the soundtrack of the Mike Nichols film The Graduate (1967), starring Dustin Hoffman and Anne Bancroft. While writing "Mrs. Robinson", Simon originally toyed with the title "Mrs. Roosevelt". When Garfunkel reported this indecision over the song's name to the director, Nichols replied, "Don't be ridiculous! We're making a movie here! It's Mrs. Robinson!"^[13] Simon and Garfunkel returned to England in the fall of 1968 and did a church concert appearance at Kraft Hall, which was broadcast on the BBC, and which also featured Paul's brother Ed sitting in on a performance of the instrumental "Anji".^[14]

Simon pursued solo projects after Bridge over Troubled Water, reuniting occasionally with Garfunkel for various projects, such as their 1975 Top Ten single "My Little Town". Simon had written it for Garfunkel, whose solo output Simon judged as lacking "bite". The song was included on their respective solo albums: Paul Simon's Still Crazy After All These Years; and Garfunkel's Breakaway. Contrary to popular belief, the song is not autobiographical of Simon's early life in New York City.^[15] In 1981, they got together again for the famous concert in Central Park, followed by a world tour and an aborted reunion album, to have been entitled Think Too Much, which was eventually released (without Garfunkel) as Hearts and Bones. Together, they were inducted into the Rock and Roll Hall of Fame in 1990.^[16]

In 2003, Simon and Garfunkel reunited once again when they received a Grammy Lifetime Achievement Award. This reunion led to a U.S. tour — the acclaimed "Old Friends" concert series — followed by a 2004 international encore, which culminated in a free concert at the Colosseum in Rome that drew 600,000 people.^[17] In 2005, the pair sang "Bridge Over Troubled Water" with Aaron Neville in a benefit for Hurricane Katrina victims.^{[citation needed]}

The pair reunited six years later in New Orleans at the New Orleans Jazz & Heritage Festival.^[18]

1971–76[link]

After Simon and Garfunkel split in 1970, Simon began to write and record solo material. His eponymous album Paul Simon was released in January 1972, preceded by his first experiment with world music, the Jamaican-inspired "Mother and Child Reunion", considered one of the first examples of reggae attempted by a white musician. The single was a hit, reaching both the American and British Top 5. The album received universal acclaim, with critics praising the variety of styles and the confessional lyrics, reaching No. 4 in the US and No. 1 in the UK and Japan. It later spawned another Top 30 hit with "Me and Julio Down by the Schoolyard".

Simon's next project was the pop-folk masterpiece, There Goes Rhymin' Simon, released in May 1973. It contained some of his most popular and polished recordings – the lead single, "Kodachrome", was a No. 2 hit in America, and the follow-up, the gospel-flavored "Loves Me Like a Rock" was even bigger, topping the Cashbox charts. Other songs, like the weary "American Tune" or the melancholic "Something So Right" – a tribute to Simon's first wife, Peggy – became standards in the musician's catalogue. The critical and commercial reception for this second album were even stronger than for his debut. At the time, it was remarked how the songs were very fresh and unworried on the surface while they were exploring socially and politically conscious themes on a deeper level.^{[citation needed]} The album reached No. 1 on the Cashbox album charts. As a souvenir for the tour that came next, in 1974 it was released as a live album, Live Rhymin', which was moderately successful and displayed some changes in Simon's music style, adopting world and religious music.

Highly anticipated, Still Crazy After All These Years was his next album. Released in October 1975 and produced by Simon and Phil Ramone, it marked another departure. The mood of the album was darker, as he wrote and recorded it in the wake of his divorce. Preceded by the feel-good duet with Phoebe Snow, "Gone at Last" (a Top 25 hit) and the Simon & Garfunkel reunion track "My Little Town" (a No. 9 on Billboard), the album managed to be his only No. 1 on the Billboard charts to date. The 18th Grammy Awards named it the Album of the Year and Simon's performance the year's Best Male Pop Vocal. With Simon in the forefront of popular music, the third single from the album, "50 Ways to Leave Your Lover" reached the top spot of the Billboard charts, his only single to reach No. 1 on this list. Also, on May 3, 1976, Simon put together a benefit show at Madison Square Garden to raise money for the New York Public Library. Phoebe Snow, Jimmy Cliff and the Brecker Brothers also performed. The concert produced over $30,000 for the Library.

