By Dr. Paul Ehrlich
Dr. Andrew Bird deserves great credit for peering into the future on possible unintended consequences from the introduction of prescription food allergy immunotherapy. His frank analysis of current practice and inadequate screening of patients for true food allergies, which Larry wrote about here, puts numbers on the extra burden over-diagnosis of food allergies places on patients and their families. Like Dr. Bird, I see malnutrition in new patients, aka failure to thrive, although rarely with the drama of a specific nutritional deficiency like the one that galvanized his practice.
We have written many time on this website about the shortcomings of the various tests for food allergies. However, applying those lessons to future therapies makes perfect sense in light of my observation of new asthma drugs over my decades of practice.
As we wrote in our book in our discussion of montelukast, Singulair, the asthma drug: “Every time referrals to our offices dry up from one doctor or another, it usually coincides with some new drug release, but over time, new patients start to trickle in as the miracle starts to wear off.” Good drug: not for everybody.
More recently I wrote about the zealous promotion of Advair, which is still a huge seller and again, not for everyone, and not without its dangers for those patients.
The new food allergy immunotherapies seem to be pretty safe and effective for people who stand to benefit from them. But for people who don’t they are completely superfluous. Yet, if the kind of “blockbuster marketing” that made Singulair and Advair so successful is applied to these treatments many such patients will get swept up in the process. We have to double down on better diagnosis. I was an early adopter of component testing. It is an excellent tool and still not used as widely or as wisely as it should be. When it was first introduced, some allergists grumbled that it would turn every GP into an allergist. But many allergists still don’t use it. Unfortunately, for those who do component tests they don’t always answer all the questions any more than blood IgE or skin tests do. Pieces of a puzzle, but the puzzle varies from patient to patient. AR101, Viaskin, OIT, OIT plus Xolair, Chinese herbal medicine—all these can help solve puzzles, but we have to make sure they are the right ones.