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Why we DON'T need more allergists*

Yes, Virginia, there IS an allergy crisis.  And in view of that, why would I make such a crazy statement in my journal header?  Especially in view of the stark statistics that the ACAAI recently published in their "White Paper" on the "Allergy/Asthma crisis" that the American public faces.   Most of us realize that  allergic/immunologic diseases in the U.S. have become much

more prevalent in the last 20-40  years.  To quote one telling statistic:  there were 6.8 million Americans affected by asthma in 1980, 13.7 million in 1994 and 22 million In 2005.  In addition, it has been estimated that the number of full-time allergists will decline by 6.8% between 2006 and 2020.  The solution proposed in the ACAAI white paper is to produce 120 more board-certified allergists annually.  In my opinion, this is a superficial solution to a much deeper problem in the allergy profession. One that we helped create and foster.  And without addressing the deeper problem, the proposed solution is a merely superficial one. 

Allergist-Broc-Cover-Web.jpgSpeaking as a professional allergists myself, I think we are both the problem (and the potential solution) to this crisis.  How could we be the problem?  Well, for starters, two major items come to mind:

 

    1. We have placed over-reliance and emphasis on pharmacologic symptom control of our patients problems, instead of immunological control based on an aggressive immunotherapy approach to our patients:  As a consulting allergist, time and again I see patients on nasal sprays, steroid inhalers, leukotriene blocking agents...and NO immunotherapy.  What gives?  We have become a specialty of "inhaler jockeys"...Inhalers and meds keep being blilthely "layered on" to the patient as the "allergic march" continues throughout their body.  Asthma "control"--not asthma "cause"--is paraded as a mantra...Reviewing outside records from other allergy clinics, I frequently find positive prick results, but no immunotherapy given.  Immunotherapy is reserved for the "elite few" and certainly is a small fraction of all patients seen in many allergy clinics.  

    2.  Failure to "market" ourselves effectively to primary care physicians and other specialists.  Perception is everything, and we've failed in this regard.  I recently made a trip to see my own family physician...during the course of my checkup, the topic of asthma came up, and he casually mentioned that "this is a disease for the family physician to treat..."  Why did he say that, in view of the fact that in his own clinic he has an allergist on staff?  Maybe because he sees he himself and the allergist as doing the same thing--you know, inhaler treatment, peak flow monitoring, etc.?  A pulmonologist from Minneapoplis came down to visit our offices, and I asked him what his opinion was of allergists in his locale, and whether he considered they were an asset to his practice.  "No", he said, "I don't use them...I found they practice 1970's medicine--do a few prick tests, and even when they are positive they don't do anything about them.  And they want the easy asthmatics too...when they get in trouble I have to handle the fallout". Let's face it, at least in my own regional area despite the crisis in allergy, allergists are not "bursting at the seams" in their practices with patients--which they should be, if the allergy crisis is indeed a real one.  For example, as a test, our own allergy nurse called a local allergist here in town to see how soon she could be booked to be seen as a new patient..."How about 1:00 today?" was the answer. 

In this weeks' ACAAI newsletter, Jay Portnoy said that testing and treatment of allergies basically defines who the allergist is.  And when it comes to the current state of allergy treatment, I''m reminded of the opening lines of Dante's Inferno:

 "Midway upon the journey of our life/I found myself lost in a dark wood"

The allergist has lost his way...and making more lost allergists is not, in my opinion, the answer.  The answer, in my opinion, is in finding the way. And why the asterisk in my heading?  That's easy.  Because when we find our way, we do indeed need more allergists...
 

Posted on Sunday, April 29, 2007 at 12:27PM by Registered CommenterGeorge F Kroker MD FACAAI in | Comments Off

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