Who is an allergist?

An allergist is a physician specialising in diagnosing and treating asthma and other hypersensitive diseases associated with the immune system. The allergist is specially trained to identify allergy and asthma triggers. Allergists help people treat or prevent their hypersensitivity issues. After earning a medical degree, the allergist completes a three-year residency training program in internal medicine or paediatrics. Next, the allergist will complete two or three more years of study in hypersensitivity and immunology. You can be sure your doctor has met these requirements if they are certified by the American Board of Allergy and Immunology.

What is the immune system, and how is it linked with hypersensitivity?

The immune system is involved in defending the body from infection. One of the marvels of the human body is that it can protect itself against harmful invaders such as viruses or bacteria. But sometimes the defences are too aggressive, and harmless substances such as dust, moulds or pollen are mistakenly identified as dangerous. The immune system then rallies its defences, incorporating several chemicals to assault and destroy the supposed enemy. In the process, some unpleasant and, in extreme cases, life-threatening manifestations may be experienced in the hypersensitivity-prone individual.

The reasons for hypersensitive responses:

Hundreds of ordinary substances can trigger hypersensitive responses. The most common are plant pollens, moulds, household dust (dust mites), cockroaches, pets, industrial chemicals, foods, medicines, feathers and insect stings. These triggers are called as “allergens.”

Who develops asthma or hypersensitivities?

Asthma and hypersensitivities can affect anyone, regardless of age, gender, race or socioeconomic factors. While it’s true that asthma and hypersensitivities are more common in children, they can occur for the first time at any age. Sometimes allergy symptoms start in childhood, disappear for many years, and start up again during adulthood.

Although the exact genetic factors are not yet understood, there is a hereditary tendency to asthma and hypersensitivities. In susceptible people, factors such as hormones, stress, smoke, perfume or other environmental irritants also may play a role.

Types of allergy problems

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

Allergic Rhinitis (Hay Fever)

Allergic rhinitis is a general term used to describe the allergic reactions that take place in the nose. Symptoms may include sneezing, congestion, runny nose, and itching of the nose, the eyes and the roof of the mouth. When pollens or outdoor moulds trigger this problem during the Spring, Summer or Fall, the condition is often called “hay fever.” When the problem is year-round, it might be caused by exposure to house dust mites, household pets, indoor moulds or allergens at school or in the workplace.

Asthma

Asthma symptoms occur when airway muscle spasms block airflow to the lungs, and the linings of the bronchial tubes become inflamed. Excess mucus may clog the airways. An asthma attack is characterised by difficult or restricted breathing, a tight feeling in the chest, coughing and wheezing. Sometimes, a chronic cough is the only symptom. Asthma trouble can cause only mild discomfort, or it can cause life-threatening attacks in which breathing stops altogether.

Atopic and Contact Dermatitis/Hives/Skin Hypersensitivities

Atopic and contact dermatitis, eczema and hives are skin conditions that allergens and other irritants can cause. Often, the reaction may take hours or days to develop, as in the case of poison ivy. The most common allergic causes of rashes are medicines, insect stings, foods, animals and chemicals used at home or work. Hypersensitivities may be aggravated by emotional stress.

Anaphylaxis

Anaphylaxis is a rare, potentially fatal allergic reaction that affects many parts of the body at the same time. The trigger may be an insect sting, a food (such as peanuts) or a medication. Symptoms may include:

• vomiting or diarrhoea
• a dangerous drop in blood pressure
• redness of the skin and hives
• difficulty breathing
• swelling of the throat and tongue
• loss of consciousness.

Frequently, these symptoms start without warning and get worse rapidly. At the first sign of an anaphylactic reaction, the affected person must go immediately to the closest Emergency Room.

What medical conditions do immunologists/allergists manage?

Clinical immunologists/allergists treat all allergic and autoimmune conditions, including:

• Systemic lupus erythematosus (SLE)
• Sarcoidosis
• Scleroderma
• Raynaud’s disease
• CREST syndrome
• Sjogren’s syndrome
• Rheumatoid arthritis
• Other arthritis
• Hypersensitivity
• Urticaria
• Anaphylaxis
• Chronic fatigue syndrome

When to see an allergist?

If you feel like you’re always getting sick, with a cough or head congestion, it’s time to see an allergist. Often, the manifestations of asthma or sensitivities build up slowly over time.

Sensitivity sufferers may be used to frequent indications such as sneezing, nasal congestion or wheezing. With the assistance of an allergist, these manifestations typically can be prevented or controlled with a significant improvement in the value of life.

Effectively controlling asthma and sensitivities requires planning, skill and patience. With specialised training, the allergist can develop a treatment plan for an individual condition. The goal will be to enable you to lead a life that is as normal and free from manifestations as possible.

A visit to the allergist might include

Allergy testing. The allergist will usually perform tests to determine what allergens are involved.

Prevention education. The most effective approach to treating asthma or sensitivities is to avoid the factors that trigger the condition in the first place. Even when it is impossible to avoid allergens altogether, an allergist can help you decrease exposure to them.

Medication prescriptions. Several new and effective medications are available to treat both asthma and sensitivities.

Immunotherapy can be given as allergy shots or sublingual tablets.

Allergy shots are given to patients every week or two and contain some or all of the allergens that cause their sensitivity problems. Gradually, the injections get stronger and stronger. In most cases, the sensitivity issues get less and less over time.

Sublingual immunotherapy is only available to ragweed, grass pollens and dust mites. These tablets are taken daily at home. However, the first dose is taken at the allergist’s office. Sensitivities improve over time while on the immunotherapy.

You should see an allergist if:

• Your hypersensitivities are causing symptoms such as chronic sinus infections, nasal congestion 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 hypersensitivities are interfering with your ability to carry on day-to-day activities.
• Your asthma or hypersensitivities decrease the quality of your life.
• You are experiencing warning signs of severe 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.

Treatments provided by allergists/immunologists/allergists

Clinical immunologists/allergists/allergists provide treatment for the many hypersensitive and autoimmune problems people may suffer, generally involving the administration of medications. These may include steroids or other immunosuppressant drugs.

What to expect at your first visit with an immunologist/allergist

History

Your clinical immunologist/allergist will focus on your current manifestations and then ask about prior indications. They may also ask you about:

• Previous treatments and their efficacy are also essential.
• Other medical problems
• Current medications
• Hypersensitivities
• Family and social history

Examination

Your clinical immunologist/allergist will begin with a general examination and focus on the area causing you the most trouble. This will vary depending on the clinical presentation.

Training and qualifications

Entry into immunology training is usually very competitive. Once selected, four years of speciality training follow.

Trainees work and operate under the supervision of a consultant/specialist immunologist/allergist.

Registrars must sit examinations, manage inpatients and outpatients and are encouraged to conduct research before eventually reaching the speciality level.

• Basic medical training
• Internship
• Residency
• Specialty training

Specialty areas of interest

• Paediatric immunology
• Hypersensitivity

Associated tests

• Blood tests, particularly for autoantibodies
• Biopsy
• Skin prick testing for allergy