The road not taken

When discussing the problem of inducing allergy by rickets prophylaxis I have argumented earlier that there are many alternatives:

  • abandon daily oral prophylaxis in the general population (attn risk of t1d, rickets, pneumonia)
  • reduce daily oral dose with on demand therapy
  • use only 1-3 single oral shots as in former East Germany
  • exchange water-soluble by oily form
  • use chemically modified isomeres
  • co-application with “physiological” substances also in liver cod oil like Ca2+, P, vitamin A…
  • co-application with “non-physiological” Cpg ODN…
  • switch to parenteral application

There is even another option that I missed — the parental application. Supplementation of the mother might work if given ~6000 IU/die to the mother as been nicely shown in a new study.

The principle is not very new – probably known since 1927. RCTs are urgently needed comparing all these treatment options while a direct oral exposure of the gut mucosa by allergen and vitamin D should be avoided.

BTW “The road not taken” is a by Robert Frost

Two roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth.


Rolf Zinkernagel made an interesting proposal last Saturday here in Munich – desenzitiation not by intradermal injection but by ultrasound directed lymphnode application.