Whew!  I can finally relax...our annual SLIT meeting to train physicians in the use of sublingual immunotherapy (SLIT) was a success...It was obvious to me (as my colleague Dr. Mary Morris once again reviewed the world's literature on SLIT at our meeting) that an astounding phenomenon appears to be shaping up:  Most allergists now admit that SLIT works--in Europe.  Europe only.  Somehow they feel (by implication) that it just doesn't work in the U.S. What else could explain the extraordinary lack of interest in SLIT by my fellow U.S. colleagues?  (laziness is always a possibility, but let's not go there...)

For example, take simple cat allergy--one of the only allergens comparatively studied for SLIT efficacy in both the Europe and the U.S.  :  it seems to work in Europe but doesn't work over here--in the U.S. study by Dr. Harold Nelson published in the JACI in 1993, it was concluded that SLIT for cat was no more effective than placebo. On the other hand, the European community, represented by Dr. Alvarez-Cuesta and associates, publishing in Allergy in July 2007   found that SLIT for cat was effective. What's the deal?  Over and over again we're hearing about European success with SLIT, but NOTHING from the U.S.  Nada.  Zero.  Null set.  Zip.  Zilch.  What could be the culprit?  Well, I've got the answer and it's a slam-dunk:

The Atlantic Ocean.

Yep, you've got that right.  It's the only logical conclusion. If it can sink the Titanic it can sink SLIT... Something in or on or above the Atlantic Ocean inactivates the effectiveness of SLIT as it migrates from the European to American continent.  Furthermore, this unidentified factor (we'll call it Sublingual Neutralizing Ocean Transatlantic Factor--SNOT for short) not only inactivates SLIT's effectiveness, but also renders American Allergists intellectually moribund in thinking about SLIT--we cop an Attitude:    "Well, the SLIT evidence is from Europe, and we have to see U.S. studies...we'll get around to them someday...but what's the rush?"   

So what can we do?  Some say we should perform U.S.  studies on SLIT and get the show on the road....well, I say--how about isolating SNOT--finding out exactly what it is about the Atlantic Ocean that makes SLIT migration from Europe to the U.S. so disastrous...you see, this would be helpful for one big reason...

...we could then make a DRUG against SNOT...and pharmaceutical companies could cash in...and that's really the point of medicine, after all, right? 

So, let's get the ball rolling...SLIT works in Europe but not the U.S.  Why?  It crosses the Atlantic Ocean and voila!  Poof!  Disaster!  So let's analyze and study and plumb the ocean's depths to find out what the Sublingual Neutralizing Ocean TransAtlantic (SNOT) factor really is, and why it keeps SLIT from working in the U.S. and stagnates American Allergists minds against exploring its effectiveness.   How about a full issue of JACI devoted to this?  Let's get some major drug company sponsored money for goodness sake to look at SNOT receptor antagonists.  C'mon guys! 

Later Dude