People are often confused when it comes to who should be taking care of patients with allergies. This is partly due to the fact that there is more than one answer. Generally, mild allergies can be treated by primary care physicians; however, in order to obtain information on the exact cause of your allergy, as well as the latest and most effective treatment options, people should consult an allergy specialist or allergist.
What is an Allergist?
Simply put, allergists are specialists who treat allergies.
Allergies arise when our body's defense system begins to react to everyday things as foreign invaders. These reactions, which occur in more than 20% of the population, cause symptoms like runny nose, itchy eyes, sneezing, wheezing, coughing, and various kinds of skin rashes. Allergic reactions can lead to such disorders as asthma, hay fever, sinusitis, stinging insect reactions, food and drug allergies, allergic rashes, and hives. These conditions are best treated by the allergy specialist.
The allergist is a physician who is first trained in a basic specialty, such as internal medicine or pediatrics, and then completed a second training period, typically two years or longer, in allergic disease diagnosis and treatment. This leads to board certification by the American Board of Allergy and Immunology. While any physician may treat allergies, it is the trained Board-Certified Allergist/ Immunologist who is an expert on allergies and the physician best able to apply the latest knowledge, techniques, and tools needed to not only determine what is causing the allergic problem but also how best to remedy it.
Finding the Best Allergist
Let's assume that you have an allergy or an allergy-related condition and that you want the best possible treatment. Where do you start?
Step 1. The first thing to do is make sure that you will receive treatment by a trained allergist. You may call the American College of Allergy, Asthma, and Immunology (or contact it via the Internet at www.allergy.mcg.edu) to get a list of members in your area. If you are in a health plan that requires authorization, a firm request from your primary care physician for a referral to an Allergist/Immunologist is helpful. Insurance plans list physicians by specialty. Under "allergy" or "allergy and immunology," you will find specialists on your insurance company's approved provider list. Sometimes Board certification will be noted on your insurance company's listings; if not, you can call the insurance company and request this information.
Step 2. The allergy specialist will first interview you, take a detailed medical, environmental, and occupational history, evaluate your symptoms, and examine you. Then tests will be done to pinpoint the cause of your allergies. These tests may be skin tests or blood tests. Even though there may be a perception, even among physicians, that blood tests are more accurate than skin tests, this is not so. I believe the best and most accurate method -- the "gold standard " for allergy testing - is skin testing. New and improved techniques have now made skin testing rapid and relatively free of discomfort and pain. Testing results are obtained within 15 minutes. However, in order to achieve accurate results, you should not take any antihistamines for 48 hours prior to your testing visit. It is best to check with the allergist's staff as to what medications are allowed in the days before your scheduled test. Though not common, sometimes breathing tests and x-rays are ordered as well.
Based on the information obtained from "Step 2," a diagnosis is made and treatment is begun. The allergy treatment recommended to you may be divided into three types of programs: elimination or avoidance of the allergen (the substance that causes your reaction); medication; and vaccination (immunotherapy). Let's look at these one by one.
Elimination and Avoidance
Many times when the allergic culprit, such as a pet, is identified, removing it is all that is needed to control allergies. However, oftentimes the offending agents can only be decreased and not avoided, as in the case of dust mites or molds. If you are allergic to dust mites, it is important to follow such simple instructions as obtaining dust mite proof covers for your mattress, pillow, and box spring and using washable bedding. With some allergies, like pollen allergies, the environment cannot be controlled except by closing the windows or staying indoors, and thus only partial or little improvement may take place. In these cases, additional measures are needed.
Medication
For some allergic illness, medication may be able to decrease most of the symptoms and return the patient to good health. The allergy specialist is knowledgeable in the currently approved methods of treating allergic disorders. Recently, many new drugs have become available that improve allergic symptoms without making the patient forgetful or sleepy as did older medications. Most of these newer drugs are only available by prescription, and the allergy specialist has considerable experience in choosing the best medication for the individual patient.
Medication alone may completely resolve your allergic symptoms; on the other hand, they may only modulate or lessen your symptoms, and do that only so long as you continue to take your medication as prescribed. Should there be problems taking your medication, such as side effects or an unsatisfactory response, then you will need to take additional measures.
