ellergist_fendot_faggot_maggi

8/7/2019 ellergist_fendot_faggot_maggi

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1.0 INTRODUCTION

Allergies are multi-organ, systemic hypersensitivity diseases which include inoconjunctivitis,

asthma, urticaria/angioedema, atopic and non-atopic eczema, food allergy, drug allergy and

anaphylaxis, etc. Allergic diseases may be divided according to the pathogenesis in IgE and

non-IgE-mediated hypersensitivity. Allergology is a medical specialty concerned with the

prevention, diagnosis, management, and rehabilitation of patients with allergic diseases.

Clinical immunology relates to immune system dysfunctions and immunological diseases

specified in the Core Curriculum. Patients with clinical immunologic diseases are often

handled in cooperation with other specialists. An allergist-immunologist is a physician who

has been trained in either internal medicine or pediatrics and who has completed an additional

2 (or more) years of training in allergy and immunology at an accredited training program.

Most are certied in internal medicine, pediatrics, or both and have passed the examination

given by the American Board of Allergy and Immunology.. An allergologist/clinical

immunologist is a specialist who has acquired the defined level of competencies in the

diagnosis and management of allergic and immunologic diseases. In some European

countries the specialty includes both allergology and clinical immunology. In others,

allergology and clinical immunology is practised as two separate specialties or it has been

implemented in such organ-specific specialties as dermatology, pneumonology, ENT, etc.


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The allergist-immunologist is uniquely trained in the following:

yallergy testing (skin test, in vitro studies);yhistory-allergy test evaluation;ybronchoprovocation testing (eg, exercise and methacholine);yenvironmental control instructions;yinhalant immunotherapy;yimmunomodulator therapy (eg, anti-IgE, intravenous immunoglobulin);yvenom immunotherapy;yfood and drug challenges;ydrug desensitization;yevaluation of immune competence;yeducation (disease, medications, and monitoring); andymanagement of chronic or recurrent conditions in which allergy is not always

identied: hinosinusitis, conjunctivitis, asthma, cough, urticaria-angioedema, eczema,

anaphylaxis.


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2.0 IMMUNOLOGIST:CAREER PATH

1.Complete required undergraduate education. You will need to earn a Bachelor'sdegree from an accredited college or university as a prerequisite to medical school. A

degree in one of the sciences is generally recommended, but other Bachelor's degreesare also accepted. This will typically take 4 years to complete.

2.Choose and attend medical school. You will need to choose a medical school that isaccredited by the Liaison Committee on Medical Education (LCME). Medical school

will take four years to complete, and will include both classroom and hands-on

clinical requirements. After medical school, you will earn your doctor of medicine

degree (MD), but will not be able to practice medicine until you earn your medical

license.

3.Choose and complete a residency program. Choose a residency program in eitherinternal medicine or pediatrics to be accepted into an allergy and immunology

fellowship. Both of these residency programs take 3 years to complete.

4.Take and pass your medical license examination after you have completed yourresidency. Each state requires licensure, and you will be licensed to practice medicine

in the state in which you completed your exam.

5.Find and complete a fellowship program. You can find a listing of Allergy andImmunology Fellowship programs at the American Academy of Allergy, Asthma and

Immunology website and other depends on preferred institutions. Once chosen, you

will need to complete your fellowship program, which typically lasts 2 years.


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2.2 clinical training

The main objective of the training in allergology and clinical immunology is to

provide the trainee with the acquisition of the appropriate knowledge and essential techniques

for the competent practice of the specialty. The trainee optimally may receive education in

both adult and pediatric allergy and must have cross-training in both out-patient and in-

patient populations. On completion of the allergology and clinical immunology training

program the allergologist/clinical immunologist can function as a specialist in the essential

roles and key competencies of allergologist/clinical immunologists: medical expert/clinical

decision maker, communicator, collaborator, manager, health advocate, scholar, and

professional. The graduate allergologist/clinical immunologist will have achieved the

following general educational objectives and must be able to:

Provide excellent, comprehensive, and evidence-based diagnosis andmanagement for patients with allergic and immunologic disorders.

Counsel patients and the broader community on prevention and rehabilitationof allergic and immunologic diseases.

Communicate effectively and compassionately with patients and theirfamilies.

Communicate constructively and effectively with other physicians (especially referring physicians) and other health care professionals.

Function as a member of the health care team and coordinate the team as

appropriate.

