Jean Julien Raoul Bousquet; a Chemist, a Pharmacist, a Biologist, a Physician and – above all – an innovative Scientist

Anna Bedbrook1 and Torsten Zuberbier2
1 MACVIA-France, Montpellier, France
2 Charité Universitätsmedizin Berlin, Department of Dermatology and Allergy

Having been given the opportunity to write this article about Jean Bousquet is certainly an honour and writing the “legend” of Jean Bousquet is an absolute pleasure. According to the Cambridge English Dictionary, a “legend” is a very old story, or a set of stories from ancient times. All of the stories, sometimes fictitious, tell of a famous event or person. Already here, a short remark may be appropriate: Jean – born in 1946 – has surely everything that is needed to become a legend. However, he is certainly not ancient, given that he is so extremely alert and up to date.

“Up to date” may in fact potentially be regarded as an insult by Jean, as we must admit that he is always at least ten years ahead of the times. I myself, Torsten Zuberbier, have been working with Jean for the past 15 years in the leadership of GA2LEN and must confess that at numerous (if not multiple) times, he has surprised me with his ever-new ideas and suggestions.

I, Anna Bedbrook, have been working very closely alongside Jean for twenty years. I arrived on the scene just as ARIA (Allergic Rhinitis and its Impact on Asthma) was emerging and my mission began by revising the English of the very first ARIA publication. Since then, I have never looked back and seem to have miraculously managed to keep up over the years with Jean’s extremely rapid pace, always endeavouring to accomplish the challenging mission of living up to his high expectations. Thanks to Jean, I have become a self-confident and strong person who thoroughly enjoys working on his exciting and creative projects.

Looking at Jean’s competences and his C.V., it can be noted that he possesses driving licences A and B, whatever that might mean… But what we do know is that he drives swiftly, carefully, with joy and (of course) in style – in a fancy German manufactured car whose brand we will not mention. This car is of course allergy friendly and certified by the ECARF Foundation which Jean also supports. The curious reader may guess the make.

The most remarkable ability about his driving skills is however not his capability of steering the car, with which most of us have no problem, but that he happens to know the manual off by heart. In fact, he probably doesn’t even need to read it as he is likely to already know every single feature before even touching the manual. Jean has not only a photographic memory but also loves and captures all details of a situation at first glance. This clearly brings us to his scientific achievements.

Jean is certainly the only physician to our knowledge who has completed 4 different university degrees, becoming a chemist at the age of 21, a pharmacist at 22, a biologist at 24 and a medical doctor at 29. His capacity of high productivity and diversity of projects conducted simultaneously was demonstrated when he obtained PhD and MD degrees in the same week – one in pharmacy “Immunology of the pleural fluid” and one in medicine “Allergic risk and its prevention” – whilst at the same time organising an international meeting on allergen standardization!

Of course, he also carries academic degrees in the other disciplines. How can anyone accomplish this??? Jean certainly has the very good luck of being equipped with such a fantastic memory, but this is only useful in combination with the important trait of his disciplined character which can be a slight challenge for the rest of the world, as he expects others to be equally as quick and disciplined!

For those who know Jean, it is easy to imagine that he is right when he tells us that at school, his teachers didn’t like him very much, that he was a bit of an annoying pest. Well, for those of you who have school-aged children at home who by chance also possess similar genius-like tendencies, maybe it would be a good idea to tell them not to correct their teacher in every lesson, or maybe only once in a while. We believe that Jean was never given this advice! At school, Jean’s admirable capacity in science was not only based on his photographic memory but also on his speed of reading, easily comparable to the xerox machines of his time. To be noted that Jean taught himself to read at the age of 6 by studying cars in the street and working out the make and model of each vehicle. We can easily imagine that in his youth, the Encyclopedia “Britannica” soon became boring. Luckily for Jean, today, he is able to read Wikipedia at bedtime wherever he may be on the planet. In fact, should you accompany Jean anywhere in the world, you don’t need to use Wikipedia yourself, as he is an actual walking encyclopedia. He can tell you everything there is to know about the monuments you visit (history, date of construction, height, width, etc.) as well as the artists whose masterpieces you admire (the techniques used in each painting, the date of birth/death of the artist). He is a museum guide’s nightmare, catching him/her out on incorrect dates or facts. To be noted that he can also name and provide detailed information on most every car, motorbike and sailing boat within sight.

As Jean himself states, one of his favourite hobbies is Astronomy. However, we must clarify that this activity involves internet research and not paradoxically a telescope. He is not attracted to the stars in the sky but to those in the Michelin Guide. He seems to know most of the names of these top restaurants as well as the city of their location. To conclude, when travelling with Jean, you can be sure that you will not need to look up the best museum, the current exhibition or the most prestigious restaurant in town.

