There is considerable news (and interest) in sublingual immunotherapy (SLIT) in the allergy community.  Our european colleagues have published extensively on the subject--and SLIT has been gaining considerable useage in Europe.  One of the puzzling aspects of this innovative approach is why the American allergist has been so reticent to take up and (at the very least) aggresively investigate a technique that could be cost-efficient, safe, convenient, and effective in treating many allergy patients.  Our European colleagues are way ahead of us here.  Why?

At least one reason is in my opinion a hidden agenda:  money.  Simply put, many allergists are afraid that they would lose income if they switched over to SLIT.  An online survey taken on the ACAAI newsletter website indicated over half of all allergists were fearful that reimburseable income would be cut if they switched to SLIT. 

The real-world trial?  In our own practice (involving 6 physicians/allergists) I have used SLIT for 25 years in a small community.  Our "competition" includes other allergists in our community.  Our community is 50,000--about large enough to theoretically support 1 or 2 allergists by AMA data.  Yet  we have been able to run a successful allergy practice; word-of-mouth referral from satisifed patients keeps our practice going; we don't have a "built-in" HMO/large clinic referral base--just patients who are satisifed.  This should be somewhat reassuring news to practitioners hesitant to make the jump to SLIT.  Our patient base includes surrounding states, since travel time can be minimized with SLIT, its been our experience that nearly all patients would exchange relatively infrequent trips to us for SLIT than to go to an allergy office frequently for injection immunotherapy.  SLIT is, in my opinion, the future direction allergy treatment will take, and the position by the leading American allergy organizations  is unnecessarily defensive, non-optimistic, and non-enthusiastic about a treatment approach that IS being embraced by our European colleagues.  My message to our parent organizations--get enthusiastic about SLIT.   Quit being so defensive, and saying that "we need American studies".  Sure we do.  But do we honestly believe that over 100 articles in support of SLIT will be overturned when we start looking at it seriously ourselves?  I don't think so...