1977–85[link]

After three back-to-back successful studio albums, Simon became less productive during the second half of the 1970s. He dabbled in various projects, including writing music for the film Shampoo and acting (he was cast as Tony Lacey in Woody Allen's film Annie Hall). He achieved another hit in this decade, with the lead single of his 1977 compilation, Greatest Hits, Etc., "Slip Slidin' Away", reaching No. 5 in the United States.

In 1980 he released One-Trick Pony, his debut album with Warner Bros. Records and his first in almost five years. It was paired with the motion picture of the same name, which Simon wrote and starred in. Although it produced his last Top 10 hit with the upbeat "Late in the Evening" (also a No. 1 hit on the Radio & Records American charts), the album did not sell well, in a music market dominated by disco music. Simon recorded Hearts and Bones, a polished and confessional album that was eventually viewed as one of his best works, but that marked a lull in his commercial popularity; both the album and the lead single, "Allergies", missed the American Top 40. Hearts and Bones included "The Late Great Johnny Ace", a song partly about Johnny Ace, an American R&B singer, and partly about slain Beatle John Lennon. A successful US solo tour featured Simon and his guitar, with a recording of the rhythm track and horns for "Late In The Evening."^{[citation needed]} In January 1985, Simon lent his talent to USA for Africa and performed on the relief fundraising single "We Are the World".

1986–92[link]

Graceland (1986) album cover.

As he commented years later, after the disappointing commercial performance of Hearts and Bones, Simon felt he had lost his inspiration to a point of no return, and that his commercial fortunes were unlikely to change. While driving his car in late 1984 in this state of frustration, Simon listened to a cassette of the Boyoyo Boys' instrumental "Gumboots: Accordion Jive Volume II". Interested by the unusual sound, he wrote lyrics to the number which he sang over a re-recording of the song. It was the first composition of a new musical project that became the celebrated album Graceland, an eclectic mixture of musical styles including pop, a cappella, isicathamiya, rock, and mbaqanga. Simon felt that he had nothing to lose. He travelled to South Africa in an attempt to embrace the culture and find the most comfortable environment for recording the album. Sessions in Johannesburg took place in February 1985. Overdubbing and additional recording was done in April, 1986, in New York. The sessions featured many South African musicians and groups, particularly Ladysmith Black Mambazo. Simon also collaborated with several artists of his own culture, singing a memorable duet with Linda Ronstadt in "Under African Skies", and playing with Los Lobos in "All Around the World or The Myth of the Fingerprints". Warner Bros. Records had serious doubts about releasing an album of this eclecticism to the mainstream, but when it did in August 1986, Graceland was praised by critics and the public and became Simon's most successful solo album. Slowly climbing the worldwide charts, it reached #1 in many countries, including the UK, Canada, Australia and New Zealand, and peaked at #3 in the US. It was the second-best-selling album of 1987 in the US, selling five million copies and eventually reaching 5x Platinum certification. Another seven million copies were sold internationally to become his best-selling album. Much of the success of the album was due to the lead single, the upbeat "You Can Call Me Al", whose lyrics describe a man experiencing an identity crisis. The track featured many memorable elements – a catchy synthesizer riff, an easy whistle solo, and an unusual bass run in which the second half was a reversed recording of the first half. "You Can Call Me Al" was accompanied with a humorous video featuring actor Chevy Chase, which introduced Simon to a new audience through MTV. In the end, the track reached UK Top 5 and the US Top 25. Further singles, including the title track, "The Boy in the Bubble" and "Diamonds on the Soles of Her Shoes", were not commercial hits but became radio standards and were highly praised.