Jean’s personality has been the foundation of his journey to becoming a legend in allergy and immunology. Along the way, he became a respiratory specialist in 1979 and then started his career.

In the 1980s, Jean was already an impressive specialist when it came to bibliography – which he studied in great detail in the weekly “Current Contents”. With the help of his dear wife, Hélène, he requested reprints, read them all… and memorized them!!! (Fig. 1)

At medical conferences, if you ever have any doubts whatsoever regarding bibliography, just ask Jean and he will give you not only the list of authors, but also the name of the journal and, as a bonus, the page numbers! And he still laughs when he does so. (Fig. 2)

At the end of 1989, he began to set up a research laboratory at the Aiguelongue Hospital (Montpellier), with the help of French and English researchers.

The construction of the new Arnaud de Villeneuve Hospital (Montpellier) marked the start of his activity in basic research. His enthusiasm and self-confidence enabled him to attract an important number of researchers in order to apply to INSERM for recognition of his already-accomplished work.

In 1992, the request to establish a recognized laboratory was accepted by the national authorities. The CJF 92-10 was created and renewed 2 years later.

Jean’s activity was never ending: travelling throughout Europe and the USA to give presentations in congresses and meetings as well as writing articles (with his researchers) in the office situated on the ground floor of his home. Despite the fact that the new hospital was only a 5-minute walk from his home, he had no time to waste and often drove there.

He also managed to find time to play tennis with one of his close Italian “fellows” who he regularly exhausted.

In order to fully understand the functioning of the INSERM committees, he applied to join Committee 5 (Heart – Lung) and was elected. His enthusiasm attracted new French and Dutch researchers, allowing him to apply for the establishment of a research unit. Unit 454 was established in 1996. This unit was renewed in 2000 and 2004, and closed in 2008. He then decided that it was time to move on to a new area of work.

Apart from doing his own research, he soon discovered that the greatest achievements could be accomplished by creating large networks and initiatives starting with GINA, the Global INitiative for Asthma, which he chaired from 1998 to 1999. He soon then discovered that allergy in general was a rather trivialized area and that linking allergic rhinitis with asthma would gain the attention of the health politicians and WHO. In this sense, he founded his greatest baby – ARIA – the most frequently worldwide-read guideline in asthma and, more than that, a network of renowned researchers spanning the globe. Many of these prestigious people from around the world became his close, foreign “family”.

He then became director of the WHO Collaborating Centre for asthma and rhinitis in Montpellier in 2001 with affiliates in 64 countries. Subsequently, he set up the WHO Global Alliance against chronic Respiratory Diseases (GARD) initiative which he chaired between 2005 and 2013 before handing the work over to successors.

Another very important political and scientific achievement was GA2LEN (the Global Allergy and Asthma European Network) which was created and funded by the European Union. Jean was one of GA2LEN’s driving forces together with Paul van Cauwenberge. Jean has been on the board as Vice-President from the very beginning and, in his own creative way, has always added new ways of thinking and new research topics, even EU Grants such as MeDALL (Mechanisms of the Development of ALLergy).

ARIA (Allergic Rhinitis and its Impact on Asthma) began in 1999 after Jean discovered that there was a definite link between allergic rhinitis and asthma. He was the first person in the world to discover also the political potential of this and thus to get WHO – via the “seriously-regarded” disease asthma – interested in allergy.

ARIA was therefore initiated during a WHO workshop and was first published in 2001. Its main aim was to provide a guideline for the diagnosis and management of allergic rhinitis and asthma. It was further developed by the WHO Collaborative Centre. In 2008, ARIA was updated and then, in its 2010 revision, it became the first chronic respiratory disease guideline to adopt the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) approach, an advanced evidence evaluation methodology. ARIA now has a 600-member working group in 80 countries and in more than 40 different languages. Determined to keep up with the times, Jean’s ARIA created MASK (Mobile Airways Sentinel networK) with a working group of 250 members. MASK uses mobile technology to develop care pathways for the management of rhinitis and asthma. It has been officially recognized by DG Santé as a Good Practice on the digital transformation of health and care in rhinitis and asthma. MASK has developed a smartphone App for Android and Apple (MASK-air) that has been launched in 24 countries and 18 languages (Fig. 3). MASK-air enables its users to keep a daily record of their allergic rhinitis and asthma symptoms as well as their medication use.

The App is currently integrating data on pollution, pollens and climate parameters. Artificial intelligence is soon going to reinforce the platform and will contribute to its utmost success in patient well-being. One of the current ARIA phases is “change management for airway diseases”, the aim of which is to provide an active and healthy life to rhinitis and asthma sufferers.

When Jean Bousquet successfully launched the next step in ARIA – the MASK-air App, he entered a new field of work: digital health. Jean soon discovered that pooled data enabled a new understanding and new ways of looking at the same facts from a different angle. The term Anamorphosis in medicine was born and soon thereafter published.

