Four reasons I still practice Allergy in the Information Age

Ever notice how everyone has #allergies these days?  I kid you not, almost everyday, a patient will tell me that #Tulsa (where I practice) has more allergies than any other place in the country.  The irony of it all, is so did patients in Kansas, and patients say the same thing in Virginia and Texas.  You get my point–we all love to be known as the Allergy Capital of the World! Maybe it’s because allergies make us feel so miserable, and we love to hear stories about how to deal with the nemesis.  Or maybe we want some “inside information” to share with our friends & family who also suffer from allergy. Whatever the reason for our obsession with allergy, you can’t argue with the fact that good allergy advise is not only helpful for better quality of life, but it’s crucial in making sure that allergy sufferers avoid heeding the WRONG advice for treating #hay fever. This is the passion I experienced in order to complete a fellowship training in allergy– I wanted to be able to interact with patients about their #allergic symptoms on their journey to good health. But wait, why practice a specialty that has so much incorrect information on-line and no doubt, “everyone’s an expert in allergy” when you could be doing real medicine to treat someone’s heart attack? Here are four reasons I still practice allergy for your consideration:

Nothing like the harvest!
Nothing like the harvest!

You Can Impact Your Community

Kansas was a great place to grow up and I always dreamed of returning to rural America to take care of patients who had to live among the pollens and mold that caused daily misery.  (you know, allergies are a trivial disease unless you have them!)  I’ve practiced in several locations since finishing my fellowship in 1992, and I’ve never been someplace that didn’t want to know more about allergies and how to treat them.  And it’s not just patients.  If you’ll look for opportunity, as a community allergist, you can present data to your local medical staff on benefits of allergen immunotherapy (shots) or discuss new injectable treatment options like Xolair and Nucala for asthma sufferers.  I’ve given 3 hour seminars right here in Tulsa to school nurses and respiratory therapists all interested in knowing more about very debilitating conditions such as asthma and allergic rhinitis.  But don’t take my word for it — allergists all across the country are finding  great fulfillment in helping patients with that nagging sneezing and runny nose!

My daughter attends Baylor in Waco, Texas, and one Saturday morning while indulging in some coffee and scones at just one of  Waco’s “hole in the wall” brick conversions, I ran across an article from a local magazine featuring an allergist who moved back to Waco to practice allergy.  I could relate to many of his reasons for moving back home: family, interesting specialty, great community resource for allergies, all of which make a very positive impact on your community.  I’ll let you read Dr. Neil Amar’s article for yourself below.

The Magazine

Allergy/Immunology is Never Boring

I'm a science geek...what can I say?
I’m a science geek…what can I say?

Most specialties in medicine haven’t experienced the explosion in basic science that has propelled much of our current therapy to treat allergies.  And mind you, it’s not just nasal allergy or hay fever that I treat.  Granted, most allergy offices would describe their bread and butter services as treating hay fever or nasal allergy.  About half of allergy patients also have asthma and some aren’t aware that cough (and not just wheezing) can also be a symptom of asthma.  Asthma affects more than 20 million Americans and at least 7 million children.  It can be triggered by smoke, cold air, exercise and stress as well as typical nasal allergies.  That means controlling asthma can be complicated in order to find the correct trigger and use the easiest and most appropriate treatment to get the job done.  Fundamentally, allergies are part of the immune system gone wild.  With allergies, the body produces too much IgE against pollen causing sneezing, runny nose and feeling terrible. Your body can also develop hives which no one likes to have to deal with, much less treat!  I always say that hives have a mind of their own and don’t listen to your wishes nor mine at times! But one thing I will say, is treating hives has multiple challenges to find the answer (most of the time there isn’t a single cause), and at the same time, very gratifying with success!  If your immune system doesn’t make enough antibody to fight infection, we call this #IMMUNODEFICIENCY. This is a condition almost the opposite of having allergies.  There are many reasons why the body gets one infection after another and requires lots of antibiotics to stay healthy, but one reason is the lack of antibody production. Remember all of those #vaccinations when you were a kid or have a child of your own having to take all of those shots? The purpose of immunization is to build antibodies BEFORE your child is  confronted with some pretty nasty infections and can’t fight them off in time.  Children and adults who don’t respond to infection often don’t make the right amount of antibodies and they need special care from your local immunology office.  As you can see, allergy doesn’t have the glamour of a neurosurgeon, but it’s never boring.

Allergists Can Measure Your Outcome

Left is normal; right side shows vocal cord interruption
Left is normal; right side shows vocal cord interruption
T.R.U.E. test at work!
T.R.U.E. test at work!

 

Testing with prick skin testing, pulmonary function, and patch testing are all measures of outcome, i.e., what is your diagnosis and how do you respond to treatment? As allergists, we do lots of testing to find out what might be the source of your problem.  Now I’m a numbers guy, and I like interpreting lab tests and funny tracings on a page that represent your lung capacity (see the above).  But measuring #outcomes can also be a little tricky if the results aren’t what you expect. For instance, you may think you have allergy to pollens, but if your testing is negative, you most likely have vasomotor rhinitis which won’t qualify you for shots.  Skin testing can prevent you from thinking you have allergy when you really don’t and need a different treatment plan altogether. It’s also very common to find out your lungs have “asthma” even though you don’t wheeze. Surprise!  Inflammation in the lungs leading to undiagnosed asthma is a treatable condition if you know you have it.  Preventive medicine in regards to asthma can be lifesaving and prevent you from having #chronic lung disease later on in life….definitely worth the testing.

Allergists Can Now Personalize Your Treatment and That’s Good!

Most of us don’t like change, but if the change leads to more convenience and better medical outcomes, why not? bythenumbers1

And come on, since that many people in America suffer from allergies, we better get our treatment right and come up with better ways if possible.  I’ll list some of the improvements in allergy care below and see if that doesn’t sound good to you:

  1.  Allergy shots for only 5 years instead of 20
  2. Monthly allergy shots can work as well as weekly and for a lot less time!
  3. Medications that aren’t steroids found to be very helpful for asthma: Xolair & Nucala. Our first example of personalized medicine.
  4. Oh no, the pollen season is here. Now you can build up to your maintenance dose of allergy shots within several weeks instead of 6 months. Ragweed, here I come!
  5. More effective therapy for hives and you won’t sleep through class because of all the antihistamines.
  6. infusions under the skin for immunodeficiency every month (HYQVIA); no infusion center, no fevers or chills during the infusion; just the comfort of your own home. And much cheaper!
  7. Can you tolerate food allergy? The answer is closer than you think.

I hope I’ve convinced you that practicing allergy is not only a rewarding profession, but we’re better at it now than we were 20 years ago.  Unfortunately, the number of patients with allergies to food, pollen, animals, and subsequent asthma attacks is on the rise but there is hope.  Better therapy, more convenience, all utilizing the most cost effective resources are now a reality.   So ask you doctor about what’s best for your allergies, asthma, and chronic sinus condition and get outside for some fresh air!

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