At age 45, Simon found himself back at the forefront of popular music. He received the Grammy Award for Album of the Year in 1987 and also Grammy Award for Record of the Year for the title track one year later. He also embarked on the very successful Graceland Tour, which was documented on music video. Simon found himself embracing new sounds, a fact that some critics viewed negatively – however, Simon reportedly felt it as a very natural artistic experiment, considering that "world music" was already present on much of his early work, including such Simon & Garfunkel hits as "El Condor Pasa" and his early solo recording "Mother and Child Reunion", which was recorded in Kingston, Jamaica. One way or another, Warner Bros. Records (who by this time now controlled and reissued all his previous Columbia albums) re-established Simon as one of their most successful artists. In an attempt to capitalize on his renewed success, WB Records released the album Negotiations and Love Songs in November 1988, a mixture of popular hits and personal favorites that covered Simon's entire career and became an enduring seller in his catalog.

After Graceland, Simon decided to extend his roots with the Brazilian music-flavored The Rhythm of the Saints. Sessions for the album began in December 1989, and took place in Rio de Janeiro and New York, featuring guitarist J. J. Cale and many Brazilian and African musicians. The tone of the album was more introspective and relatively low-key compared to the mostly upbeat numbers of Graceland. Released on October 1990, the album received excellent critical reviews and achieved very respectable sales, peaking at #4 in the US and No. 1 in the UK. The lead single, "The Obvious Child", featuring the Grupo Cultural Olodum, was a Top 20 hit in the UK and appeared near the bottom of the Billboard Hot 100. Although not as successful as Graceland, The Rhythm of the Saints was received as a competent successor and consistent complement on Simon's attempts to explore (and popularize) world music, and also received a Grammy nomination for Album of the Year. Here are also more songs about past loves; his ex-wife Carrie Fisher says in her autobiography Wishful Drinking that the song "She Moves On" is about her. It's one of several she claims, followed by the line, "If you can get Paul Simon to write a song about you, do it. Because he is so brilliant at it." ^[19]

The importance of both albums allowed Simon to stage another New York concert, and on August 15, 1991, almost a decade after his concert with Garfunkel, Simon staged another concert in Central Park with both African and South American bands. The success of the concert surpassed all expectations, and reportedly over 750,000 people attended, becoming one of the largest concert audiences in history. He later remembered the concert as the "most memorable moment in my career". The success of the show led to both a live album and an Emmy-winning TV special. In the middle, Simon embarked on the successful Born at the Right Time Tour and promoted the album with further singles, including "Proof" – accompanied with a humorous video featuring, again, Chevy Chase. On March 4, 1992 he appeared on his own MTV Unplugged, offering renditions of many of his most famous compositions. Broadcast in June, the show was a success, though it did not receive an album release.

1993–98[link]

After Unplugged, Simon's place in the forefront of popular music dropped notably. A Simon & Garfunkel reunion took place in 1993, and in another attempt to capitalize on the occasion, Columbia released Paul Simon 1964/1993 in September, a three-disc compilation that received a reduced version on the two-disc album The Paul Simon Anthology one month later. In 1995 he only made news for appearing at The Oprah Winfrey Show, where he performed the song "Ten Years", which he composed specially for the tenth anniversary of the show. Also that year, he was featured on the Annie Lennox version of his 1973 song "Something So Right", which appeared briefly on the UK Top 50 once it was released as a single in November.

Since the early stages of the nineties, Simon was fully involved on The Capeman, a musical that finally opened on January 29, 1998. Simon worked enthusiastically on the project for many years and described it as "a New York Puerto Rican story based on events that happened in 1959—events that I remembered." ^[20] The musical tells the story of real-life Puerto Rican youth Salvador Agron, who wore a cape while committing two murders in 1959 New York, and who went on to become a writer in prison. Featuring Marc Anthony as the young Agron and Ruben Blades as the older Agron, the play received terrible reviews and very poor box office receipts from the very beginning, and ended up closing on March 28 after just 68 performances, becoming a failure from which Simon reportedly lost 11 million dollars. Simon recorded an album of songs from the show, which was released in November 1997. It was received with very mixed reviews, though many critics praised the combination of doo-wop, rockabilly and Caribbean music that the album reflected. In commercial terms, Songs from The Capeman was a failure—it found Simon missing the Top 40 of the Billboard charts for the first time in his career. The cast album was never released on CD but eventually became available online.

