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Patient Education

What is an Allergist and Immunologist?

An allergist is a physician who specializes in the diagnosis and treatment of asthma, allergies and certain immunological diseases. The allergist is specially trained to identify the factors that trigger asthma or allergies. Allergists help people treat or prevent their allergy problems.

What Kind of training do Allergists and Immunologists have?

After earning a medical degree, the allergist completes a three-year residency-training program in either internal medicine or pediatrics. Next the allergist completes two or three more years of study in the field of allergy and immunology. This training deems the physicians eligible for certification by the American Board of Allergy and Immunology (ABAI). Once they pass the certification exam they are considered board certified inan the field of Allergy and Immunology and become a diplomat of the ABAI. You can be certain that your doctor has met these requirements if he or she is certified by the American Board of Allergy and Immunology.

You should see an allergist if:

  • You have symptoms such as chronic sinus infections, nasal congestion, post nasal drip or difficulty breathing.
  • You experience hay fever or other allergy symptoms several months out of the year.
  • Antihistamines and over-the-counter medications do not control your allergy symptoms or create unacceptable side effects, such as drowsiness.
  • Your asthma or allergies are interfering with your ability to carry on day-to-day activities.
  • Your asthma or allergies decrease the quality of your life
  • You are experiencing warning signs of serious asthma such as:
    • You sometimes have to struggle to catch your breath.
    • You often wheeze or cough, especially at night or after exercise.
    • You are frequently short of breath or feel tightness in your chest.
    • You have previously been diagnosed with asthma, and you have frequent asthma attacks even though you are taking asthma medication.
    • You needed to be seen in the emergency department or admitted to the hospital for asthma and other allergic diseases
  • You have hives
  • You have multiple drug allergies
  • You have food allergies
  • You have egg allergy that prevents you being able to be vaccinated.

How do allergists and immunologists work with other health care professionals?

The role of the allergist and immunologist is typically to work with other physicians, sometimes acting as a consultant to advise other physicians about a specific diagnosis and treatment plan. In other situations the allergist acts as a manager and keeps the primary care physician updated on the care and treatment of the patient.

Is specialty care more expensive?

You may be surprised to learn that specialized care may save time and money and reduce the severity of disease. An allergist is trained to spot clues in the medical history, physical examination and allergy testing. The proper tests done early may save money in the long run. Prompt diagnosis and specially tailored treatment often save money by preventing complications of chronic allergy inflammation.

Frequently Asked Questions (FAQ)

Q - What is an allergy?

One of the marvels of the human body is that it can defend itself against harmful invaders such as viruses or bacteria. In some people, the body reacts to harmless substances such as dust, mold or pollen by producing an antibody called immunoglobulin E (IgE). When patients with one of the allergic diseases (such as rhinitis or asthma) are exposed to these substances, the immune system then rallies its defenses, launching a host of complex chemical weapons to attack and destroy the supposed enemy. In the process, some unpleasant and, in extreme cases, life-threatening symptoms may be experienced.

Q - What causes an allergic reaction?

Hundreds or even thousands of ordinary substances can trigger allergic reactions. These are called "allergens." Among the most common are plant pollens, molds, household dust (dust mites), animal dander, industrial chemicals, foods, medicines and insect stings.

An allergic reaction may occur anywhere in the body, but usually appears in the skin, eyes, lining of the stomach, nose, sinuses, throat and lungs -- places where special immune system cells are stationed to fight off invaders that are inhaled, swallowed or come in contact with the skin.

Q - What is the best method of testing for allergies?

The best first step in the diagnosis of allergies is a thorough health history and physical examination. If you have allergy symptoms that occur in association with exposure to certain things, that is highly significant. Allergy diagnostic tests, such as skin tests or blood tests, provide similar information and merely confirm what your health history tells the doctor. If your doctor were to rely exclusively on the results of skin or blood tests (without history and physical examination), you could be diagnosed as having an allergic problem that you don't necessarily have.

Skin tests, in most situations, are preferable because (1) the results are available immediately, (2) they are less expensive and (3) they are more sensitive to subtle allergies.

A blood test is appropriate in certain situations, particularly when you (1) cannot suspend antihistamine therapy which can inhibit skin tests, (2) have widespread skin disease making skin testing difficult, (3) are so sensitive to the allergen that the test might be risky or (4) cannot be skin tested for some other reason.

Q - What are allergy shots all about?

Allergy shots are an effective and safe treatment for people who suffer from a variety of allergic diseases, including allergic rhinitis (hay fever), allergic conjunctivitis, asthma and insect stings. The treatment – also known as immunotherapy or allergy immunization – works by introducing small amounts of purified substances to which the person is allergic, in gradually increasing amounts. The allergy shots improve the patient’s natural resistance to the allergens and minimize or eliminate the need for medications.

