There were several studies at 2012 American Academy of Allergy, Asthma and Immunology that showed the effectiveness of SLIT. However, high doses of allergen are required. This may be due to much of the allergen is being broken down by saliva and other factors. On average, the DAILY dose of SLIT is about twice the MONTHLY dose of SCIT. One study using dust mite sublingually used 70 micrograms of allergen daily, whereas the effective injection dose is around 5-10 micrograms per month. If you look at a variety of studies, you see that the total dose of SLIT is about 30 to 200 times the total injection dose.

So, the result is that the cost of the allergen extract can become prohibitive if the patient is being treated for more than a few allergens. A very rough estimate would be that for year-round type allergens (dust mite, cat, for example), the cost would be $100 per allergen per month. Seasonal pollens would cost about $10-20 each per month.

So, if someone was allergic to dust mite, cat, and a few pollens pollens, the extract or “sublingual drops” would cost about $300 per month just to purchase the extract from the manufacturer (this is not even accounting for the administrative costs). So, it would get quite expensive. In addition, until a product is approved by the FDA, SLIT won’t likely be covered by insurance plans. That is, the entire cost would be out-of-pocket. If you look at Grazax, a sublingual tablet for grass pollen that is approved for use in Canada and Europe, it costs about $200 per month just to treat grass pollen allergy.

Although there are few studies that compare SLIT to SCIT, the general consensus is that SCIT is more effective. On average, SCIT (shots) studies show a 40% improvement in symptom scores, where SLIT (drops or tablets) improve symptoms by 20%. However, SLIT is appealing in that the patients can treat themselves mostly at home, and that no needles are involved. Plus, SLIT drops have been associated with less allergic reactions than SCIT shots.

In summary, the question is not whether sublingual allergen immunotherapy works (it apparently does), it is whether physicians are using adequate doses. For unclear reasons, allergic individuals in the US tend to be allergic to multiple allergens. This results in sublingual therapy being an expensive proposition.

I foresee that SLIT will have a place in certain situations (small children, patients allergic to one or two allergens). We are still in the process of deciding whether to begin using this method of allergy treatment. I would advise, however, that any potential patients ask their doctor about whether they are receiving an adequate dose of each allergen. Otherwise, that patient might be receiving a very expensive placebo.

Neil Gershman, MD

What I mean is that if you are actually take your asthma medicines appropriately (using the inhalers correctly and as often as your doctor recommends), it is very unlikely that you end up in the ER with an asthma attack. The medicines are VERY effective these days. It’s people who can’t afford the medications or those who don’t get the proper medical advice (or won’t take or understand the advice) who end up in the ER for the most part.

So, if the asthma aren’t working, we think of VCD. I should mention that part of the recognition problem is that different medical professionals call this problem different things. I mentioned “VCD” to an ENT specialist, and he looked at me blankly. When we started talking about it, he said “oh yeah, that’s blah, blah, blah (I forgot what he called it!). So, you see the problem.

In any case, once it is recognized we can start to look for a solution. I find that most patients can learn to control it on there own with yoga and meditation breathing techniques. In more difficult cases, speech pathology therapists can help.

I found this nice video on youtube.com demonstrating the problem. I should warn you that it might be a little gross to some.

I am going to try and work with a  speech therapist to make a more comprehensive video.

http://youtu.be/-kphDd3Xxco

Dr. Gershman’s interview on NBC

Dr. Gershman discussing the importance of roach allergy

Michelle and Babie make a great support team

http://www.youtube.com/watch?v=91B8-Z-B7-A

Dr. Mark Young helped to answer questions at the Expo.

Dr. Neil Gershman

A Fine Looking Staff mans the Table

Dr. Mark Young and Dr. Charlene Shookoff enjoy the festivities

On your mark, get set, wait... we need more coffee

A lot of fun for a good cause

Dr. Gershman with the rest of the Advisory Board of the local chapter of the American Lung Association

This year, like every year, Asthma & Allergy Associates of Florida was a major sponsor of the event. Our practice has worked closely with the  American Lung Association – Dr. Miller and I are Advisory Board members for two of the South Florida Chapters. The next major event is the Fight for Air Climb in downtown Ft. Lauderdale on December 11th.

Neil Gershman, MD

We were up bright and early for the Fight for Air Run/Walk

 Conventional wisdom among pediatricians was to tell moms to hold off on feeding kids certain foods until the children were “old enough.” This came from allergy researchers who thought avoiding these foods would make the child less likely to develop an allergy to peanut, for instance. Unfortunately, it looks like this advice to parents is probably folklore.  That is, there was no real hard science behind this advice. It turns out that the opposite advice is might be better. Researchers are starting to feel that children should be exposed to allergenic foods (peanut, shrimp, tree nuts, for example) early and often.

 Studies looking at the effectiveness of government-based guidelines seeking to decrease peanut allergy by later introduction of peanuts found them at the very least to be ineffective, and possibly detrimental.  Early feeding of allergenic foods may lead to tolerance. Tolerance is the response where the immune system learns to ignore a substance – or to not react in an allergic way.

 I must clarify one important point. If a person is already allergic to a food, the only current recommended treatment is strict avoidance and that the patient should carry a self-injectable epinephrine device in case of accidental ingestion. What I am talking about here is trying to prevent children from becoming allergic to a food in the first place.

 Food allergy continues to be a problem which seems to be on the increase despite the measures we take. We as doctors and parents must take the recommendations of the past with “a grain of salt.”

Greetings,

Asthma and Allergy Associates is pleased and proud to announce the official opening of the West Kendall Office on July 23, 2010. We are very excited and have worked very hard to make this office as beautiful and successful as all of our other offices. Please feel free to stop by and visitour newest home in the West Kendall location. We will be having a grand opening celebration that will be announced soon. We look forward in seeing all of you there.

13550 SW 120^th Street

          Suite 520

    Miami, FL 33186

www.allergyweb.com