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The Big Lie 

A Half-truth is a whole lie

 --Old Yiddish Proverb


Cindy sat across from me in my office and shyly smiled.  This 8 year old girl was being brought in by her parents for allergy assessment...

But with a twist.

"We want Cindy checked for food allergies" her mother said, "but nothing else--she's had all the routine blood work."   Their finances were limited, she explained, and Cindy's asthma was "being taken care of" by her other allergist.  As I looked over the enclosed ELISA IgE antibody report from Cindy's  other allergist, I found astoundingly high IgE values for dog, as well as for dust.  And...yes, she had a dog at home.  Furthermore, she had seasonal hayfever in the springtime.  And what, you might ask, was her treatment for her allergies?  

Flovent 110 2 puffs bid.  

Her mother explained that Cindy's asthma really "wasn't an issue", but she had been scared the preceeding week when Cindy had an acute anaphylaxis episode after eating.  It didn't surprise me that Cindy's anaphylactic episode might occur during the spring allergy season. Her seasonal springtime hayfever told me she was probably tree pollen sensitive.  A recent article By Vetander et al published online March 15 in Clinical & Experimental Allergy found that "our study suggests an associated risk for anaphylaxis during leaf tree pollen season among 35 pollen-allergic individuals." And clinically I see this all the time in patients. For example,  I can recall one girl who had 6 episodes of anaphylaxis, all clustered around the ragweed season.    In her case a combination of ragweed and food sensitivities  would reach a "critical mass" and trigger a severe reaction.    

When we did intradermal skin testing on Cindy, she had strongly positive reactions to dust, dog, multiple spring & fall pollens, and alternaria mold.  

And here she was, her parents only wanting her to be assessed only for food allergy, because her asthma "was just fine" on Flovent, and her hayfever "was being taken care of" with antihistamines.   

Cindy's parents had unknowingly bought into The Big Lie.  

Somehow, somewhere, the message we Allergists have given our patients is that symptom-controlling medication is all we can--and should--offer most of our them. In truth, Cindy's immunological reactivity was spreading--first hayfever, then asthma, and now anaphylaxis.  In essence, although her asthma was "controlled" most days, her allergic reactivity wasn't.  

But if we look further, we can find what's really behind The Big Lie  --And that's The Big Secret.

The Big Secret is we indeed have a potentially disease-modifying treatment at our disposal:  immunotherapy.  However, as allergists, we don't talk about it enough, educate patients enough, and use it enough.  Period.  Think I'm wrong?  Check out the recent USA Today Allergy Supplement.  There you will find a semi-comprehensive guide to asthma.  Why do I refer to it as semi-comprehensive?  Because there is no mention of immunotherapy as an option.  None!  And yet, there is a nice write-up about Cystic Fibrosis--a non-allergic disease!  

Let's get back to the basics:  As allergists, we discover allergies and then try to induce tolerance with immunotherapy. To a large extent, the ability to do immunotherapy defines who we are and what we do. In that regard, we are like surgeons, only we do "knifeless surgery" on the immune system.  What would your reaction be if you read a USA Today Supplement on Surgery and only medications and "control" of illness was discussed, and not actually surgery? Would something be missing?  

Of course, I have some understanding why immunotherapy is not "shouted from the rooftops" by my colleagues--and that's because subcutaneous immunotherapy (SCIT) can of course be dangerous.  The beauty of sublingual immunotherapy (SLIT) is it's safety and effectiveness.  It has the chance to breathe new life into our specialty.  And for someone like Cindy, who began SLIT the day I saw her, it gives her hope of a better future.

Later, Dude 



Posted on Monday, May 28, 2012 at 04:58PM by Registered CommenterGeorge F Kroker MD FACAAI | Comments1 Comment

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Reader Comments (1)

Dr George

I'm Business Tained, and as you may have heard said > Follow the Money.

Unfortunately the Medical GateKeepers who have taken an Oath to Do No Harm .. Fail to see that their Skin Testing / Immuno-Allergy SHOTs are Old School and have been Replaced by IgE Blood Testing & SLIT DROPs.

We all know that the Best Therapy / Drug in the World is render UseLess IF the Patient is Non-Compliant ..

Which frankly is the "Definition of Allergy Skin Testing & SHOTs" ..

I Pray ( and I "do" mean Pray ) that soon Allergy / Asthma Parents with Allergy Children can go to their Allergist ..Receive a Blood Test .. followed by Peppermint DROPs .. and know that the Progression of their Child's Allergy to Allergic ASTHMA has been Stopped and that they and their Child no longer have to live in Fear of Asthma Emergence / Attacks.

Dr. George..
You TOOO are truely in my Prayers for Strength / Valor and continued Persistence in your Mission of Truth.

The Money Machine behind Allergy and the "Control & Magagement" of Asthma Symptoms is HUGE ..

But ( Please ) Do Not give up the Fight..

Its for our Children.



June 26, 2012 | Unregistered CommenterStephen

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