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Of Allergists, Emperors, and SLIT

History repeats itself, first as tragedy, second as farce.
Karl Marx

In the absolutely superb book Abundance: The Future is Better Than You Think  by Diamandis & Kotler, is an interesting story...going back two millenia.  

In the first chapter of their book, the authors relate a fascinating story told by Pliny the Elder, who was a brilliant Roman naturalist who wrote a 37 volume tome Naturalis Historia. In one of his later volumes, Earth, book XXXV, he tells the following story:  

A goldsmith brought a unique dinner plate to the court of Emperor Tiberius. It was a show-stopper: light, shiny, and gorgeous.  The goldsmith claimed he'd extracted it from clay using a secret technique and formula known only to himself.  Upon seeing this beautiful plate, however, Tiberius became very concerned.   He feared the value of his treasure trove of gold would seriously decline if people suddenly had access to a new metal rarer than gold.  "Therefore", recounts Pliny, "instead of giving the goldsmith the regard he expected, he ordered him to be beheaded."

And thus, aluminum was lost for nearly 2000 years.

My point?  New innovation is not always welcomed by the powers-that-be. And SLIT (sublingual immunotherapy) is a new innovation. And is it being welcomed with open arms by our American Allergy Establishment?  And if not, why not?    

The practicing Allergist is hungry to know more about SLIT.  One of the absolutely most common "search hits" I have on my Blog Site is searching for information on SLIT.  I see searches on my site for "SLIT"  "SLIT protocols", "sublingual immunotherapy" etc. etc. etc.  

But what about the "Allergy Establishment"?  What can we expect in the next few years?  I'll hazard a guess:  more defensive posturing.     Here are some examples we've already seen:  

1.  "It's not FDA-approved"  This is the tired, stalling tactic that has become our mantra as American Allergists. What isn't stated by the Allergy Establishment is that using extracts that are FDA approved in an off-label manner is perfectly legal and is consistent with historical medical practice.   And let's use common sense here--what's the difference between getting an extract into our body by injecting it or by giving it under the tongue?  It's still the same extract, right? Why would we not be enthusiastic about exploiting this route of administration, especially if the current literature attests to its overwhelmingly favorable safety profile?   

2.  More studies highlighting the "danger" of sublingual immunotherapy:  this has major benefits for the Allergy Establishment.  It  "packages" the treatment as something that should only be done by the board-certified allergist, and away from the domain of the ENT, and family practitioner who would consider using it.

3.  Glacial movement towards a protocol for treatment, while attempting to marginalize the fact that an effective protocol for treatment already exists and has published data regarding efficacy.  Yes, that's right. The La Crosse Method of SLIT.  Check out the Feb Issue of the Journal of Allergy:  Quality of Life Improvement with Sublingual Immunotherapy:  A Prospective Study of Efficacy by Morris, Lowery, Theodoropoulos, Duquette, and Morris.  Then check out my lecture on SLIT protocols to compare the La Crosse Method with others.  

As allergists, we've served up the shining, beautiful "plate" of SLIT---to our patients, AND to our allergy establishment.  How are each of them receiving it?  

Something to think about.

Later, Dude

Posted on Monday, March 19, 2012 at 01:38PM by Registered CommenterGeorge F Kroker MD FACAAI in | CommentsPost a Comment

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