​Specialist Q&A: What Can an Allergist Do for You?

Davidson: It's one of two paths. After medical school, there's primary residency training that either is in pediatrics or internal medicine. From there, after finishing those three years, you apply for a fellowship, which is either two or three years specifically in allergy and immunology.

One unique aspect, for example, is that I went into pediatrics and then did allergy and immunology. As an allergist, you see all ages, so even though I did pediatrics, primarily I see adults as an allergist, and the same would go for the internal medicine doctors who complete an allergy/immunology fellowship, so they would actually see children in addition to adults.

As the name allergy and immunology implies, it's a lot about the immune system. To me, it's interesting because it kind of covers the two ends of the immune spectrum.

Allergies are typically examples of the immune system going overboard or overreacting, whether it be because of the environment, foods, medications or even bee stings. On the flip side, I also manage patients with immunodeficiencies or weak immune systems, and that's where immunology comes in. It covers both ends.

It's a little cliché, but I grew up with a lot of asthma and allergies. Those are two of the primary conditions I treat now, so I can definitely empathize with a lot of the patients I treat.

The common conditions are hay fever or allergic rhinitis, asthma, eczema [an allergic skin condition], chronic hives and food allergies. Those, collectively, are the main reasons.

In general, it's skewed toward the more moderate or severe versions of those conditions that a primary care physician is either uncomfortable with treating or unable to treat.

I think allergy is a unique field. It's a bit like playing detective every day because there's a lot about the history of the patient, what they've been exposed to, the timeline of their reactions, if any, and what they feel sets it off. I often appreciate a good history. If someone can think about what triggers set off their symptoms, whatever their condition may be, that's always helpful.

Ultimately, one of the biggest things allergists do is test to best identify those triggers. If an allergist gets a good sense of what the potential triggers are, it only makes the visit more likely to be successful for the patient.

You can ask about their philosophy on how they approach treatment. Why I say that is because some allergists are more likely to push toward allergy shots versus others. Allergy shots are a way to desensitize patients to their allergies, at least environmentally, and can be highly effective. It's just that some of the allergists are a little too aggressive with that.

I think it's important for patients to be prepared for that and to have a sense of what they're looking for, because the medications treat symptoms and the allergy shots kind of treat the cause. It can be very helpful but it's not always necessary.

Certain medications that are easy to take as needed might be enough for some patients to manage symptoms. The allergy shots are a real commitment. It's a three- to five-year commitment timeline of routine shots. It's not a short-term regimen, so it's a lot to ask of patients. Plus, there are side effects. You're getting shots of what you're allergic to, so you can have allergic reactions.

Usually, it's one of two ways: either skin or blood testing. Both are available and easy to perform and identify a patient's environmental allergies, such as dust mites, pollen, cat or dog dander, or food allergies.

It varies. If we get the testing all done in one visit, maybe I'll review their results if it's a blood test, but the skin tests are available the same day, so there's a decent number of patients who just want to find out their allergies and then I never see them again.

For others, especially people with chronic conditions such as asthma or eczema, they'll be seen three or four times a year even. That would be the extreme.

The next step will be treatments for food allergies. Right now it's a lot about just identifying the allergy and avoiding it, which doesn't sound much like treatment but is obviously effective if you're not exposed to the food. In the next few years, we'll likely see effective food allergy treatments hitting the market, which will be exciting for a lot of patients.