Still, the importance of this initiative goes much deeper than many anticipated and, once again, Jean has been the first in allergy to make a discovery: the potential that digital health offers in future treatment. Novel interactive tools can not only help to ensure the adherence of patients but also to link predictions with pollen flight, allowing proactive suggestions for step-up and step-down in medication.

Another important topic of his recent work is the area of Active and Healthy Ageing (AHA) in Horizon 2020 within the programme of the European Innovation Partnership (EIP). Jean has not only managed to enter his own region in France as a reference site – now already highly decorated – but also to establish GA²LEN as a pan-European network, also as a reference site. With this, and within the important field of Active and Healthy Ageing, allergy now has a clear footprint reminding us all that not only the early lifetime events should be considered in research (starting with the birth cohorts) but also that allergies have a relevant impact in older age, e.g. they are responsible for up to 7% of car accidents. In addition, with the lack of cohort studies in the elderly, we also need better data on novel sensitisations beyond the age of retirement and the personal impact of allergies on the lives of the elderly. Gaining this knowledge will truly support research in finding better strategies for helping allergy sufferers to achieve their personal AHA, while Jean himself – now aged 73 – can be quoted that he himself is already a living example of a personal HAHA (HYPER Active and Healthy Ageing).

Last but not least, summarizing Professor Jean Bousquet’s steps in becoming a legend in allergy has proven that he truly thinks in universal terms although limited to our planet Earth (where, as pointed out above, he also believes that stars can be found). He was the first ever to link allergy and active and healthy ageing, not only with climate change but with the truly universal term “planetary health” which unites all necessities of our planet, going beyond the wishes of a better nature, a better climate and better wildlife protection.

Planetary health is the understanding of the inter-dependencies of all human and all natural systems, including plants, animals, water, air and the human constructions as well as the health of humans. Ideally, a win-win situation can be created, where interventions are good for humans, human health and the health of the planet. Thus it appears only logical to think ahead – as Jean usually does – and to take a look at allergy in this context. Worldwide, we clearly have a growing number of allergy sufferers, not only in the field of airway allergy with sensitization against trees such as Birch, Japanese Cedar, Tree of Heaven (Ailanthus) (now planted also in Europe) and Olive but also in cross-reactions leading to food allergy against a variety of fruits and vegetables. Planetary health and allergy can both be helped with novel scientific concepts, taking into account the cultivation of plants with low allergenicity as well as good resistance in times of climate change. Within this field, Jean has already formed a new Alliance using the synergistic effects of his various pro bono offices, in this case GA²LEN, with him being vice president, and ECARF, the European allergy foundation, where he serves as a member of the advisory board and French ambassador. More about this topic will certainly soon be published in this journal. The paper has not yet been written but soon will, given that his articles are produced in record time, which is also legendary. To be noted that Jean has published over 1,000 articles throughout his career, the majority of which having been written by himself, and has an extremely impressive Hirsch factor of 158 on Google Scholar. He is the most frequently quoted author in asthma worldwide and cannot be overlooked at any conference, despite a few of his regular quotes: “I’m a crazy guy” – “I’m a simple guy”.

Well, Jean, whatever you think… We think that you are not just “any” guy but a most wonderful and brilliant (no other word to describe you) person and, to be precise, you are already more than a “Legend in Allergy”. You have well and truly earned your place as a “Legend in Medicine”!

• Table 1. Jean’s major contributions:
  Confirmed the importance of eosinophils in the pathogenesis of asthma and its severity (1990)
  Proposed and confirmed the concept of airways remodeling in asthma (1992)
  Showed that rhinitis alters quality of life more than mild to moderate asthma (1992)
  Proposed that mono and polysensitization are different diseases (1992)
  Allergen immunotherapy guidelines, WHO position paper (1997)
  Initiated the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines, which reclassified allergic rhinitis according to its persistence and severity (1999)
  Initiated the Global Alliance against Chronic Respiratory Diseases (GARD), WHO (2004)
  Proposed the concept of epigenetic mechanisms in asthma (2004)
  Proposed and confirmed that allergic rhinitis is not a disease remodeling the airways because of its embryologic origin (2004)
  Improved current understanding on the mechanisms implicated in the initiation of allergic diseases (MeDALL, 2011)
  Identified a multimorbid polysensitized phenotype and its association with a Type 2 pattern and the severity of allergic diseases (2015)
  Developed and implemented mobile technology in rhinitis and asthma: Mobile Airways Sentinel networK (MASK) (2016)
  Combined big data, classical epidemiology, bio-informatics and a genomic approach, distangled rhinitis as a single disease and rhinitis and asthma, and showed that rhinitis and conjunctivitis are two different diseases (2020)
  Extract from the article in Allergy pub. 15.04.2020 – doi.org/10.1111/all.14321