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Sneezes and coughs, runny noses and strange rashes – these are all common symptoms that might signal you're having an allergic reaction to something in your environment. An allergy is triggered "when your immune system reacts to a foreign substance, called an allergen," according to the Asthma and Allergy Foundation of America. "It could be something you eat, inhale into your lungs, inject into your body or touch. This reaction could cause coughing, sneezing, itchy eyes, a runny nose and a scratchy throat. In severe cases, it can cause rashes, hives, low blood pressure, breathing trouble, asthma attacks and even death." Allergies can be a minor nuisance, or something quite serious, and the specialist doctor who can help you manage these problems, no matter the cause, is an allergist.
Dr. Puneet Bajaj, an allergist with Geisinger in Danville, Pennsylvania, says environmental allergies are the most common complaints patients have when visiting an allergist. The common allergies patients face are reactions to pollen, pets, dust mites and mold, Bajaj says."Typically, the patients will have symptoms of runny nose, itchy eyes, chronic sinus symptoms and some of them may have worsening symptoms when the pollen levels are high." Many of these symptoms can be effectively suppressed with common over-the-counter medications, like antihistamines, but sometimes that's not enough. "If the over-the-counter stuff is not working [patients will] be sent to us."
In addition to garden-variety environmental allergies, an allergist can also help you manage more chronic diseases, such as asthma or eczema. "We see a lot of asthmas, especially allergic asthma. Allergies and asthma go hand-in-hand, so patients who have asthma and allergies come to us," Bajaj says. An allergist may also treat reactions to insect venom (bee stings, etc.), immune deficiency diseases, reactions to medications and food allergies. "Allergies impact quality of life big time," he says. "You miss school, you miss work, you have to make changes and you have to stop eating certain foods," he says. Therefore, it's important to find a good allergist to help you manage these conditions.
So what makes a good allergist? "A good allergist is someone who will spend time with you, review your history and explain the treatment to you in detail. If you find a doctor that has a good communication style and good bedside manner and spends time with you, that's what I would look for," Bajaj says.
When you begin looking for an allergist, do a little research first. "If I had to select an allergist for my child or myself, I'd make sure to check the credentials. I believe you should see an allergist who's board-certified," Bajaj says. The American Board of Allergy and Immunology offers certification to doctors in this field.
To become a board-certified allergist, the doctor completes a residency in general pediatrics or general internal medicine, says Dr. Carah B. Santos, assistant professor of pediatrics in the department of clinical allergy and immunology at National Jewish Healthin Denver. "After that we do something called fellowship training, which is two to three years where we just focus on treating allergic and immunologic disorders both in adults and children. We're the only subspecialty that cross-trains to treat both adults and kids, and that's why oftentimes when you find an allergist they say they can treat any age." Once this training is complete, the doctor sits for a rigorous exam. If she passes, as Santos did in 2014, she's board-certified.
Maintaining that certification takes some effort. "We're required to stay up-to-date with guidelines, research and medical evidence," Santos says. This is done by taking additional examinations and fulfilling other continuing education requirements for the rest of one's career.
In addition to checking a doctor's credentials, Bajaj says "you should look into recommendations. Check with your primary care physician." Santos also recommends "getting referrals from people you know and trust, particularly your primary care provider, family members, friends and neighbors just to see who has a positive reputation and who people you know and trust have had good experiences with."
Santos also suggests checking the allergist's website "to get a better idea of their approach to treatment. As allergists, not all of our treatment involves medications. We also tend to emphasize looking for triggers in the environment that might contribute to symptoms of hay fever or asthma and eczema, and we also really strive to educate patients on ways to modify or control the environment." She recommends looking for language on the doctor's website indicating he or she emphasizes educating patients about environmental measures.
And there's more to the allergist than just the doctor herself, Santos says. "When it comes to picking an allergist, along with a great allergist comes a great care team also. The physician assistants, nurse practitioners, nurses and medical assistants are the ones often performing the diagnostic tests and teaching patients how to use their medications. When you're deciding on a provider, I think it's important to think about the entire care team as well," she says.
Santos says this care team comes into play in a comprehensive way for some patients with severe or complicated cases of allergies or immune disorders who visit National Jewish Health for its multidisciplinary program that evaluates and manages the condition during a two-week stay. This intensive, holistic approach that involves a range of specialists can help unravel difficult to diagnose or control conditions. "We can really accomplish so much more during a two-week stay than during several shorter visits," she says, making it a good option for some patients.
Making sure your personality and communication styles mesh is also important, as for some patients, the relationship with an allergist could be long term. "Obviously, you should be comfortable with the doctor's communication style," Bajaj says. "Don't feel pushed into treatments that you're not ready for. And the allergist should offer you relevant testing. There's a lot of allergy testing and treatment that's not approved, and sometimes patients come to us expecting treatments which are not the best for them. The allergist should educate you on avoiding such testing procedures or such unapproved treatments," he says.
"If I was looking for an allergist for myself or family members, I would want to make sure they're listening to my needs and validating my concerns," Santos says. "'Is that doctor able to explain the medical condition, the tests they're recommending and the medications they're recommending in a manner and language that is easily understandable? Are they laying out the different management options and weighing out the pros and cons of each? And are they involving the patient in the decision-making process? Is that allergist someone you'd entrust [a family member's] care with?' I think if you can say yes to all that, then you've found someone who sits in line with your personality and what your treatment goals are."
When preparing for your first visit with a new allergist, Bajaj recommends gathering any and all past test results you have and coming armed with details of your symptoms. "With allergies, you want to know details of what happens timing-wise and when it happened. Sometimes people come and they're not exactly sure about reactions, so it's better if you come prepared with all the information," including any previous allergy shots you've had or imaging studies, breathing tests or bloodwork that's been done. He also recommends bringing a list of questions to ask the doctor. "If you have time, do some research on some of these questions and then come prepared so that it's a productive visit for you. If you're prepared, you'll get more out of the visit."
Bajaj also says you might want to consider calling ahead to see if the practice offers allergy testing on site and whether you'll undergo any testing on that initial visit, because you may need to stop taking allergy medicines seven to 10 days prior for the testing to produce reliable results. You should ask for guidance on this before your first appointment so you know which medications to eliminate and how best to prepare for your appointment.
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