Portal de Periódicos da CAPES

Dr Lawrence Youlten 1936–2023

2023; Wiley; Volume: 53; Issue: 10 Linguagem: Inglês

10.1111/cea.14403

1365-2222

Pamela Ewan, Shuaib Nasser,

Contact Dermatitis and Allergies

Lawrence Youlten was a distinguished allergist. He was unusual, a gifted polymath with a dry sense of humour, rather different from present day doctors. His expertise was in clinical pharmacology and allergy with particular interest in venom allergy and desensitisation. Lawrence graduated in medicine from Guy's Hospital, University of London in 1961. His early career was in physiology, initially as a lecturer at the Sherrington School of Physiology at St Thomas's Hospital Medical School. He did his PhD on the physiology and pharmacology of the vascular response to inflammation at the Royal College of Surgeons, Lincolns Inn, under Sir John Vane – later Nobel Prize winner for his work on aspirin and prostaglandins. Lawrence's research area was vascular permeability and the chemical mediators of inflammation, particularly prostaglandins. Between 1977 and 1982, at the invitation of Professor Maurice Lessof, he combined work in Pharma with SmithKline Beecham (SKB) and allergy at Guy's. At SKB, as a clinical pharmacologist and later Director of Clinical Pharmacology Compliance, he organised trials to evaluate efficacy and safety of injected and oral vaccines for immunotherapy. This involved developing techniques to act as surrogate measures of efficacy in immunotherapy trials, including nasal allergen provocation and serial skin testing. He wrote the ‘Clinical Expertise’ documents on the Pollinex range of vaccines for the successful application for product licences in UK and Europe. These are still the only subcutaneous pollen allergy vaccines with a product licence in UK. Of interest to allergists now, an oral enteric coated pollen vaccine was dropped in the early phase of development as it caused a systemic reaction a few hours after administration in a hay fever subject. Lawrence devised the initial proof of concept studies of nasal ipratropium for the treatment of rhinorrhoea. This was the groundwork which led directly to the development of ipratropium nasal spray (Rinatec and Rinaspray). From 1982–2002 he was an honorary lecturer/consultant allergist at Guy's and St Thomas' NHS Trust, where he set up the desensitisation clinics for pollen, venom and animal allergy. At that time, the Guy's Allergy Department was led by Professor Maurice Lessof, and latterly Professor Tak Lee. Special interests were mechanism of allergy and the investigation and management of patients who survived anaphylactic reactions. He has published about 60 scientific papers, mainly on allergy. He contributed to the British Society for Allergy and Clinical Immunology (BSACI), as Council member, then Assistant Secretary and then Secretary in the early 1990s. In those days the Secretary and Assistant Secretary organised the BSACI annual meetings without the current-day support of a professional secretariat and conference organiser. He was a member of the BSACI and Association of Anaesthetists joint working party on ‘Management of anaphylaxis during general anaesthesia’. He was also a member of the BSACI group making representation to the Committee on Safety of Medicines on the safety of allergy immunotherapy vaccines in 1987. In 2009 he was awarded the William Frankland Award by BSACI for Outstanding Services to Clinical Allergy. His last appointment was as Visiting Consultant in Allergy at Addenbrooke's Hospital, Cambridge (later Cambridge University Hospitals Trust). For 13 years from 1998 to 2011, he would drive up in his big Citroen from his lovely home in Winchelsea, East Sussex, over the Dartford crossing to Cambridge, to work in the Allergy Department on Tuesdays. In due course this became a burdensome drive, so he came 2 days every fortnight and Pam Ewan became his landlady for dinner, B&B, thus fortunate to get to know him well. He liked to play chess late into the evenings with her husband, Keith Peters. He was greatly liked by all in the department, and his secretary Linda would rush to offer him coffee on his arrival from Sussex. On his way in he had usually bought an expresso from the Costa in the Concourse using his loyalty card, which resulted in a free coffee every 5th purchase. He had a distinctive ‘LY’ clinic letter style, always finished clinics first, then could be seen reading his paper, doing crosswords and puzzles. He enjoyed having long chats with Shuaib Nasser on a variety of topics including religion, politics, current affairs, novels and of course Allergy. In summer he would occasionally have a round of golf after work with Shuaib and was expert at teeing off with his driver only for the ball to travel along the ground for 200 yards towards the green. In 2009 he said, ‘I have been extraordinarily lucky in my career to have had such wonderfully supportive colleagues, including Maurice Lessof, Tak Lee, Noemi Eiser, Pamela Ewan and Shuaib Nasser who have been brave enough to overlook my somewhat unconventional CV and enable me to have the fulfilling clinical career I have enjoyed for the past 32 years.’ Amongst other varied contributions to allergy, he invented two methods of measuring nasal airway patency. One, the peak nasal inspiratory flow meter (PNIF), was used in ENT departments. Rita Mirakian, a colleague of Lawrence's in the London Allergy Clinic and Cambridge arranged for his discovery to be displayed in the Addenbrooke's Hospital Museum. The nasal volume method, which involved filling the nasal cavity with warm saline, then measuring the retrievable volume - to use Lawrence's own words – never caught on. He was an allergist in the London Allergy Clinic on Wimpole Street, from around 1982 when it was formed and later became Medical Director for 15 years. Lawrence developed other unusual skills. He became a Forensic Medical Examiner working (moonlighting) for the Metropolitan Police and had many tales of visiting police cells in the night. This led to him become a medico-legal expert in allergy, and he was proud his opinion was sought equally by plaintiffs and defendants, and that his cases were always settled out of court. Lawrence was an imposing figure not only because of his height (at 6 feet 8 inches) but also his intellectual and somewhat formal approach. Beneath the exterior, he was warm and engaging and those who worked with him were fortunate to know him. He was a great raconteur with a brilliant memory and told many stories from his early career and the early days when he and his wife Felicity lived near Guy's (he married as a medical student). He was proud that he could claim he was related to Sebastian Faulkes, who married his daughter Veronica. Another favourite story was of injecting Pam Ewan's cat with insulin in Cambridge when she was away. He was adopted and spoke fondly of his adoptive seamstress mother. Only late in life did he discover he had a sister, Kath, a retired nurse in New York, through ancestry.com. During his time in Cambridge, he developed atrial fibrillation; then later heart failure due to cardiomyopathy. He received good cardiological advice and was managed well for nearly 20 years, latterly with an implanted defibrillator. Sadly, from January 2023 he became progressively unwell and died of heart failure. Family was important to Lawrence, and he spoke proudly of the grandchildren. He leaves his wife Felicity, a retired headmistress to whom he was happily married for many years and his children, Maddy, Paul and Veronica, eight grandchildren, four great-grandchildren. And a legacy to Allergy. Dr Lawrence Youlten receiving the William Frankland Award 2009 from Dr Frankland. Dr Lawrence Youlten and colleagues at his leaving party, Addenbrooke's Allergy Clinic, Cambridge, 2011. From left Drs Andrew Clark, Lawrence Youlten, Shuaib Nasser, Annette Wagner and Pam Ewan. Dr Lawrence Youlten after retirement at his secretary Linda's leaving party, Addenbrooke's Allergy Clinic, Cambridge, 2013. From left, Drs Lawence Youlten, Shuaib Nasser and Andrew Clark.