I want to be an expert. Always have and always will, but now it’s a little easier than 30 years ago. In fact, all you need now to become an expert is a little fame, a published book or memoir, and Shazam! you’re an authority on any subject you want to write on. So where’s the beef on my book?
Well, that’s not exactly how an allergist becomes an expert. I won’t bore you with the details, but doctors are trained by experience in the clinic (office) and reading about the medical conditions you have to treat….over and over again. Eventually your training ends and what do you do then? No more residency programs, no more allergy fellowships, and no more mentors. I have found a valuable resource through the American Academy of Allergy, Asthma, and Immunology (AAAAI) entitled “Ask the Expert” (hey they get paid for content, not the title). Here’s an example of a conversation about hives. (click on the link at the end) Patients all hate hives and just from this discussion alone I propose the following take home messages:
1. Hives are caused by allergy only 20% of the time. We usually want an easy answer, but if that were the case you would never show up in the allergy office. It’s important to look for the underlying cause of the hives, but in up to 50% of cases, the hives are due to autoimmunity….more on that later.
2. Once hives are identified, change your mindset to 6-12 months of treatment. Hives can resolve spontaneously, but it doesn’t happen quickly.
3. Hives that bruise should be evaluated ASAP….no exceptions.
4. The usual dose of antihistamines prescribed by your doctor is usually for treating hay fever. The effective dose for treating hives may be 4 times as high; beware of feeling sleepy for several days, but that side effect will usually improve.
5. I try to avoid steroids because of long-term side effects, but sometimes steroids are necessary to get the itching under control. Limit your use and look for alternative medications. But I will warn you, it’s not always allergy!
Yes, you too, can become an expert with your health—you’ll spend a lot less time in the doctor’s office if you do!
Acute urticaria resistant to therapy.