It is truly rare that I read a newspaper article that resonates with my opinions & beliefs like the article, "Where are Today's Leonardos?" by Dr. Howard Zucker  in USA Today.  Although the article was officially addressed to the graduating class of 2009, it could just as easily have been addressed to our professional allergy community.  In his article, Dr. Zucker (a resident fellow at the Institute of Politics at Harvard University), states

"Perhaps it is time for a rebirth, a time to create a better world through the energies of the Class  of 2009"...The Renaissance was a period when our search to perfect one's worldly knowledge transcended obstacles and bridged intellectual divides.  Students of creative thought--including da Vinci, Michelangelo, Copernicus and Galileo--questioned conventional wisdom...  Just as the Renaissance masters cast away conventional concepts, so too shall we discard friction that creates inertia in our thoughts."

Conventional Wisdom in the allergy community today involves several key underpinnings, which permeate all thinking and research in the field and (in my humble opinion) don't exactly "transcend obstacles and bridge intellectual divides".  Here are 3 key points in allergy Conventional Wisdom:  

1.  Since IgE mediated disease is the only "true" allergy, it is the only sensitivity we should be concerned about. Delayed food reactions, mold reactions, etc. really aren't our concern...so let's sweep them under the rug.  Let them die a death of benign neglect, not flourish in an atmosphere of curiosity...

2.  Asthma and upper respiratory disease should encompass what the allergist is "all about".  Other organ systems (besides pulmonary) should (once again) die a death of benign neglect as it regards interest in them as allergically responsive systems.  

3.  Other chronic disease states--chronic fatigue syndrome, fibromyalgia, migraine headaches, interstitial cystitis, have no allergic component, because everybody knows they don't.  So let's not be curious and study if indeed they DO have an allergy component to them.  

Examples of this "intellectual straightjacket" abound.  You can generally pick up any current issue of any allergy journal and see Conventional Wisdom at work--and trumpeted...Here's just one small example:  In the June issue of Current Opinion in Allergy and Clinical Immunology DRs. Randhawa and Bahna wrote a comprehensive review entitled "Hypersensitivy reactions to Food Additives".  They comprehensively review the protean manifestations of food additive reactions, and I heartily recommend the article for those allergists who see this problem in clinical practice.  However, near the end of their article, they state:

To our knowledge, there are no published reports on successful desensitization procedures.  

What?  You mean there isn't even a single case report in the entire body of medical literature on successful desensitization to food additives, despite multiple articles on successful aspirin desensitization?  Hello--isn't anyone anyone curious & interested?  Where's creative thought?  

It was this form of unconventional thinking that drove me to try oral desensitization to yellow dye #5 in a patient I had seen in my office earlier, who had presented with a history of seasonal allergic rhinitis, and repeated urticarial reactions to foods containing yellow dye.  As with many allergy patients, she wanted help with the "difficult issue" (dye sensitivity), and not the "easy issue" (allergic rhinitis).  As a businesswoman, she frequently went on trips and ate at restaurants, and found it always a risky procedure

We began her on a progressive program of yellow dye oral desensitization, starting with dilution #9 of yellow dye #5, and working progressively up to a dilution #1 without serious problems.  We knew we had successfully desensitized her when she told me she was on a business trip and gulped down a glass of Tang, which she had mistaken for Orange Juice, and had no reaction. Conventional Wisdom would have just treated her for her allergic rhinitis (which she could handle just fine with an OTC antihistamine, thank you).  

So here's the thought for the day--are we graduating Leonardo's from our allergy training programs, or just good Asthmalogists and technicians?

Do allergists think "outside the box"--or inside a straightjacket? 

Later, Dude