leonardo-da-vinci-ornihopter-large.jpgWhere should we begin with this one?  We've got more problems than we can shake a Caduceus at.  Those of us who attend national allergy meetings and listen to the lectures and receive biweekly newsletters are given the platitude "no one does it better than the allergist".  Let's take the "spin" off this phrase for just a moment...Just what exactly is "it", and do we really "do it better" than everyone else?  We're pretty good at layering on prick tests, and giving drugs, but what about managing the difficult allergy patient?  Finding out what's really wrong with them?...I think not.  As allergists, we were at one time masters of all allergic aberrations in all organ systems...our specialty has atrophied down to nearly exclusive concentration on the respiratory tract...we have become "asthma doctors"--inhaler jockeys--and not allergists. 

Some problems in our field (and by no means an inclusive list):

 

1.  Too much reliance on drugs & medications to treat symptoms instead of finding allergic causes of our patients illnesses... We see "big Pharma" booths at the allergy meetings, Big Pharma-sponsored lectureships, given by physicians receiving drug company sponsored grants, etc. We've become a specialty of  'script jockeys, and our skills at finding underlying causes of our patients problems have atrophied.

2.  A lack of emphasis on what we should do best:  immunotherapy.   Perhaps only 5% of our patients receive immunotherapy--yet it's the only therapy we can offer with disease-modifying potential.  Let's get our ass off the chair and start doing more.  Scared of side effects with your patients?--then start learning how to use sublingual immunotherapy in your practice.   

3.  An embarassing late and incomplete/inadequate response to sublingual immunotherapy.  This year the FDA for the first time approved a sublingual grass tablet as well as a sublingual Ragweed tablet.  Yet anyone who has studied the medical literature critically and looked at the history of SLIT, will inevitably ask the question:  WHAT TOOK SO LONG? The half-hearted, tired approach investigating SLIT for use in the US is a damning incrimination of our specialty's lack of innovation and over-complacency with the status quo. 

4.  If it isn't IgE, we don't care about it.  Let's get a life.  There's more to allergy than IgE mediated disease.  Non-IgE sensitivity issues abound.  But you'll hear nary a talk on food additive sensitivity, non-IgE mediated food intolerance and late phase skin test reactions at most meetings.  Instead we're drenched with the same old tired talks on asthma management, typically with a drug emphasis.    

5.  We are facing increasing competition from all quarters:  Let's face it.  We are in competition with the family physician, ENT physician, dermatologist, pulmonologist, chiropracter, alternative health practitioner, and more other doctors than you can swing a Caduceus at...

7.  We aren't supplying what the public wants..or needs:   Let's face the stark truth:  Patients come to us to find the allergic causes of their problems, not for more medicine to cover them up.  Patients now can get non-sedating OTC antihistamines for hayfever without our help.  They can get inhalers from their primary care physician for their asthma without our help.  They can get steroid creams from their dermtologist without our help.  They can get OTC nasal steroids without our help.  So When a patient goes to an allergist, they expect more than these options.  When they see an allergist, they want (and  expect) answers.  And they often don't get them from the allergist.  Why, you ask?  Because the allergist typically looks for only IgE mediated illness, and (even if this is found) doesn't usually start his patients on immunotherapy.  

 8.  If it isn't in the respiratory tract, we don't care about it:  An ugly fact is that our interest in allergic diseases of the body has atrophied; we largely have become a specialty of "asthma doctors" who would rather give out colorful inhalers than investigate other areas of the body that suffer from allergic disease.  During the "Golden Age" of allergy, we were Masters of allergic aberrations in all areas of the body.  Now, at allergy meetings we emphasize asthmatic disease and respiratory diseases almost exclusively, and give mere lip service to other areas of the body involved in allergic reactions--like the vaginal, gastrointestinal, and dermal areas.  In some tertiary care centers, you see in their listing the following:   "The Department of Pulmonology, Critical Care Medicine and...Allergy"  We've become a tag-along poodle to the pulmonary and critical care specialties.  What happened to our once grand specialty?