Allergy & Immunology

What is an Allergy/Immunology specialist?
 
An Allergist/Immunologist is a medical doctor with specialty training in the diagnosis and treatment of allergic diseases, asthma and diseases of the immune system. To become an Allergist, a person must first graduate from medical school and undergo residency training in either internal medicine or pediatrics. The physician then must pass a difficult exam to become board-certified in either of these fields.
 
Once board-certified, the internist or pediatrician has to obtain additional specialty training in allergy and immunology, called a fellowship. An Allergist/Immunologist who is board-certified has also passed an additional examination showing competence in the fields of Allergy and Immunology.
 
As medical information is constantly changing and new therapies become available, specialists are needed to deliver specialized and up to date care in medicine. Allergists are trained to identify and manage all forms of allergic diseases and are constantly updated on the latest evidence based treatments that are available.
 
Allergy
Allergies are among the most common chronic conditions worldwide. It is not exactly known why, but prevalence of allergic diseases will increase as a country becomes more modernized.
This condition can affect up to 30-40% of the population in developed nations. 
 
Normally our immune system protects us from dangerous invading organisms that can cause illness. In allergic diseases, your immune system mistakes an otherwise harmless and commonly encountered substance (such as flower pollen) as an invader. This substance is called an allergen. The immune system overreacts to the allergen by producing Immunoglobulin E (IgE) antibodies. These antibodies travel to cells that release histamine and other chemicals, causing an allergic reaction. 
Allergy Symptoms
An allergic reaction typically triggers symptoms in the nose, lungs, throat, sinuses, ears, lining of the stomach or on the skin. For some people, allergies can also trigger symptoms of asthma. In the most serious cases, a life-threatening reaction called anaphylaxis (an-a-fi-LAK-sis) can occur.
 
Allergy Diagnosis and Treatment
It is a common misunderstanding that allergies are not important and that the patient should just learn to deal with it. Studies have showed that uncontrolled allergic inflammation (such as in asthma) can lead to tissue destruction with resultant decreased lung function. When properly diagnosed and treated, patients with allergies will have better health, quality of life and improved function. 
 
In some patients, allergen specific immunotherapy can be prescribed to modify their allergic diseases for potential cure. Gone should be the days where someone is told “You have allergies, there’s no cure, just take these medications for the rest of your life”
 
If you or your child have allergy symptoms, an Allergist/Immunologist, often referred to as an Allergist, can help with the diagnosis. An Allergist has advanced training and experience to properly diagnose your condition and prescribe an allergy treatment and management plan to help you feel better and live better. 
 
You may not know some of the common conditions that Allergists treat:
 
Asthma and Frequent Cough.  
Asthma is a disease that affects the airways in the lungs, making them inflamed and swollen. 70% of asthma patients have an allergic cause. The inflammation makes airways more likely to be bothered by things such as smoke, stress, exercise or cold air. Airway muscle spasms block the flow of air to the lungs, causing symptoms that may include difficulty breathing, a tight feeling in the chest, coughing and wheezing. Sometimes the only symptom is a chronic cough, especially at night, after exercise or when laughing. Asthma may have only mild symptoms, or it can be life-threatening when attacks stop breathing altogether.
 
Allergic Rhinitis (Hay Fever or Sinus Allergy).
Allergic rhinitis is a general term used to describe allergic reactions that take place in the nose and nasal passages. Symptoms may include sneezing, stuffy nose, runny nose, and itching of the nose, the eyes or the roof of the mouth. When triggered by pollens or outdoor molds – especially during the spring, summer or fall – the condition often is called “hay fever” or seasonal allergy. When the problem is caused by exposure to house dust mites, pets, indoor molds or other allergy triggers at home, school or work, it is called perennial allergic rhinitis. 
 
Atopic Dermatitis.
Atopic dermatitis (eczema) flare can be caused by allergic triggers and other irritants. Relying on specific IgE alone for food allergy evaluation in atopic dermatitis can result in high rates of false positives. This is because patients with atopic dermatitis produce very high levels of IgE which can cross react with the IgE assay. The Allergist can work with the patient in evaluating food and environmental triggers and institute appropriate treatment to reduce atopic dermatitis flares.
 
Skin Allergies.
Contact dermatitis and hives are skin reactions that can be caused by allergy triggers and other irritants. Sometimes the reaction can happen quickly. Other reactions may take hours or days, as in poison ivy. Common skin allergy triggers can be medicines, insect stings, foods, animals and chemicals used at home or work. Experts can only diagnose the culprit allergen 10% of the time; as a result, patch testing can be done by the Allergist to identify the responsible allergen. As there are thousands of chemicals that can be responsible, patch testing is designed for 80% screening sensitivity.
 