Q - Do allergy shots have side effects?

Like all medical treatments, allergy shots (immunotherapy) can have side effects. Your doctor will discuss this with you in detail.

Q - Why is it that frequent exposure to an allergen can increase sensitivity and cause allergic reaction, yet repeated exposure to an allergen in allergy shots helps build ups immunity?

Regularly scheduled, repeated exposure to small amounts of an allergen can lead to immunity, whereas infrequent and erratic exposure does not confer immunity but increases the likelihood of producing allergen sensitization.

Irregular exposure to allergens can lead to the production of antibodies (called IgE-mediated antibodies). The presence of these antibodies, when exposed to an allergen can lead to an allergic reaction.

In allergy shots or immunotherapy, the allergen exposure is closely regulated and given on a scheduled basis. Small amounts of allergens are given over a period of time to build up to maintenance doses. This leads to the production of blocking antibodies (called IgG antibodies) and a decrease in the level of allergic or IgE-mediated antibodies.

Q - What is asthma?

Asthma is a chronic, inflammatory lung disease characterized by recurrent breathing problems. People with asthma have acute episodes when the air passages in their lungs get narrower, and breathing becomes more difficult.

The problem is an oversensitivity of the airways, which overreact to certain "triggers" and become inflamed and clogged.

Q - What causes asthma?

The cause of the lung abnormality that is asthma is not yet known. For 90% of children and 65% of adults who develop asthma it is due to or associated with allergies. Through research, scientists have established that the disease is a special type of inflammation of the airway that leads to contraction of airway muscle, mucus production and swelling in the airways. The airways become overly responsive to environmental allergens and irritants. The result is wheezing, shortness of breath, chest tightness and coughing.

Q - Can asthma be cured?

As yet there is no cure for asthma, but asthma can be controlled with proper treatment. People with asthma can use medicine prescribed by their physician to prevent or relieve their symptoms, and they can learn ways to manage episodes. They also can learn to identify and avoid the things that trigger an episode. By educating themselves about medications and other asthma management strategies, most people with asthma can gain control of the disease and live an active life.

Q - Is asthma a psychological or emotional disease?

No. Although episodes of asthma can sometimes be brought on by strong emotions, it is important to know that asthma is not the result of emotional factors such as a troubled parent-child relationship. Years ago, people more commonly believed that asthma was "all in one's head" and therefore not a real illness. Physicians and other medical scientists today know that this is wrong.

Q - How is asthma diagnosed?

Asthma is sometimes hard to diagnose because it can resemble other respiratory problems such as emphysema, bronchitis and lower respiratory infections. For that reason, asthma is under diagnosed – that is, many people with the disease do not know they have it and therefore are never treated. Sometimes the only symptom is a chronic cough, especially at night. Or, coughing or wheezing may occur only with exercise. Some people mistakenly think they are having recurrent bronchitis, since respiratory infections usually settle in the chest in a person with asthma.

To diagnose asthma and distinguish it from other lung disorders, physicians rely on a combination of medical history, a thorough physical examination, and certain laboratory tests. These tests can include spirometry (using an instrument that measure the air taken into and out of the lungs, chest X-rays and blood and allergy tests).

Q - What does an asthma attack feel like and what happens during an attack?

An asthma episode feels somewhat like taking deep breaths of very cold air on a winter day. Breathing becomes harder and may hurt, and there may be coughing. Breathing may make a wheezing or whistling sound.

These problems occur because the airways of the lungs are getting narrower. The muscles that surround the airways tighten, the inner lining of the airways swells and pushes inward, and the membranes that line the airways secrete extra mucus, which can form plugs that further block the air passages. The rush of air through the narrowed airways produces the wheezing sounds that are typical of asthma.

Q - Are there asthma patient support groups?

There are several asthma support groups. One national organization is the Allergy and Asthma Network Mothers of Asthmatics. Another is the Asthma and Allergy Foundation of America. There also is a Food Allergy and Anaphylaxis Network.

Here are some links to visit:

Q- What are the main national allergy associations in the United States?

They are The Academy of Allergy, Asthma and Immunology (AAAAI) and The American College of Allergy, Asthma and Immunology (ACAAI).

Q- What are some of the anti-asthma medications?

Advair, Alvesco, Asmanex, Flovent, Pulmicort, Qvar, Singulair, Symbicort, Dulera, Xolair, ProAir, Proventil, Ventolin and Combivent.


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