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Candida Related Illness and Sublingual Immunotherapy--Similar Struggles

This week on Thursday I'll be giving a Webinar on the Spectrum of Candida Related Disorders (the lecture is available for download). In preparing the lecture, I've reflected on my journey over the last 33 years in looking at this mysterious illness.  The journey began in 1978 when I was an allergy Fellow in Training in Chicago.  I received an unexpected phone call from a patient of mine who told me she had not gotten better with my treatment, but had gotten dramatically better after receiving treatment with antifungal medication from Dr. Orion Truss in Birmingham Alabama.

And so my journey began.  And, after 33 years, I am still on it.

But I am on another journey too.  A journey involving the use of Sublingual Immunotherapy (SLIT) and probing it's depths to determine how best to treat my allergy patients.

Candida related illness is a disease in search of a pathogenic mechanism and diagnostic test.  SLIT is a therapy in search of a mechanism of action and therapeutic efficacy. 

However, in reflecting on these two journeys I've been on, it occurred to me thathe struggles for Candida-related illness to gain acceptance has striking parallels in the struggles for sublingual immunotherapy (SLIT) to gain acceptance

  Consider these points:  

1.  Both concepts were developed outside mainstream academia.

2.  Both concepts suffered from "The Tomato Effect".  As described by Goodwin & Goodwin in their landmark article in JAMA in 1984, the tomato effect is derived from the true story that no one in America ate tomatoes in the early 19th century because "everyone knew it was poisonous".  Why?  Because "we just knew it".  Never mind that Europeans were eating this New World Fruit (imported from Peru) by the bushelbasketful! Finally, in 1820 Robert Gibbon Johnson sat down at the Courthouse steps in Salem, New Jersey and shocked the townspeople by eating a tomato and not dying.  The contention of Goodwin & Goodwin is that the Tomato Effect retards progress in medicine when a treatment doesn't "make sense" in the prevailing medical atmosphere.   

In the case of SLIT, allergists knew it didn't work because "they just knew it".  In the case of Candida, the same thing happened--Candida just causes infections and not allergic disease, because, well, "we just knew it".  

3.  In both cases, rather perfunctory, negative studies were done by academia which dismissed Candida and SLIT as not being worthy of further study. (think about the Dismukes study on Candida in the NEJM in 1990 and the studies by Nelson et al in 1993 on SLIT for cat antigen as good examples)

4.  In both cases, later studies showed efficacy but American academia was still reluctant to enthusiastically endorse either of these concepts.  They just "didn't make sense".  

5.  In both cases, despite academic resistance, general practitioners found the efficacy of antifungal treatment for Candida-sensitive patients and SLIT treatment for allergy patients was just too good to ignore.  Regarding SLIT, our European colleagues have begun utilizing  this form of treatment more and more extensively.  Regarding Candida and antifungal treatment, our Alternative Medicine colleagues have also utilized this form of treatment more and more extensively.  

6.  In both cases, of course, (as to be expected), insurance problems exist with both issues--both reimburse as well as coding problems.   

And what about the future?  Here again, there are similarities with both Candida Related Illness and Sublingual Immunotherapy:

1.  In both cases, much more study is needed in area of mechanisms--in the area of SLIT, we need to further research the  mechanisms of therapeutic action, and in the area of Candida related illness, we need studies in the mechanism of disease pathogenesis.  

2. In both cases, we need to encourage American Academic Institutions to perform studies in these two areas.

And the biggest similarity in the struggle for SLIT and Candida-related illness to gain credence?  Easy answer:  

They both highlight the glaring deficiencies in the mind-set of our general American Allergy Community.

As a group, we have had a myopic, restricted drug-oriented, immunotherapy-minimizing, one-organ system (respiratory tract) viewpoint that frankly embarrasses me.  We need to enlarge considerably and (yes)  embrace and welcome  different viewpoints and new ideas and concepts.  Let's quit our intellectually  lazy "business as usual" mindset, and broaden our horizon beyond the respiratory tract and IgE mediated sensitization states.  We need to open our eyes to new ideas and treatments.  SLIT?  Bring it on!  Candida related illness--let's check it out!

So joint me on my journey.  And trust me:  It's worth it.  

Later, Dude



Posted on Sunday, March 4, 2012 at 05:17PM by Registered CommenterGeorge F Kroker MD FACAAI | Comments1 Comment | References2 References

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Reader Comments (1)

Dear Renaissance Allergist, AKA....MY HERO!
Thank you so much for your perserverance and thinking "outside the box"! I can not even imagine what my life would be like without SLIT therapy! I often reflect back to the "before" time which was a constant cycle of anti-biotics for sinus infections, upper-respiratory infections, constant IBS, asthma attacks, various rashes, runny nose, migraines etc...As a testament to my hero and his wonderful Sorell, I HAVE NOT HAD TO TAKE AN ANTI-BIOTIC SINCE I BEGAN SLIT THERAPY!!! I now know what triggers I need to avoid and Dr. Kroker et al. gave me a quality of life I had never known. I have been able to re-introduce foods back into my diet that were previous triggers AND I can have an occasional BLIZZARD!!!So,to my hero and his team....YOU ROCK!!!I look forward to seeing you in May =) Your loyal subject...Sarabeth

March 5, 2012 | Unregistered CommenterSarabeth Salan Stielow

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