Contribute to the education of students, other physicians, other health careprofessionals, and patients and their families.Perform necessary technical skills specific to management of patients with

allergic and immunologic diseases.

Maintain complete and accurate medical records.Undertake accurate self-appraisal, develop a personal continuing education

strategy,

and pursue lifelong mastery of allergology and clinical immunology.Evaluate the allergology and immunology literature critically and apply

pertinent

information to patient management.


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During the allergology and clinical immunology training program, the trainee must

undertake a broad range of practical clinical experiences including acute and chronic allergic

and clinical immunologic care, ambulatory care, and prevention and rehabilitation. The

trainee must be involved in a program of formal educational activities, and have exposure to

and involvement with current research activities. The trainee must demonstrate the

knowledge, skills and attitudes relating to gender, culture and ethnicity pertinent to

allergology and clinical immunology. In addition, all trainees must demonstrate an ability to

incorporate gender, cultural and ethnic perspectives in research methodology, data

presentation and analysis. Gradually, the trainee must assume responsibility for clinical

decision making and patient care, and be able to function as an independent clinical decision

maker at graduation.


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2.1 Pre clinical study.

Strategies and resources for acquiring the body of knowledge within the Basic Science Core

Curriculum will vary among institutions but should include structured, didactic programs

(courses, lectures, and seminars), recommended textbooks, reading lists, and regional and

national seminars. The fund of knowledge obtained through the Basic Science Core

Curriculum should serve as the foundation for understanding allergic diseases,

immunodeficiencies, immunoregulatory disorders, immunodiagnostics, and therapy for

allergic and immunologic disorders.

Anatomy and Cellular Elements of the Immune SystemLymphoid organs - anatomy and functionsCells of relevance to the immune response, their unique identifying features,and

positive and negative selection during ontogeny

Innate and acquired immunityThe major histocompatibility complex - molecular structure and functionAntigens - processing and presentationAllergens - structure, epitopes.ImmunogeneticsT cell mediated immunity

T cell mediated immunityT cell activation - T cell receptor, epitope recognition and accessory molecules in

signal transduction

Cytokines and co-stimulatory molecules in T cell activationT cell-mediated immune responses - participating cells

B cell-mediated immunityB cell activation - T cell interaction and signal transductionImmunoglobulin production and epitope recognitionAntibody isotype and maturation of the antibody responseBiologic processes initiated by antibody. IgM, IgG, and IgA mediated, e.g.

opsonization, complement fixation, antibody dependent cell-mediated cytotoxicity

IgE - structure, function, synthesis, regulation, receptorsIgE mediated immediate and late phase reaction


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Immune complexes - physical properties, immunologic properties and mechanisms ofclearance

ImmunodeficienciesOther immune mechanisms

Natural killer cellsLymphokine activated killer cellsComplement and complement deficienciesReceptor ligand interactions in immune functioning - adhesion

molecules,complement receptors, IgE receptors, Fc receptors.

Signal transduction resulting from receptor ligand interaction. Genetic polymorphismsproducing gain or loss of function.

Immunologic Memory

Immunomodulation in the Immune ResponseCytokines, chemokines, adhesion molecules and growth factorsInflammation and its modulation

a) Mediators - preformed and newly generate

b) effector cells in inflammation - allergic and other

c) Mast cells and basophils - structure, activation, preformed mediators,

arachidonic acid metabolisms, prostaglandins, leukotrienes, PAF

d) Eosinophils - structure, activation, mediators

Mucosal ImmunityNon-immunologic - enzymes, acids, glycocalyx, normal flora, etc.Immunologic - mucosa associated lymphoid tissue, antigen processing, antibody and

cellular production, cell trafficking and homing

Transplantation ImmunologyMechanisms of allograft rejectionGraft versus host reactions (GVHR)


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Tumor ImmunologyAntigens of tumor cells - unique tumor specific antigens and tumor associated

antigens.

