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How many allergists does it take to change a lightbulb?

How many allergists does it take to change a lightbulb?  Actually it takes 11.  One to change the lightbulb, and 10 to run to the FDA and seek approval for the procedure...One of the biggest hangups in the acceptance of sublingual immunotherapy (SLIT) among my colleagues is that "there is no FDA-approved formulation for SLIT in the United States"  (Cox, Sublingual Im munotherapy:  Review of Clinical Efficacy, Vol 28, pp 162-166, April 2007).  Greer Labs is finishing up phase III safety trials of SLIT and approval by the FDA is  imminent in the near future, in my opinion.  It will be no doubt a relief to all of us that--big surprise here--that it is SAFE to orally ingest what allergists have DIRECTLY  injected into people for decades. We have no problem with injecting a high dose of Ragweed into somebody--no questions asked--but suddenly we'll give them Ragweed orally, and eyes widen in alarm---oh my goodness, this could be DANGEROUS!  In short, many of my colleagues have "hid" behind the lack of FDA approval for SLIT as an excuse for not investigating SLIT...why so?  Why the lack of incredible enthusiasm in a technique shown to help so many people? Why is the glass half-empty instead of half full?  Why have American Allergists been so slow to get going in this area while our European colleagues have surged forward? 

The truth is often ugly, and here we have a good example of it...one difference between the American Allergist and the European Allergist's viewpoint on SLIT is that the American Allergist brings "baggage" with him.  Bad baggage.  At least ONE of the reasons allergists have been unenthusiastic about SLIT ("we need more studies"  "the FDA hasn't approved it" , etc etc etc ) is that  in the 60's and 70's the doctors using sublingual immunotherapy--and saying it worked--belonged to the "Clinical Ecology" movement in the United States.  Shhhhhhh....I'll tell you a secret, but don't say it out loud, OK?  The traditional allergist detests Clinical Ecologists.   And SLIT has at least informally been identified with them.  It will be a bitter pill for some allergists to swallow to admit that SLIT can be an effective therapy.  But the pill must be swallowed...because there are ALOT of lightbulbs out there that need changing...

Posted on Saturday, April 21, 2007 at 01:28PM by Registered CommenterGeorge F Kroker MD FACAAI in | CommentsPost a Comment

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