Dr. Bestermann,
Thank you for sharing your insights on the knowledge and practice gap that unfortunately exists in our healthcare system. Your example from The National Academy of Medicine acknowledging the “17-year gap” seems absurd given all the talk in the U.S. about being the healthcare innovators and on the leading edge of development. Your example of Optimal Medical Therapy (OMT) having been outlined 34 years ago—yet still unembraced – is ridiculous given the fact that the protocol is so elegantly simple, cost effective and above all, safe.
Your writing parallels what we see in the allergy treatment industry. One of our “Wake Forest” research moments happened in 1986, when a distinguish research team headed by Dr. Glenis Scadding conducted the first in-depth research study of immunotherapy for allergy treatment – the only disease-modifying treatment that can change, even eliminate, the disease and its triggering of other related diseases (asthma, eczema, sinusitis, etc.). There are two viable approaches to allergy immunotherapy – subcutaneous (SCIT - allergy shots delivered via injection to the humoral system at regular intervals over a period of many years) and sublingual (SLIT - allergy drops, likewise given regularly, but delivered under the tongue and absorbed into the lymphatic system). Both forms retrain the immune system to no longer react to allergens, both use the same FDA approved extracts combined to treat a patient’s specific allergies (most have many more than one allergy). The Scadding research focused on SLIT and found a 72% positive response rate with study subjects and no serious side effects. For reasons that are too many to elaborate here, allergy shots became the primary method in the 1980’s with the major allergy academies, and continues to this day to be the “status quo” approach for allergists to provide immunotherapy.
Just as you refuse to let OMT be ignored, our organizations are doing the same with SLIT. Our protocol and use of SLIT dates back to the 1960s, and it was based on previous treatment work of allergy specialists across the globe. Since then, we have collected hundreds of studies, papers and presentations on SLIT including the gold-standard Cochrane meta-analyses supporting comparative reviews in 2005 and updated in 2010. Both include high quality, peer-reviewed double blinded studies, and a comprehensive double-dummy, head-to-head comparison with SCIT. The findings provided strong and consistent evidence that SLIT works, has comparable efficacy to SCIT, and more importantly – a better safety margin. In 2013, our protocol authors requested a similar review of the Agency for Healthcare Research and Quality (AHRQ) in the U.S. Led by a team from Johns Hopkins, the AHRQ found a similar positive and consistent result with Cochrane; their report was updated in 2017.
After seeing the benefits and clinical results we’ve experienced, we continue to advocate for patients to have treatment options that address the root cause with a safe, affordable and elegantly simple method. Once a patients allergies are identified through testing (skin or blood, which allergens and the level of each) personalized treatment sets are mixed every 90 days per the La Crosse Method (LCM) protocol. The annual cost is in the range of $600 a year for inhalant/environmental treatment of all positive allergens, delivered to the patient to be taken daily (safety profile allows drops to be taken at home). Compared to standard SCIT given in a medical office, LCM SLIT is generally 25% or less of the cost of SCIT. Patients continue to seek it, more providers continue to learn and offer the protocol (more than 2000 across the U.S.). Though it is still under-utilized, use is growing, though rarely is SLIT acknowledged, studied or talked about by U.S. allergy industry leadership. Hundreds of thousands of patients have already benefited when SCIT, or other treatments, were not viable options for them. Many more stand to benefit if more patients, providers and employers become aware of the immunotherapy choices available and the potential to impact chronic allergy sufferers’ health and quality of life. Waiting for specialty groups to support healthcare treatment innovations doesn’t need to continue to frustrate us.
Thanks for the opportunity to share another story.
Jeff Kessler, FACHE
Allergychoices, Inc.
It’s absolutely wonderful to see likeminded sharing the stories of the journey of their endeavor to improve human condition! Bravo!