Oncogenes, translocations and tumor suppressor genesMechanisms of immunosurveillance

immunoregulatory mechanismtolerance mechanismidiotypic networkapoptosis


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3.0 DIAGNOSTIC PROCEDURE

Skin testing

a. Skin prick test:

Theoretical: Principles of the test, indications, contraindications, interactions

by drugs and diseases, side-effects, reproducibility, sensitivity, specificity and predictive

value, cost-effectiveness

Practical: Perform skin prick tests

b. Intradermal skin test:



value, cost-effectiveness, immediate and late phase reaction

Practical: Perform intradermal skin tests

c. Patch test:



value, cost-effectiveness, immediate and delayed type reaction

Practical: Perform patch tests

d. Delayed type skin tests with recall antigens:




Practical: Perform intradermal skin tests

Nasal examinations

a. Anterior nasal examination (speculum):




Practical: Perform anterior nasal examinations with speculum

b. Nasal endoscopy examination:


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Practical: Perform nasal endoscopy examinations (optional)

c. Rhinomanometry:

Theoretical: Principles of the test, indications, contraindications, interactions by drugs and

diseases, side-effects, reproducibility, sensitivity, specificity and predictive value, cost-

effectiveness, immediate and late phase reaction

Practical: Perform rhinomanometry (optional)

Pulmonary tests

a. Peak flow:




Practical: Perform peak flow registrations

b. Spirometry:




Practical: Perform spirometry registrations

c. Whole-body plethysmography, airway resistance, and diffusion:




Practical: Perform whole-body plethysmography registrations (optional)

d. Bronchoalveolar lavage:





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Practical: Perform bronchoalveolar lavage (optional)

e. Induced sputum: Theoretical: Principles of the test, indications, contraindications,

interactions



Practical: Perform induced sputum

Provocation Test

a. Conjunctival allergen provocation test:




Practical: Perform conjunctional allergen provocation tests

b. Nasal non-specific provocation test:




Practical: Perform nasal non-specific provocation tests

c. Nasal allergen provocation test:

Theoretical: Principles of the test, indications, contraindications, interactions by drugs and

diseases, side-effects, reproducibility, sensitivity, specificity and predictive value, cost-

effectiveness

Practical: Perform nasal allergen provocation tests

d. Bronchial non-specific provocation test:




Practical: Perform bronchial non-specific provocation tests

e. Bronchial allergen provocation test:


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Practical: Perform bronchial allergen provocation tests

f. Food challenges:




Practical: Perform food challenges

g. Drug challenges:




Practical: Perform drug challenges

h. Occupational allergen exposure test:




Practical: Perform occupational allergen exposure tests

i. Living insect sting challenges:




Practical: Perform living insect sting challenges (optional)

j. Exercise provocation tests:


by food, drugs and diseases, side-effects, reproducibility, sensitivity, specificity and

predictive value, cost-effectiveness

Practical: Perform exercise provocation tests


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k. Physical provocation tests (cold, heat, pressure):




Practical: Perform physical provocation tests


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4.0 CASES STUDY AND TREATMENT

1.Hospital patient with penicillin allergy. Patient is admitted to hospital for treatment of

MSSA osteomyelitis and started on vancomycin given a history of penicillin allergy.

Penicillin allergy reaction goes back to infancy when he apparently developed a rash after

being given a penicillin antibiotic. He subsequently has had 3 hospital admissions for

treatment of various infections including pneumonia, cellulitis, and a post-operative infection

all treated with more expensive alternative antibiotics to the penicillin family. The patient

is seen by an allergist at the hospital and penicillin skin testing done with diluted penicillin G

solutions as well as a histamine control which proves negative. They are subsequently given

a test-dose of IV penicillin G and tolerates this and has subsequently been able to switch to

cloxicillin antibiotic which he tolerates well and his infection responds more quickly to his

choice of antibiotics.

2. Eating disorder patient with multiple food allergies. A 20-year-old woman is

admitted to Eating Disorders Ward in hospital with severe malnutrition with a tentative

diagnosis of anorexia nervosa and bulimia. The patient claims she is allergic to multiple

foods and has been unable eat. She has seen a naturopath in the past who did blood testing

which came back with multiple food sensitivities and the patient has been trying to avoid

the suspected foods. The patient is assessed by an allergist and skin testing various foods is

negative. The patient undergoes double-blind placebo-controlled challenges in hospital

none of which elicits any significant reactions to the foods she was supposed to be allergic to

and she is counseled to expand her diet more effectively which allows her to regain weight.