Food Allergies.  
An allergic reaction to food can cause mild to serious symptoms such as vomiting or nausea, stomach cramps, indigestion, diarrhea, hives or other skin rashes, headaches, asthma, or stuffy nose, sneezing and runny nose. In extreme cases, food allergy can trigger a severe and life-threatening reaction called anaphylaxis. Some mild symptoms may actually be caused by food sensitivity rather than an allergic reaction. An Allergist can help determine if it is a true allergic reaction. Skin prick testing along with clinical interpretation is superior to blood tests in the evaluation of food allergy. An Allergist can help determine if it is a true food allergic reaction and educate the patient on appropriate food avoidance. Importantly, some food allergies can be outgrown and the Allergist can provide appropriate evaluation for when that happens. Currently, oral immunotherapy to certain foods is being investigated as a means to induce tolerance in certain selected patients. 
 
Sinus infections.
Sinus infections, also called sinusitis, are common in people with allergies that affect the nose such as allergic rhinitis. The constant stuffy and runny nose can inflame the nasal passages and make them swell. Symptoms include a runny nose with a thick discharge, cough and occasionally pain in the forehead, around and in between the eyes, or in the upper jaw, cheeks and teeth. In some cases, sinusitis can be chronic and cause several infections a year.  People with asthma are more likely to have chronic sinus infections that can complicate their disease and make their symptoms more severe
 
Urticaria/Hives.
Urticaria can occur due to exposure to allergens from food or contact with aeroallergens. In autoimmune urticaria, immunosuppressants or newer biologic medicines can be used. An allergist can evaluate for the triggers and provide effective management. 
 
Eosinophilic Esophagitis.
This is a newly recognized condition with the definition of    > 15 eosinophils/high powered field in an esophageal biopsy. This condition usually manifests as feeding disorder and vomiting in young children to abdominal pain, difficulty swallowing, and food getting stuck in the esophagus in adults. Evaluation for food allergy triggers along with Gastroenterology assistance is necessary for diagnosis and management. 
 
Drug/Vaccine allergy.
Some patients might develop adverse reaction to drugs or vaccine. Sometimes there is no need to use the drug or vaccine in the future. However, if the drug is absolutely necessary, induction of temporary tolerance via drug desensitization can be done. It is important to understand that not all drugs can be desensitized. But for those that can be done, the procedure is usually done in the hospital at a monitored setting and can take up to 6 hours. Upon desensitization, the desensitized state will remain as long as the drug is administered daily. Allergy will return once the drug is stopped for 24-48 hours. Penicillin allergy is a common drug allergy which fortunately can resolve after a prolonged period of avoidance. If penicillin antibiotics are anticipated to be used in the future, it is helpful to determine if the allergy has resolved via skin testing and drug challenge. Vaccine allergy may present as angioedema, urticaria or anaphylaxis. Sometimes the allergy might not be to the vaccine itself but towards the ingredients found in the vaccine such as egg, gelatin and yeast. If the vaccine is necessary, appropriate evaluation can be done to determine if it can be safely administered.
 
Insect Allergy.
Patients who develop severe allergic reactions to insect stings from bees, yellow jackets, wasps or fire ants are candidates for immunotherapy to stinging insects. Untreated, these patients can develop fatal anaphylaxis upon re-sting by the insects. Injection immunotherapy has 99% efficacy in preventing anaphylactic reaction on re-sting by the insect.
 
 
Primary Immune Deficiency.
Warning signs for primary immunodeficiency diseases include: Frequent respiratory infections requiring multiple courses of antibiotics and multiple “asthma exacerbations” with pneumonia requiring hospitalization for antibiotics. It was found that patients with chronic sinusitis requiring multiple courses of antibiotics for sinus infections, approximately 22% have antibody deficiency. With appropriate diagnosis, patients with antibody deficiency can be appropriately treated with significant improvement in morbidity.
 

Our Doctors Specializing In Allergy & Immunology

Dr Kent Woo Chee Keen

MD (USA), AAAAI, ACAAI, American Board of Allergy and Immunology, American Board of Internal Medicine
Specialty: Allergy & Immunology, Asthma, Internal Medicine
Location : Gleneagles Hospital Kuala Lumpur