The practice of allergology

The practice of allergy involves the diagnosis and care of patients with:

• Rhino-conjunctivitis, along with nonallergic rhinopathy

• Sinusitis, both acute and chronic, alone or complicated with nasal polyps 

• Otitis and Eustachian tube disorders 

• Asthma and all its forms including cough-variant asthma and exercise-induced asthma 

• Cough from all causes 

• Bronchitis, chronic obstructive pulmonary disease (COPD) and emphysema 

• Hypersensitivity pneumonitis 

• Alveolitis 

• Atopic dermatitis/eczema 

• Contact dermatitis 

• Urticaria and angioedema 

• Drug allergy 

• Food allergy 

• Latex allergy 

• Insect allergy and stinging-insect hypersensitivity 

• Gastrointestinal reactions resulting from allergy, including eosinophilic esophagitis and gastroenteritis 

• Anaphylactic shock

• Immunodeficencies, both congenital and acquired 

• Occupational allergic diseases 

• Identifying and managing risk factors for progression of allergic diseases — the «allergic march» 

• Other specific organ reactions resulting from allergy

• Conditions that may mimic or overlap with allergic disease 

• An expert knowledge of the epidemiology and genetics of allergic diseases Immunodeficencies and autoimmune diseases, with special knowledge of regional and local allergens

As part of the practice of allergy, the allergist should be capable of ordering and interpreting allergy-and immunology-related laboratory tests:

• Evaluating total IgE and allergen specific IgE measurements

• Carrying out appropriate provocation testing for allergic and immunologic disease 

• Providing analysis and advice regarding local environmental/airborne allergens and irritants, as well as the analysis and advice regarding ingested allergens/ irritants

• Conducting and/or evaluating tests of pulmonary function and tests of inflammatory markers

• Conducting and/or evaluating tests of nasal function; this may include examination of nose and throat via fiberoptic rhinoscopy and nasal endoscopy 

• Specific allergen and venom immunotherapy 

• Providing pharmacotherapy of allergic disorders and related diseases including aero-allergens, drugs, venoms, occupational allergens, and food allergens 

Because of the highly specialized training, the allergist can advise both patients and other members of the medical community on:

 The role of effector cells involved in allergic disease (stem cells, • lymphocytes, mast cells, basophils, eosinophils, neutrophils, • monocytes, macrophages, dendritic cells) 

• The molecules involved in the immunological response (both innate and acquired) including chemical mediators; immunoglobulins; antibodies; complement; cytokines;interleukins; chemokines and their receptors; human leukocyte antigen/major histocompatibility complex (HLA/MHC) antigens • The main hypersensitivity reactions 

• Cell-to-cell interactions 

• The scientific in vitro laboratory diagnostic tests for allergy and 

• their selection and interpretation, including allergenspecific in vitro assays; enzyme-linked immunosorbent assays (ELISAs); Western blotting; tests for inflammatory markers, protein and cellular antigen stimulation tests; histamine release assays

The allergist is especially competent in performing/interpreting the following: 

• Allergic history and physical examination 

• Skin testing 

• Where necessary, investigating alternative diagnoses 

• Environmental modification strategies to reduce allergen exposure 

• Specific immunotherapy (allergen vaccines; both oral and injective)

• Immunomodulatory therapy 

• Drug desensitization 

• Evaluation and treatment of allergic and immunologic competence 

• Management and treatment of anaphylactic shock 

• Education for patients, caregivers and primary care physicians