3. Multiple drug-allergic patient. A 50-year-old woman is admitted to the general

medical ward in hospital with severe hypertension and mild renal function impairment. Her

stay in hospital is prolonged and complicated by apparent drug reactions to just about every

medication she has been put on to treat her hypertension. She is seen by an allergist who

elicits history. She has had a history of urticaria and sensitive skin in the past and elicits

dermatographia reactions even though she is not on any medications. The allergist diagnoses

chronic urticaria probably auto-immune in origin and not multiple drug allergies. The patient

is treated with a combination of H1 antihistamine and H2 blocker and is able to tolerate anti-

hypertensive medications without any significant problem subsequently.


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4. Allergic asthma patient. A 36-year-old man is admitted to hospital with severe

exacerbation of his asthma. His attacks come on quite suddenly and are quite severe and he

is not aware of what specific factors have brought this on. In the past he has been

hospitalized for several days on at least 2 occasions for management of severe asthma. The

patient is subsequently assessed by an allergist who confirms severe cat allergy. Avoidance

measures are implemented and immunotherapy started to reduce his sensitivity to cat allergy

and he has subsequently been able to avoid any further emergency visits or hospitalizations

because of asthma exacerbations.

5. Recurrent throat swelling. A 40-year-old woman is presented to emergency on at

least 6 occasions complaining of throat swelling, difficulty swallowing, and some shortness

of breath. On examination by the emergency physicians on each occasion failed to see any

obvious swelling of her throat. Chest is clear and oxygen saturation levels are normal. She is

given antihistamine injection and her symptoms seem to settle down. No obvious trigger

factors have been noted but the patient wonders whether she might be allergic to certain

foods or is sensitive to perfume smells. The patient was subsequently seen by an allergist and

allergy skin testing is negative to all common foods and environmental factors. Serum

tryptase level is done at the time of her next presentation to emergency which comes back

negative. The patient is subsequently diagnosed by an allergist as having globus hystericus

and psychiatric counseling helps to reduce her anxiety levels.

6. Insect sting anaphylaxis. A 25-year-old woman has come to emergency on 4

occasions following insect sting reactions which have caused faintness and generalized

urticarial reactions. She has been prescribed an EpiPen autoinjector but is afraid to use it,

preferring to go to emergency at the local hospital which has been fairly close at hand. The

patient is subsequently seen by an allergist who confirms yellow-jacket venom allergy and

started on immunotherapy for desensitization. The patient is subsequently stung the second

year of immunotherapy and has no further reactions and continues the immunotherapy for a 5

year period. She is no longer required to obtain her epinephrine autoinjectors which she had

been obtaining but not using because of her fear of injections.

7. Recurrent infections. A 56-year-old man is seen in hospital by an


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all i t/ li i al i l i t ardi robl it recurrent infections. He has been

hospitali ed with severe pneumonia, including requiring ventilation in the IC on 3

occasions in the past. He has had numerous respiratory infections and sinusitis and has also

undergone sinus drainage procedure in the past. Assessment by the allergist by doing

quantitative immunoglobulins confirms he has severe hypogammaglobulinemia, probably of

the common variable type. The patientis subsequently trained for home subcutaneous

globulin administration and remains generally in good health, not requiring any additional

hospitali ations.

8. Recurrent heartburn and dysphagia. A 32-year-old man presents in emergency

with complaints of difficulty swallowing and having a piece of meat getting stuckin his

esophagus. The patientis admitted to hospital and subsequently undergoes endoscopy which

retrieves the impacted piece of meat and biopsies which were done confirmed eosinophillic

esophagiis. The patient was subsequently seen by an allergist/clinicalimmunologist and

starts him on inhaled fluticasone powder and his symptoms greatly resolve and he has not had

any further episodes of dysphagia. He has not had any further episodes of dysphagia.


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5.0 COMMON DISEASES

Urticaria/Angioedema

Who to refer to an allergist/immunologist:

Patients with chronic urticaria or angioedema, i.e..those with lesions recurringpersistently over a period of six weeks or more.

Patients who may have urticarial vasculitis or urticaria with systemic disease(vasculidities, connective tissue disease, rarely malignancies).

Why an allergist/immunologist:

Allergist/immunologist training and expertise should allow appropriate differentialdiagnosis, determination of the need for biopsy, elimination of a specific inciting

agent and optimal pharmacotherapy.

Occupational Asthma


Patients with a history suggesting occupational asthma should undergo testing toconfirm the diagnosis of asthma and referral to an allergist/immunologist for

evaluation to establish that the asthma is caused by or triggered by agents at the

workplace and to initiate appropriate avoidance therapy.