1999–2007[link]

After the disaster of The Capeman, Simon's career was again in an unexpected crisis. However, entering the new millennium he maintained a respectable reputation, offering critically acclaimed new material and receiving commercial attention. In 1999, Simon embarked on a North American tour with Bob Dylan where each alternated as headline act with a "middle" section where they performed together, starting on the first of June and ending September 18. The collaboration was generally well-received, with just one critic, Seth Rogovoy, from the Berkshire Eagle, questioning the collaboration.^[21]

In an attempt to return successfully to the music market, Simon wrote and recorded a new album very quickly, with You're the One arriving in October 2000. The album consisted mostly of folk-pop writing combined with foreign musical sounds, particularly grooves from North Africa. While not reaching the commercial heights of previous albums, it managed at least to reach both the British and American Top 20. It received favorable reviews and received a Grammy nomination for Album of the Year. He toured extensively for the album, and one performance in Paris was released to home video.

On September 21, 2001, Simon sang "Bridge Over Troubled Water" on "America: A Tribute to Heroes", a multinetwork broadcast to benefit the September 11 Telethon Fund. In 2002, he wrote and recorded "Father and Daughter", the theme song for the animated children's movie The Wild Thornberrys Movie, The track was nominated for an Academy Award for Best Song. In 2003, he participated on another Simon & Garfunkel reunion. One year later, Simon's studio albums were re-released both individually and together in a limited-edition nine-CD boxed set, Paul Simon: The Studio Recordings 1972–2000.

At the time, Simon was already working on a new album with Brian Eno called Surprise, which was released in May 2006. Most of the album was inspired by the September 11 terrorist attacks, the Iraq invasion and the war that followed. In personal terms, Simon was also inspired by the fact of being over 60 years old, an age that he turned in 2001 and that he humorously referred already on his single "Old" from the You're the One. Simon showed special care about the musical venture he traveled since 1986's Graceland. As he put it, "Once you go away for a bit, you wonder who people think you are. If they don't know what you're up to, they just go by your history. I'm so often described as this person that went to other cultures, which is true, but I never thought of it that way. I suspect people are thinking, 'What culture did you go to?' But this record is straight-ahead American." Surprise was a commercial hit, reaching #14 in the Billboard 200 and #4 in the UK. Most critics also praised the album, and many of them called it a real "comeback" for the artist. Stephen Thomas Erlewine from Allmusic paid attention to the attempts of Simon in embracing his classic folk sound with Eno's electronic textures, and wrote that "Simon doesn't achieve his comeback by reconnecting with the sound and spirit of his classic work; he has achieved it by being as restless and ambitious as he was at his popular and creative peak, which makes Surprise all the more remarkable." The album was supported with the successful Surprise Tour.

On March 1, 2007, Simon made headlines again when he was announced as the first recipient of the recently-created Gershwin Prize for Popular Song. The Prize, created by the Library of Congress, was awarded to Simon during a Concert Gala featuring his music at the Warner Theatre in Washington, D.C., on the evening of May 23. The event was nationally broadcast on PBS on the evening of June 27, 2007.^[22] Performers at the concert included Shawn Colvin, Philip Glass, Alison Krauss, Jerry Douglas, Ladysmith Black Mambazo, Lyle Lovett, James Taylor, and Stevie Wonder as well as Simon's former collaborator Art Garfunkel.^[23] On June 26, Warner Bros. released the definitive Paul Simon greatest-hits collection. The Essential Paul Simon consisted of two discs that reviewed 36 songs from his ten studio albums, and was also released on a special edition featuring a DVD of music videos and memorable live performances. The album was a commercial hit, reaching #12 in the UK.

2008–12[link]

Simon performing live in Germany, in 2008.

