I'm a father of 3 teenagers; and I've learned that sometimes underneath the apparently innocent straight-forward question, "Dad, can I borrow the car?" there's a hidden agenda.  I love my teenagers dearly, and usually (if there is) a hidden agenda, it's relatively innocuous. 

But sometimes I've been glad I've asked myself if there's been a hidden agenda.  Because occasionally there was a hidden agenda.

And I was glad I asked the question. 

And it is in this spirit that I have comments and concerns about how our major allergy societies will view sublingual immunotherapy (SLIT).  Like my teenagers, I dearly love my allergy societies that I belong to.  But like my beloved teenagers, I think it's healthy to ask if there is sometimes a "Hidden Agenda" at work.  I realize that there is always a fine line between being paranoid and being prudent.  But for argument's sake, let's let the ultimate "loose cannon" of allergy--the Angry Allergist--fire off a shot or two, and "weigh in" on this topic.  

We all know that our major allergy socities have SLIT on their agendas--ostensibly to study, debate, and ultimately comment on the usefulness of SLIT to treat our allergy patient population. 

But what if there's another agenda--a Hidden Agenda that is either consciously or subconsciously on our collective minds?   

Why would the Hidden Agenda make sense?  How could it involuntarily arise?  In my opinion, the Allergy Profession  is going through its Second Great Crisis.  What was the first crisis?  The development and subsequent wide availability of effective non-sedating antihistamines and effective asthma controller medications that non-allergists could prescribe.    Non-allergists could suddenly treat asthma and allergic rhinitis cases without referral to the allergist for injection immunotherapy.  I remember being interviewed on television about one of our professional allergy societies stating they were against loratadine being OTC.  Why?  To protect "our" patient population, it seemed to me.  And it really made no sense that benadryl could be OTC but not loratadine. ..unless a Hidden Agenda is invoked, that is...

Now we have a second Great Crisis in the Allergy Profession:  The potential availability of a form of immunotherapy that is safe enough to be done by non-allergists.  Grazax is available in Europe.  SLIT will be available soon here.  And the ENT community has shown a great deal of interest in it. In fact, alot of family physicians have shown an interest in incorporating it into their practices.  But not allergists.  They still have injection immunotherapy, and it's their Exclusive Domain.  Could this have something to do with why we don't have a rush for more American-based SLIT studies?  Where are they?  If we understand the Hidden Agenda, the answer becomes obvious--as long as we have no American-based SLIT studies, insurance companies will exclusively cover injection immunotherapy as "the only game in town"...and the allergist is safe with his patient population.  A recent ACAAI poll of allergists on their biweekly newsletter gave a telling statistic--over half of all allergists surveyed were fearful that SLIT would result in a loss of income to their practices.   Could this be one reason  the American Allergist isn't rushing to prove SLIT works?  Just a thought...

Here's another puzzling phenomenon that could be explained with a Hidden Agenda--an emphasis in major American allergy position papers on anaphylaxis risk of SLIT and its potential for problems, even though many studies have shown its safety.  As long as SLIT is seen as something with potential serious complications, we have "packaged it" for being done by allergy specialists exclusively.  Generally, SLIT is so safe that non-allergists can make use of it, but if there is a Hidden Agenda, then we should be prepared for an emphasis on how scarey SLIT is, and how it is "best" left exclusively for the Allergist to do...Just a thought... 

So I wonder whether there's a potential hidden agenda that we have to watch for:  "packaging" SLIT as a technique to be used exclusively by allergists for their patients--to "capture" our patient population.  As I implied before, maybe there's a Hidden Agenda, and maybe there's not.  Also As I said before, the line between paranoia and prudence is a fine one.  But as a father of 3 teenagers, it has paid off to watch for hidden agendas.  And we allergists should do the same.

Later, Dude