Allergist/immunologists can outline an algorithm for the clinical investigation ofsuspected occupational asthma. Allergists can arrange and interpret studies to confirm

bronchial hyperresponsiveness and workplace challenges.

Rhinitis


Patients with prolonged or severe manifestations of rhinitis with co-morbid conditions(e.g. asthma, recurrent sinusitis, nasal polyps); with symptoms interfering with quality


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of life and/or ability to function; or who have found medications to be ineffective or

have had adverse reactions to medications.


Allergist/immunologist care for rhinitis is associated with improved quality of life,compliance and satisfaction with care.

Allergist/immunologists have familiarity with the wide variety of both indoor andoutdoor aeroallergen exposures that have been shown to impact on the upper

respiratory tree and have the expertise to provide avoidance education and

immunotherapy when indicated.

Allergist/immunologists are specifically trained and experienced in the medicalmanagement of nasal polyps, including intranasal steroids, oral steroids and treatment

of complication sinusitis.

Food Allergy


Persons who have limited their diet based upon perceived adverse reactions to foodsor additives.

Persons who have experienced allergic symptoms (urticaria, angioedema, itch,wheezing, gastrointestinal responses) in association with food exposure.


Following allergy evaluation, an estimated one third of perceived adverse reactions tofoods and a small fraction of adverse reactions to additives are verified.

Evaluation by an allergist/immunologist is likely to result in an individuals ability toliberalize their diet (thereby likely improving nutrition and quality of life).

The allergist/immunologist can perform diagnostic tests such as skin tests, serum IgEtests and oral food challenges to determine the cause of the reaction so that necessary

avoidance can be instituted.


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Anaphylaxis


Individuals with a severe allergic reaction (anaphylaxis) without an obvious orpreviously defined trigger.

Persons with anaphylaxis attributed to food or drugs.Why an allergist/immunologist:

After a severe allergic reaction without a known cause, a trigger should be identifiedif at all possible. Suspected food and drug allergy should be confirmed if possible so

that necessary avoidance can be instituted. An allergist/immunologist is the most

appropriate medical professional to perform this evaluation, which may include skin

testing, in vitro tests and challenges when indicated.

Insect Hypersensitivity

When to refer to an allergist/immunologist:

Consider referral of patients with systemic reactions suspected or possibly due toinsect for accurate identification of specific allergen and consideration for venom

immunotherapy (or whole body extract in case of fire ant).


Allergy testing and history-test correlation can more accurately identify specificinsects responsible for an allergic reaction and may be helpful in diagnosis, treatment

and avoidance recommendations.

Skin testing is generally preferred overin vitro testing for the initial evaluation ofvenom-specific IgE antibodies.

Venom immunotherapy (or fire ant whole body extract) greatly reduces the risk ofsystemic reactions in stringing insect-sensitive patients.


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Asthma Treatment: Adherence


Patients with asthma in whom adherence problems may be limiting optimal control.Why an allergist/immunologist:

Patients who have visited an allergist/immunologist in the prior year weresignificantly more likely to have been dispensed an optimally effective number of

inhaled steroid canisters.

Specialty care is associated with more refills of anti-inflammatory medications.After visiting an allergist/immunologist, patient compliance with national asthma

guidelines was higher

Asthma Diagnosis


Patients with respiratory symptoms suggestive of asthma but with normal PFT and nosignificant reversibility.

Exercise-induced symptoms that are atypical or do not respond well to pre-treatmentwith albuterol.


Allergist/immunologists perform methacholine challenges, which have a highsensitivity for current asthma.

Further objective evaluation and confirmation with pulmonary function testing (including

exercise challenge) in conjunction with appropriate allergist/immunologist evaluation will

define diagnosis or differential diagnosis


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Allergic bronchopulmonary aspergilllosis (ABPA)


Patients with suspected/proven asthma or cystic fibrosis who have pulmonaryinfiltrates and peripheral blood eosinophilia.

Patients with known ABPA for management.Why an allergist/immunologist:

Allergen skin testing and in vitro tests, when correlated with history, can establish thediagnosis of ABPA

Allergist/immunologists are specifically trained to manage this disease, and positiveoutcomes of such management have been reported by allergist/immunologists.

Primary Immune Deficiency


Patients with any of the following warning signs:Frequent or severe infections (8 total or 2 serious)Two or more months on antibiotic with little or no effect or need for IV

antibiotics to clear infections.