Paul Simon resides in New Canaan, Connecticut.^[24] He is one of a small number of performers who are named as the copyright owner on their recordings (most records have the recording company as the named owner of the recording). This noteworthy development was spearheaded by the Bee Gees after their successful $200 million lawsuit against RSO Records, which remains to this day the largest successful lawsuit against a record company by an artist or group.

All of Simon's solo recordings, even the ones originally issued by Columbia Records, are currently distributed by Sony Records' Legacy Recordings unit. His records were issued by Warner Music until mid-2010.^[25]

In February 2009, Simon performed back-to-back shows in his native New York City at the Beacon Theatre, which had recently been renovated. Simon was reunited with Art Garfunkel at the first show as well as with the cast of The Capeman; also playing in the band was Graceland bassist Bakithi Kumalo.

In May 2009, Simon toured with Art Garfunkel in Australia, New Zealand and Japan.

In October 2009, Simon appeared alongside Art Garfunkel at the 25th Anniversary of The Rock & Roll Hall of Fame concert at Madison Square Garden in New York City. The pair performed four of their most popular songs, "The Sound of Silence", "The Boxer", "Cecilia", and "Bridge Over Troubled Water".

Simon paying tribute to musician Chuck Berry and Leonard Cohen who were the recipients of the first annual PEN Awards for songwriting excellence, at the JFK Presidential Library, on February 26, 2012.

In mid-2010, Simon moved his catalogue of solo work from Warner Bros. Records to Sony/Columbia Records ^[25] where Simon and Garfunkel's catalogue is. Simon's back catalogue of solo recordings would be marketed by Sony Music's Legacy Recordings unit.

Simon's latest album entitled So Beautiful or So What,^[26] was released on the Concord Music Group label on April 12, 2011.^[27] The album received high marks from the artist, "It's the best work I've done in 20 years."^[25] It was reported that Paul Simon attempted to have Bob Dylan guest on the album.^[25]

On November 10, 2010, Simon released a new song called "Getting Ready for Christmas Day". It premiered on National Public Radio,^[28] and was included on the album So Beautiful Or So What. The song samples a 1941 sermon by the Rev. J.M. Gates, also entitled "Getting Ready for Christmas Day".^[29] Simon performed the song live on The Colbert Report on December 16, 2010.^[30] The first video featured J.M. Gates' giving the sermon and his church in 2010 with its display board showing many of Simon's lyrics; the second video illustrates the song with cartoon images.

In the premiere show of the final season of The Oprah Winfrey Show on September 10, 2010, Simon surprised Oprah and the audience with a song dedicated to Oprah and her show lasting 25 years (an update of a song he did for her show's 10th anniversary).^[31]

Rounding off his 2011 World Tour, which included United States, England, the Netherlands, Switzerland and Germany, Simon appeared at Ramat Gan Stadium in Israel in July 2011, making his first concert appearance in Israel since 1983.^[32] On September 11, 2011, Paul Simon performed "The Sound of Silence" at the National September 11 Memorial & Museum, site of the World Trade Center, on the 10th Anniversary of the September 11th attacks. ^[33]

On February 26, 2012, Simon paid tribute to fellow musicians Chuck Berry and Leonard Cohen who were the recipients of the first annual PEN Awards for songwriting excellence at the JFK Presidential Library in Boston, Massachusetts.^[34] In 1986 Simon was awarded an Honorary Doctor of Music degree from Berklee College of Music where he currently serves on the Board of Trustees.^{[35] [36]}

Songwriting[link]

In an indepth interview with American Songwriter, Simon discusses the craft of songwriting with music Journalist, Tom Moon. In the interview, Simon explains the basic themes in his songwriting: love, family, social commentary etc. as well as the overarching messages of religion, spirituality, and God in his lyrics. Simon goes on in the interview to explain the process of how he goes about writing songs, "The music always precedes the words. The words often come from the sound of the music and eventually evolve into coherent thoughts. Or incoherent thoughts. Rhythm plays a crucial part in the lyric-making as well. It’s like a puzzle to find the right words to express what the music is saying."^[37]

Projects[link]

