All of that makes complete sense-- and the ONLY thing that doesn't make sense to me (or to our allergist, who, recall, used to be affiliated with some of the same physicians who are now doing desensitization clinically) is the claims of success rates topping 90%.
The reason that doesn't quite add up for us is that this is just SO far from what controlled OIT studies have found, which is more along the lines of 60-70%. The other bit that doesn't make sense is the part about serious reactions in just 1-2% of individuals. Clinical studies have demonstrated that rate to be somewhere between 5-10% of patients, depending upon the allergen. It's a big difference. Maybe it's selection bias, maybe it's less rigorous intake protocols, maybe it's a lot of the little details in refinement (noted by Lakeswimr)-- but in any event, I have to wonder how much of that stuff is coincidence or luck rather than actual causation (that is, why carbs and not something else-- and why "before" as well as after dosing... and why would illness not play a role when it seems to have done so in the controlled studies...). Less than 500 persons is still pretty small numbers when you think about how different the manifestations of atopy can be from one individual to another-- and honestly, without a negative control group (actually, SEVERAL control groups), numbers up to a thousand or two aren't even completely compelling. Yet. I also wonder if they simply don't
know the reasons when people drop out of treatment and don't
say why they've done so. That was one factor in the high success rates of very early OIT trials, like the one that Melissa's DS participated in at Hopkins. When participants dropped out of the experimental arm of the protocol, they weren't followed super-aggressively to determine WHY.
That's not to say that it doesn't work
precisely as stated for some, maybe even "most" patients who do it.
One hesitation that our allergist in particular has had w/r/t DD doing something like this is that her immune system seems to be generally rather trigger-happy. That is, we KNOW that pushing on one thing with immunotherapy is likely to result in unpredictable, unrelated, but definitely IgE-mediated stuff popping up elsewhere. So for people like her, it can be a game of Let's Make a Deal-- I just want to know what IS behind all of those doors, myself. If one of them is something
worse, then I'd like to know what those odds are, and whether or not they could be higher/enhanced for a particular individual, and how would one know that at the outset of treatment.