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September 20, 1971

Sublingual Desensitization

JAMA. 1971;217(12):1703-1704. doi:10.1001/jama.1971.03190120069019

To the Editor.—  Samter's recommendation against sublingual desensitization was correct.1 Subsequent letters2-3 have indicated that this method is employed by some practitioners treating reagin (IgE, Type I) mediated allergic disease. Dickey3 also advocated other precepts of Rinkel et al.4-5 These practitioners represent a small portion of the allergy community. Most allergists practice in accordance with established immunological concepts, as summarized in several textbooks6-8 and symposia.9-11Rinkel's precepts4-5 include "optimal dosage" determined by intracutaneous or sublingual "titration," the intracutaneous "provocative test" with the so-called provoking and neutralizing doses, and sublingual desensitization. These methods are supported by uncontrolled, testimonial impressions only. The basis for asserting benefit is not indicated, and immunological data have not been offered. Recently the food provocative test has been subjected to a controlled investigation12 and shown to be valueless.In contrast, the practice of allergy in accordance with immunologic principles