Music for Broadway[link]

In the late 1990s, Simon wrote and produced a Broadway musical called The Capeman, which lost $11 million during its 1998 run. In April 2008, the Brooklyn Academy of Music celebrated Paul Simon's works, and dedicated a week to Songs From the Capeman with a good portion of the show's songs performed by a cast of singers and the Spanish Harlem Orchestra. Simon himself appeared during the BAM shows, performing "Trailways Bus" and "Late In the Evening". In August 2010, The Capeman was staged for three nights in the Delacorte Theatre in New York's Central Park. The production was directed by Diane Paulus and produced in conjunction with The Public Theatre.^[38]

Film and television[link]

Simon has also dabbled in acting. He played music producer Tony Lacey in the 1977 Woody Allen film Annie Hall, and wrote and starred in 1980's One Trick Pony as Jonah Levin, a journeyman rock and roller. Simon also wrote all the songs in the film. Paul Simon also appeared on The Muppet Show (the only episode to use only the songs of one songwriter, Simon). In 1990, he played the character of—appropriately enough—Simple Simon on the Disney channel TV movie, Mother Goose Rock 'n' Rhyme.

Simon has also appeared on Saturday Night Live (SNL) either as host or musical guest for a total of 13 times. On one appearance in the late 1980s, he worked with his political namesake, Illinois Senator Paul Simon.^[39] Simon's most recent SNL appearance was on the February 18, 2012 episode hosted by Maya Rudolph.

In one SNL skit from 1986 (when he was promoting Graceland), Simon plays himself, waiting in line with a friend to get into a movie. He amazes his friend by remembering intricate details about prior meetings with passers-by, but draws a complete blank when approached by Art Garfunkel, despite the latter's numerous memory prompts.

Simon also appeared alongside George Harrison as musical guest on the Thanksgiving Day episode of SNL (November 20, 1976). The two performed "Here Comes the Sun" and "Homeward Bound"" together, while Simon performed "50 Ways to Leave Your Lover" solo earlier in the show. On that episode, Simon opened the show performing "Still Crazy After All These Years" in a turkey outfit, since Thanksgiving was the following week. About halfway through the song, Simon tells the band to stop playing because of his embarrassment. After giving a frustrating speech to the audience, he leaves the stage, backed by applause. Lorne Michaels positively greets him backstage, but Simon is still upset, yelling at him because of the humiliating turkey outfit. This is one of SNL's most played sketches.

On September 29, 2001, Simon made a special appearance on the first SNL to air after the September 11, 2001 attacks. On that show, he performed "The Boxer" to the audience and the NYC firefighters and police officers. He is also friends with former SNL star Chevy Chase, who appeared in his video for "You Can Call Me Al" lip synching the song while Simon looks disgruntled and mimes backing vocals and the playing of various instruments beside him. He is a close friend of SNL producer Lorne Michaels, who produced the 1977 TV show The Paul Simon Special, as well as the Simon and Garfunkel concert in Central Park four years later. Simon and Lorne Michaels were the subjects of a 2006 episode of the Sundance channel documentary series, Iconoclasts.

He has been the subject of two films by Jeremy Marre, the first on Graceland, the second on The Capeman.

On November 18, 2008, Simon was a guest on The Colbert Report promoting his book Lyrics 1964–2008. He did an interview with Stephen Colbert and then performed "American Tune".

Simon performed a Stevie Wonder song at the White House in 2009, at an event honoring Wonder's musical career and contributions.

In May 2009, The Library of Congress: Paul Simon and Friends Live Concert was released on DVD, via Shout! Factory. The PBS concert was recorded in 2007.

In April 2011 Simon was confirmed to appear at the Glastonbury music festival in England.

Awards and honors[link]

Simon won 12 Grammy Awards (one of them a Lifetime Achievement Award) and five Grammy nominations, the most recent for his album You're the One in 2001. In 1998 he received a Grammy Hall of Fame Award for the Simon & Garfunkel album Bridge over Troubled Water. He received an Oscar nomination for the song "Father and Daughter" in 2002. He is also a two-time inductee into the Rock and Roll Hall of Fame; as a solo artist in 2001, and in 1990 as half of Simon & Garfunkel.

