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The La Crosse Method: Old and Antiquated?  

No idea is so antiquated that it was not once modern. No idea is so modern that it will not someday be antiquated. 

Ellen Glasgow

I was recently talking with a friend who mentioned she had a conversation with an ENT allergy nurse who was utilizing the La Crosse method for treating her allergy patients, and she was very pleased with the results she was getting. However, the doctor who headed her department had recently attended some of the AAOA courses and now believed that shey should be using the AAOA Method for sublingual allergy treatment.  His reason?  He told her that the La Crosse method was "old and antiquated".

I have already given a powerpoint lecture comparing current sulbingual protocols so I won't go into all the technical details as to why the La Crosse method is clearly superior.  You can find out why it's superior by downloading the lecture, available here as "SLIT protocols". Enough said on that.   

Rather, what I want to do is to address the rather interesting and puzzling issue of why some people (like the young doctor mentioned above) gravitate to the AAOA protocol despite the clear superiority of the La Crosse method.  Why is this?

I would suggest that it has less to do with objectively reviewing the comparative merits of both protocols, and more on relying subconsciously on a more subjective "belief system" which I believe is pervasive in the allergy professional culture today.  

And this "belief system" is not strictly scientific and rational. Rather, "it is what it is"--a belief system--utilized subconsciously by many allergists today. Like most "belief systems" it has certain tenants, and one of them is the thought that "newer is always better".    

Nothing could be further from the truth.  

Sometimes when we jump on the "newer is always better' bandwagon we can get thrown off the bandwagon--rather rudely.  Two quick examples:  Remember that glorious "new" antihistamine Seldane, the first real non-sedating antihistamine that the allergist had to use?  It was withdrawn from the market because of serious cardiac arrhythmias.  Remember most allergists contention in the 1990's that sublingual immunotherapy just "didn't work" because the ""latest studies" (and I'm referring here to prior studies done years ago ) showed no significant improvement with treatment? We've certainly changed our tune on that one! New meds and new studies--just because they're new doesn't mean they're "better".   

The "flip side" of the "newer is always better" philosophy is the "old methods are always antiquated methods" viewpoint.  Again--not necessarily. Older methods may have a rich and highly successful  empirical history behind them and just "make common sense." to continue to use.  Should the La Crosse method be considered "old and antiquated"  because it was built upon a rich clinical history utilizing concepts of quantified titration and multi-antigen customized threshold dosing first utilized decades ago?  I think not. In truth, rather than being "old and antiquated" the protocol fuses the best of both worlds--rich historical concepts of treatment combined with the latest European research.  "Old and antiquated"?  I think not.  How about "versatile and effective, consisting of a family of protocols that are effective for multiple clinical situations?"  Now that's more like it.  

But there is more to this belief system than just "newer is better" and "older is antiquated".  Another unspoken tenant is that if an allergy organization endorses a position/product, it must be the best approach.   

My answer to that?  Not necessarily.  Again, using my earlier non-sedating antihistamine as an example, I remember when the "position" of my official allergy organization was against the introduction of non-sedating antihistamines as over-the-counter medications.  In fact, I remember giving a television interview on this issue, and said it really made no sense to me why Benadryl could be over-the-counter (with all of its potential side effects) but non-sedating antihistamines could not. I was "going against the establishment" with that position.    Unfortunately, allergy organizations and their positions are not necessarily always exempt of contamination by economic and political considerations.  Buyer beware!

Finally, I think that many allergists are tempted to utilize the AAOA protocol because of a false sense of security that they are using a "society sponsored" method of treatment, which somehow will be "more acceptable" to colleagues and associates.  But the point is moot if an alternative protocol is more versatile, robust, and effective for their patients.   

 In conclusion, it is wise for any young, prospective allergist contemplating incorporating sublingual immunotherapy to put aside his or her preconceived "belief system" and have a cold, objective look at the sublingual protocols available.

And one of the questions the young allergist should ask, is whether or not the protocol has been studied in a "real world" clinical setting.  And the La Crosse method has.  Check out the Quality of Life Improvement with Sublingual Immunotherapy article by Morris, Lowery, et al.  

I am confident if protocols are graded on their merits, and not on a preconceived "belief system" the choice will be obvious as to which one to use.

The La Crosse Method.  We've been modifying and honing our family of protocols for 30 plus years now, and simply put

it rocks.


Later, Dude 



Posted on Saturday, January 19, 2013 at 03:56PM by Registered CommenterGeorge F Kroker MD FACAAI | CommentsPost a Comment

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