Failure of an infant to gain weight or grow normallyPersistent thrush in mouth or elsewhere on skinFamily history of immune deficiency.


Allergist/immunologists are trained to diagnose and treat primary immunodeficiency.Immunologic therapy reduces infections, prevents complications and improves the

quality of life in patients with primary immune deficiencies.

Drug Allergy


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Patients with a history of penicillin allergy who have a significant probability ofrequiring future antibiotic therapy or have an infection in which a penicillin-class

antibiotic is the drug of choice.

Patients with histories of multiple drug allergy/intolerance.Patients with a history of possible allergic reactions to biotherapeutics, NSAIDS,

chemotherapy medications, local anesthetics, or other drugs they may need.


Allergist/immunologists provide a comprehensive plan to evaluate the historicaladverse drug reactions and provide suggestions on future therapies to minimize risks.

Allergist/immunologists perform skin testing using appropriate concentrations andtechniques to determine current sensitivity

Allergist/immunologists perform desensitization and incremental drug challengeswhen necessary

Asthma Treatment: ImmunotherapyWho to refer to an allergist/immunologist:

There is a clear relationship between asthma and exposure to an unavoidableaeroallergen to which specific IgE antibodies have been demonstrated and any of the

following:

Poor response to pharmacotherapy or avoidance measuresUnacceptable side effects of medications

Desire to avoid long-term pharmacotherapy .Coexisting allergic rhinitis.


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The efficacy of immunotherapy for allergic asthma has been demonstrated in manystudies. Immunotherapy may also prevent the development of new allergen

sensitivities.

Asthma Treatment: Prevention of Morbidity


Patients with uncontrolled asthma.Patients who use excessive amounts of reliever medicationsPatients with who require emergency department care for asthma.Patients with moderate or severe persistent asthma.


Allergist/immunologist care reduces subsequent asthma emergency department visits,hospitalizations, asthma symptoms, overuse of short acting beta agonists and cost of

care for asthma.

Allergist/immunologist care improves physical functioning and asthma related qualityof life.

Allergist/immunologist care results in improved patient self-managementAsthma: Environmental diagnosis and management


Patients with a history of seasonal or persistent asthma for evaluation of inhalantsensitization.

Patients who need management and education concerning environmental triggers.


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Exposure to indoor and outdoor allergens may worsen asthma.Allergist/immunologists have familiarity with the wide variety of both indoor and

outdoor aeroallergen exposures that have been shown to impact on asthma and

respiratory function. Allergist/immunologists are specifically trained to identify

relevant environmental triggers and provide education regarding appropriate

avoidance measures. Allergen avoidance can improve asthma.

Conjunctivitis


Patients with prolonged or recurrent manifestations of allergic conjunctivitis.Patients with co-morbid conditions such as asthma, rhinitis or recurrent sinusitis.Patients with symptoms interfering with quality of life and/or ability to function.Patients who have found medications to be ineffective or have had adverse reactions

to previously prescribed medications.


Allergy cannot be diagnosed on the basis of history alone. Diagnosis is derived from acorrelation of clinical history and diagnostic tests, with which allergist/immunologists

are experienced. Allergist/Immunologists can provide environmental control advice

and immunotherapy that can lead to reduced symptoms and need for medications

Cough


Patients with chronic cough of 3-8 weeks or more.Patients with coexisting chronic cough and asthma.Patients with coexisting chronic cough and rhinitis.Patients with chronic cough and tobacco use or exposure.


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Allergist/immunologists have extensive training to evaluate the upper as well as lowerairway in a patient with chronic cough.

The allergist/immunologist can both provide expert consultation to ensure thediagnosis of asthma is correct and maximize therapy in the asthmatic patient.

Allergist/immunologists are specifically trained and experienced in the managementof rhinitis which can cause cough.

Atopic Dermatitis


To confirm the diagnosis of atopic dermatitis in a patient with dermatitis.To identify the role of dust mite allergy in patients with atopic dermatitis.To identify the role of food allergy in patients with atopic dermatitis.Patients whose atopic dermatitis responds poorly to treatment.Why an allergist/immunologist:

Defining IgE-mediated sensitivity (by skin or in vitro testing) is useful in thedifferential diagnosis.

Avoidance of relevant mite or food allergens improves atopic dermatitisAllergist/immunologists are specifically trained and experienced in managing atopic

dermatitis in both children and adults.


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