In 2001, Simon was honored as MusiCares Person Of The Year. The following year, he was one of the five recipients of the annual Kennedy Center Honors, the nation's highest tribute to performing and cultural artists.

In 2005, Simon was saluted as a BMI Icon at the 53rd Annual BMI Pop Awards. Simon's songwriting catalog has earned 39 BMI Awards including multiple citations for "Bridge Over Troubled Water," "Mrs. Robinson," "Scarborough Fair" and "The Sound of Silence". As of 2005, he has amassed nearly 75 million broadcast airplays, according to BMI surveys.^[40]

In 2006, Simon was selected by Time Magazine as one of the "100 People Who Shaped the World."

In 2007, Simon received the first annual Library of Congress Gershwin Prize for Popular Song in 2007. Stevie Wonder and Paul McCartney were to follow in 2009 and 2010. Named in honor of George and Ira Gershwin, this newly created award recognizes the profound and positive effect of popular music on the world’s culture. Upon being notified of receiving this honor, Simon said, “I am grateful to be the recipient of the Gershwin Prize and doubly honored to be the first. I look forward to spending an evening in the company of artists I admire at the award ceremony in May. I can think of a few who have expressed my words and music far better than I. I’m excited at the prospect of that happening again. It’s a songwriter’s dream come true." Among the performers who paid tribute to Simon were Stevie Wonder, Alison Krauss, Jerry Douglas, Lyle Lovett, James Taylor, Dianne Reeves, Marc Anthony, Yolanda Adams, and Ladysmith Black Mambazo. The event was professionally filmed and broadcast and is now available as Paul Simon and Friends.

In 2010, Simon received an honorary degree from Brandeis University, where he performed "The Boxer" at the main commencement ceremony.

In October 2011, Simon was inducted into the American Academy of Arts and Science. At the induction ceremony, he performed "American Tune".

Personal life[link]

When Simon moved to England in 1964 he met Kathleen Mary "Kathy" Chitty (born 1947) on 12 April 1964 at the very first English folk club he played, the Railway Inn Folk Club in Brentwood, Essex, where Chitty was working part-time selling tickets. She was 17, he was 22 and they fell in love. Later that year they visited the US together, touring around mainly by bus.^[41] Kathy returned to England on her own with Simon returning to her some weeks later. When Simon returned to the US with the growing success of "The Sound of Silence" Kathy (who was quite shy^[42]) wanted no part of the success and fame that awaited Simon and they split up.^[43] She is mentioned by name in at least two of his songs: "Kathy's Song" and "America," and is referred to in "Homeward Bound" and "The Late Great Johnny Ace." There is a photo of Simon and Kathy on the cover of The Paul Simon Song Book.

Simon has been married three times, first to Peggy Harper in late autumn 1969. They had a son, Harper Simon, in 1972 and divorced in 1975. The song "Train in the Distance," from Simon's 1983 album, is about this relationship.^[44] Simon's 1972 song "Run That Body Down," from his debut solo album, casually mentions both himself and his then-wife ("Peg") by name.

His second marriage, from 1983 to 1984, was to actress and author Carrie Fisher to whom he proposed after a New York Yankees game.^[44] The song "Hearts and Bones" was written about this relationship. The song "Graceland" is also thought to be about seeking solace from the end of this relationship by taking a road trip.^[45] A year after divorcing, Simon and Fisher resumed their relationship for several years.

He married folk singer Edie Brickell on May 30, 1992. They have three children together, Adrian, Lulu, and Gabriel.^[46]

Philanthropy[link]

Simon is a proponent of music education for children. In 1970, after recording his "Bridge Over Troubled Water," at the invitation of the NYU School of the Arts, Simon held auditions for a young songwriter's workshop. Advertised in the Village Voice, the auditions brought hundreds of hopefuls to perform for Simon. Among the six teenage songwriters Simon selected for tutelage were Melissa Manchester, Tommy Mandel and rock/beat poet Joe Linus, with Maggie and Terre Roche (the Roche Sisters), who later sang back-up for Simon, joining the workshop in progress through an impromptu appearance.

