As an environmentalist and mom of a child with allergies, I requested a copy of Asthma Allergies Children: a parent’s guide.
The book is written by two allergy specialists in New York, Dr. Paul Ehrlich and Dr. Larry Chiaramonte, with the help of Henry Ehrlich of Third Avenue Books. (The Ehrlichs are cousins, by the way.)
First, some quick reactions: I am grateful no one in my family has severe food allergies. How frightening for parents to worry about their children going into shock, even if they come across a trace of peanuts. Likewise, it can really hinder young adults’ life when they can’t choose mates with pets, or in a case mentioned in the book, a young woman who went into shock after kissing her boyfriend who had eaten something with peanuts.
For being a book dense with scientific and medical information on allergies and asthma as well as treatment, the doctors did a good job of presenting the information in an interesting way. Their case studies of patients read a lot like case studies in a marriage column, or an episode of a medical TV show.
Finally, I learned a lot, and highly recommend this book to anyone with children suffering from allergies and asthma. The good doctors even have a website to take questions and engage the public in discussion.
For one, I learned that despite the increasing number of allergies and asthma cases in this country, the allergy specialist is a dying breed.
There are only 5,000-6,000 board-certified allergists out of 600,000 practicing MDs in the United States, and as of late 2009, just over 300 doctors were in accredited training programs for allergy and immunology, compared to more than 22,000 for internal medicine. Since allergy programs are at least two years, roughly 150 new allergists are produced each year. (Figures are from the Accreditation Council for Graduate Medical Education.) If allergists have a thirty-year career, then some 170-200 retire each year, for a net loss in the pool of board-certified allergists. The problem is complicated further by the fact that many of those residents will go into research, not into clinical practice at the same time many allergists are getting older. There’s no way to measure exactly how many of our colleagues are retiring, but when we go to the conferences, there are more doctors who look the way we do now than there were thirty-five years ago.
A large part of the problem is that insurance companies encourage primary care physicians to treat allergies rather than refer the patients to allergy specialists. As the doctors pointed out, there are many problems with this, including ordering tests an allergy specialist could have ruled out, and also not properly treating a patient, which in the long run, is costly and possibly deadly.
Still, as the doctors pointed out, it is possible to live a normal life with severe allergies and asthma, as long as patients are prescribed the correct treatment and are disciplined about taking their medications.
Here is one of the many anecdotes I enjoyed in the book:
My 12-year-old patient Mordechai was preparing for his bar mitzvah when his distraught parents brought him into the office. He was adamant about not continuing his studies, which included reading extensively from the Torah, because since he started studying the scrolls he had become congested, even losing sleep, and begun snorting. Furthermore, his friends were making fun of him because he “dripped” over everything.
“I’m not going to any more studying, and that’s that,” he said, and that was that. Oy vey!
A detailed history had revealed that he had used eight medications, but none seemed to make inroads into the problem. It became clear to me that the Torah was the source of his symptoms. Testing found him very allergic to dust mites, and as he poured over this sacred–but dusty–scroll his exposure became the issue. (Where is King Solomon when you need him?) We rapidly desensitized him to the mites (by giving him “allergy shots” or immunotherapy), placed him on a nonsedation antihistamine prior to his exposure to the Torah, and he reacted the big day without a problem.–Dr. Ehrlich
I have to say that, in Ari’s case, it was very helpful to see an allergy specialist. (Thank you, Kaiser Permanente!) I offered the doctor no other information except that congestion was causing Ari to snore and compromise his sleep. After a series of “stick” tests, I was told within a half hour that Ari was allergic to grass, ragweed and oak trees, and he was prescribed a nasal spray to sleep at night.
In the future, if Ari’s allergies worsen, we may consider more tests and even allergy shots for him. But for now, this course of treatment works. With the increasing number of cases in our country, it doesn’t make sense to do away with the allergy specialist.
Do you or your children suffer from allergies? What about asthma? Did you see an allergy specialist?