When should you consult an allergist?


allergistThe question of when to consult an allergist is a frequently asked question. This is especially true in light of the fact that approximately 50 million Americans have asthma, hay fever, or other allergy symptoms. Primary care physicians, especially pediatricians, are on the front line in the recognition of allergy symptoms and in allergy treatment and asthma treatment. Fortunately, most patients present with allergy symptoms which are mild, are easy to manage with minimal intervention, and never require a referral to an allergist.  But, there are cases of allergies and asthma which can be very serious and difficult to treat. These patients should be referred to an allergy specialist for evaluation and treatment.

Allergy symptoms which are recurrent or chronic, especially if they are present every day, should be evaluated by an allergist.  Recurrent or chronic allergy symptoms are generally caused by dust allergies, mold allergies, food allergies, dog allergies, cat allergies, or any other types of pet allergies.  Due to the ever-present nature of these allergies, such cases should be referred to an allergist for a thorough evaluation. Even though allergies generally cannot be “cured”, allergy relief is usually possible, and even highly probable, under the treatment of a board certified allergist.

What is an allergist?

Allergists are sometimes called “allergy doctors”. An allergist is a physician trained to treat many types of allergic disorders, asthma, and other immunologic disorders. The most common allergic diseases treated by an allergist include allergic rhinitis or hay fever, sinusitis, non-allergic rhinitis, nasal allergies, skin allergies including hives and eczema, and both allergic and non-allergic asthma. Allergists are also experts in the diagnosis and treatment of food allergies, stinging insect allergies, drug allergies, and a variety of allergy related issues.

Allergy doctors are highly trained. Formal training to become an allergist takes a minimum of nine years after college. After four years of medical school, one then does an internship and residency in either pediatrics or internal medicine, a process lasting 3-4 years. In order to become an allergist, one would then do a fellowship lasting 2-3 years in an approved allergy training program. An allergist would then take an exam in order to receive board certification. Board certification indicates that the allergist has reached a high level of expertise and is recognized by the public and the medical community as an expert in his or her field of medicine. Many allergists are double boarded, meaning that they have board certification in two areas, Allergy, Asthma, and Clinical Immunology, as well as either Pediatrics or Internal Medicine.

What does an allergist do?

Allergists are trained to diagnose and treat allergies, asthma, and a variety of immunological disorders. Although some allergists refer to themselves as pediatric allergists, and some are referred to as adult allergists, all allergists are trained to care for both children and adults. Pediatric allergists are also pediatricians, and are thus very much focused on the special needs and concerns of children and their families. Whether one is designated as a pediatric allergist or an adult allergist, all allergy specialists generally devote a great deal of time in understanding, evaluating, and counseling their patients.

An allergy evaluation can be performed in the allergist’s office, and is generally performed in one or two visits. The allergy evaluation begins with a thorough history of a patient’s allergy symptoms and the circumstances which affect the onset, frequency, and severity of those symptoms. A physical exam is then performed, with an emphasis on the ears, nose, and throat, lungs, heart, and skin. Based on the history and physical exam, the allergist will decide whether allergy testing is indicated.  The allergist has the capability of allergy testing the patient to a variety of possible allergens, including inhalants and foods, in order to better understand what is causing the patient’s symptoms. If allergy skin testing is performed, the results are available within minutes. All allergists can also perform and interpret lung function testing to assess asthma and other respiratory disorders. Imaging studies, including X-Rays and CT Scans, may also be part of the allergy evaluation.

At the conclusion of the allergy evaluation, the allergist will explain to the patient and family members the nature of the allergy diagnosis, and will suggest a comprehensive allergy treatment plan tailored to the individual patient. Allergists are generally excellent communicators. Patient education will be emphasized and questions will be encouraged, as the best outcomes can be attained when a patient is well informed and is empowered to take control of their management, in concert with the allergist.

The allergist will likely recommend excellent allergy products that can help alleviate symptoms and bring allergy relief.  Effective allergy bedding is a common recommendation as it can provide relief to both allergy and asthma sufferers who are allergic to dust mites. There are also effective asthma products, such as nebulizers, which may be recommended, especially for young children.  A mist humidifier is another example of a simple product that can also have a great impact, and which might be a part of a patient’s treatment plan. An allergist will guide you in determining which asthma or allergy products are right for you or your child.

Who should be referred to an allergist?

There is no absolute answer for who should be referred to an allergist, but, if allergies or asthma symptoms are frequent, recurrent, or chronic an allergy consultation would certainly be appropriate. An allergy referral is also in order if symptoms are moderate to severe and they have not responded to previously recommended treatment. For those who have had life-threatening allergic reactions such as anaphylaxis or severe asthma, an allergy consultation with a board certified allergist is highly recommended.

In many cases, it is not necessary to have a physician’s referral to an allergist. Many allergy evaluations are performed after being self referred. Regardless of whether one is referred for an allergy evaluation of self referred, allergy doctors will likely send a complete and comprehensive report to the referring physician or the patient’s primary care physician.

What is the likely outcome?

Many studies have demonstrated the value of an allergy referral and an allergy evaluation in the care of an allergy or asthma patient. Almost all data suggests that when referred to an allergist for evaluation and treatment, the allergy or asthma patient will have a significant decrease in their symptoms, find allergy relief, and will have an improved quality of life. Such intervention is also very cost efficient in terms of higher productivity and fewer days lost from school and work, less expenditures for medication, as well as fewer emergency room visits and hospitalizations.

Allergy doctors are critical players in the approach to wellness. They and their staff spend a great deal of time communicating with patients and families about the nature of the allergic condition and the optimal allergy treatment recommended. They readily share allergy information and strongly encourage a team approach to health and wellness. Not only will they diagnose and treat the allergies or asthma, they will provide ongoing allergy information or asthma information to the patient, to keep them informed of present and future treatment options. Working in collaboration with the primary care physician, the patient, and the family, and by leveraging the benefits of environmental control through the use of effective allergy products, one can maximize the likelihood of good health and excellent control of allergy symptoms and asthma symptoms.



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