Simon invited the six teens to experience recording at Columbia studios with engineer Roy Halee at the board. During these sessions, Bob Dylan was downstairs recording the album Self-Portrait, which included a version of Simon's "The Boxer". Violinist Isaac Stern also visited the group with a CBS film crew, speaking to the young musicians about lyrics and music after Joe Linus performed his song "Circus Lion" for Stern.

Manchester later paid homage to Simon, on her recorded song, "Ode to Paul." Other younger musicians Simon has mentored include Nick Laird-Clowes, who later co-founded the band The Dream Academy. Laird-Clowes has credited Simon with helping to shape the band's biggest hit, "Life In A Northern Town".^[47]

In 2003, Simon signed on as an official supporter of Little Kids Rock, a nonprofit organization that provides free musical instruments and free lessons to children in public schools throughout the US. He sits on the organization's board of directors as an honorary member.

Simon is also a major benefactor and one of the co-founders, with Dr. Irwin Redlener, of the Children's Health Project and The Children's Health Fund^[48][49] which started by creating specially equipped "buses" to take medical care to children in medically underserved areas, urban and rural. Their first bus was in the impoverished South Bronx of New York City, but they now operate in 12 states, including on the Gulf Coast. It has expanded greatly, partnering with major hospitals, local public schools and medical schools and advocating policy for children's health and medical care.

In May 2012, Paul Simon performed at a benefit dinner for the Turkana Basin Institute in New York City, raising more than $2 million for Richard Leakey's research institute in Africa.^[50]

Controversy[link]

In 1971, as a jury-member of the Rio de Janeiro song contest, Simon gave no points to the 15-year-old Marianne Rosenberg, an ethnic Sinti (Gypsy) and child of an Auschwitz survivor (which Simon may not have known), because she represented Germany.^[51]

Guitars[link]

• Martin Paul Simon Signature PS2
• Martin Paul Simon Signature OM42
• Martin D-28 Acoustic
• Martin D-42 6/12 String Acoustics
• Ovation Custom Legend^[52]
• Yamaha Paul Simon Signature Model Acoustic
• Yamaha FG700S
• Yamaha FG730S
• Yamaha FX300C
• Yamaha F30BL
• Yamaha F40BL
• Yamaha GCX31C
• Taylor PS10
• Taylor 114
• Taylor 210
• Taylor 214
• Takamine TC132SC Classical
• Fender Stratocaster
• Fender Jaguar
• Fender Acoustic Guitars

Gear[link]

• Dunlop Paul Simon Picks Accessories
• Dunlop String Accessories
• Fender String Accessories

Discography[link]

Number-one albums

• 1972 – Paul Simon (UK, Japan, Norway)
• 1973 – There Goes Rhymin' Simon (US Cashbox)
• 1975 – Still Crazy After All These Years (US)
• 1986 – Graceland (UK, Australia, Canada, Switzerland)
• 1990 – The Rhythm of the Saints (UK)

Work on Broadway[link]

• Rock 'N Roll! The First 5,000 Years (1982) – revue – featured songwriter for Mrs. Robinson
• Asinamali! (1987) – play – co-producer
• Mike Nichols and Elaine May: Together Again on Broadway (1992) – concert – performer
• The Capeman (1998) – composer, co-lyricist and music arranger – Tony Nomination for Best Original Score
• The Graduate (2002) – play – featured songwriter

See also[link]

• List of songs written by Paul Simon
• Bronson, Fred (2003). The Billboard Book of Number 1 Hits. Billboard Books. ISBN 0-8230-7677-6. http://books.google.com/books?id=PgGqNrqfrsoC&pg=PT12&dq=billboard#v=onepage&q=&f=false. 

References[link]

External links[link]

Wikimedia Commons has media related to: Paul Simon

• Official website for Paul Simon