"Is this all they really do?"
A few years ago while attending the annual meeting of the American College of Allergists, I had an interesting experience. A friend of mine, who is a family physician, decided to attend the meeting also, and we sat through the plenary sessions together. For the longest time, he made no comment, simply listening to the sessions, and taking notes. Finally, at the conclusion of the session, he looked at me, and asked--rather incredulously--
"George, PLEASE tell me that this isn't all an allergist does (i.e., meaning prescribe drugs). I DO ALL OF THIS IN MY OWN PRACTICE!"
His comment is very telling. As a consulting allergist, I often see patients coming to me for a "second opinion" on how to best manage their allergy condition, after they have been already seen by at least one other allergist. In my own experience of over 25 years, it seems most allergists manage patients with the following priority for treatment:
1. Drugs
2. Environmental control
3. Immunotherapy--as A LAST RESORT.
In truth, there are several things that set us apart from the primary care physician. We might be able to better jockey drugs, measure peak flow measurements, run PFT's etc for the asthmatic patient, but I believe what REALLY and PRINCIPALLY sets us apart from our family practice colleagues is our ability to use IMMUNOTHERAPY to aid our patients.
In my own practice, I REVERSE the priorities mentioned above, in the following manner:
1. Immunotherapy as a FIRST--and not a LAST--priority
2. Environmental control
3. Drug management as a LAST priority.
Finding the CAUSE of a patients problems, then setting about aggressive immunotherapy has generally given a much more rewarding outcoming to my patient (and myself!). And the use of SLIT--not SCIT--makes immunotherapy much more attractive...But more about that later...
George F Kroker MD FACAAI
in Allergy and the allergist
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