Immunotherapy
When neither elimination and avoidance nor medication are sufficient to solve the problem or control your symptoms, specific allergen immunotherapy - commonly known as "allergy shots" - may be used.
Immunotherapy has been available for allergy sufferers since 1911. There has been considerable research done to improve the materials and techniques used over the past 90 years. It is now a proven and effective method for decreasing allergy sensitivity to the specific substances causing your allergic disease. Immunotherapy is a natural method for increasing your tolerance to the substances in the environment that cause allergic illness.
The immunization procedure begins with injections of small amounts of the purified materials that are causing your allergic reactions. The allergist determines which materials to use through skin testing, and this program works best when the same allergens used for your skin testing are used for your immunotherapy. The vaccine allergens may be derived from pollens, mold spores, animal danders, dust mites, insect venom, and other substances.
The vaccine allergens which are injected into allergy patients are harvested and prepared by pharmaceutical manufacturer. Manufacturers' facilities and procedures are inspected and meet approval by the Federal Drug Administration; in the past few years there has been considerable improvement in the quality of these allergens, and most of the important ones have been standardized. For the patient, this means that immunotherapy has become a safer, more effective, and reliable treatment.
The treatment program
The initial injections contain small doses of allergen; subsequent injections are gradually increased in strength. Injections are given in the arm, just below the skin surface once a week or once every two weeks. Typically, shots are given at this rate until the desired level (the "maintenance level") is achieved, and then a booster shot is given every few weeks. Under some circumstances, the injection schedule may be accelerated so that maintenance is achieved after one or two prolonged visits. This is called "rush immunotherapy."
Immunotherapy is frequently continued for several years. In some patients, allergy treatment can then be discontinued with maintenance of their symptoms for a number of years. For other patients, treatment may need to be continued for longer periods of time. A number of research studies have shown that allergy shots are not only effective but also produce changes that help direct our immune response away from allergic reactions in general and toward normal reactions.
With this type of treatment program, allergy symptoms are prevented. There is a decrease in the medications needed, fewer days missed at school and work, and a general improvement in the way allergy sufferers feel. Immunotherapy has been given to young patients, pregnant patients, and elderly patients with good results, and with no noted toxic effects or interactions with drugs.
Since immunotherapy deals with substances to which one is allergic, there is a possibility that one may experience local reactions or generalized reactions (like hives, asthma, or anaphylaxis) when first treated. This is why allergy shots should be given in a physician's office where any unwanted reaction, if one occurs, can be safely and promptly handled. Nevertheless, you should know that there is an extremely small chance (1 in 65 million) that an injection can result in a fatality. Treatment with immunotherapy should, therefore, be undertaken only after a careful and correct diagnosis and under the supervision of physician who are qualified to administer and manage this type of therapy.
A case study
The following account shows how immunotherapy, by stimulating your immune system to fight allergies, can effectively and naturally restore you to good health
Mr. S. is a 36-year-old accountant. Last spring, when the trees were pollinating, he developed severe allergic rhinitis (runny nose, continuous sneezing), and allergic conjunctivitis, with symptoms occurring up to 24 times on a day that Oak pollen was high. His eyes were so red and teary that he could not focus on his computer at work. Even though he stayed indoors for two weeks, took the newest antihistamine advertised on TV, used eye and nose drops, he still could not work and lost one week of pay due to illness. Allergy tests showed that he was allergic to oak, birch, and maple pollen along with ragweed. He began immunotherapy last summer and now takes injections every two weeks. This recent spring, while many of his colleagues were missing work as had happened to him the year before, he was fine and needed no medication. Not only could he go out, but he went for walks in the park during pollen season, something he hadn't done since boyhood.
More Information for Allergy and Asthma Sufferers
The number of people with allergies, and asthma in particular, has been dramatically increasing in the past few years. In order to confront the asthma epidemic, the National Institutes of Health convened an "Expert Panel" of asthma experts to make recommendations. Allergists were an important part of the Panel and the Panel's recommendations for the best standards of care for the treatment of asthma. Allergists/Immunologists have also written a number of guidelines that have been approved by their National Societies for the treatment of a number of allergic illnesses. These guidelines may be found online (www.nhbi.nih.gov/guidelines/asthma/asthgdln.htm).
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