The practice of allergology

The allergist is especially competent in appropriately providing the following treatments:

• Antihistamines 

• Mast cell stabilizers

 • Bronchodilators

• Nasal, oral, ocular, topical, and inhaled glucocorticosteroids 

• Decongestants 

• Leukotriene modifiers 

• Phosphodiesterase modifiers, including theophylline 

• Adrenergic agonists 

• Anticholinergics (oral, topical and inhaled) 

• Mucolytics 

• Antibiotics 

• Adrenaline, epinephrine 

• All other pharmacologic and immunologic agents used to treat allergic and immunologic diseases The allergist is uniquely aware of the pharmacologic properties of the treatments, their limitations and side effects. He/she is also keenly aware of how other medications may affect allergic processes and cause allergic conditions, for example, coughing and angioedema (ACE inhibitors).

Allergists treat a variety of skin conditions and are expert in the use of: 

• Emollients 

• Antibiotics 

• Topical glucocorticosteroids 

• Immune modulators and all other agents and techniques used to manage eczema and other allergic skin disorders

Part of the current therapeutic arsenal includes: 

• Use of immune modulators, such as specific allergen immunotherapy (oral and injective) 

• Immunoglobulin replacement used to treat allergic and immunologic disorders 

• Monoclonal antibodies, including anti-IgE

Part of the education of patients involves: 

• Instruction on the methods and value of allergen avoidance techniques 

• Avoidance diets and nutritional implications of dietary modification 

In particular for pediatric patients the allergist should be able to educate the parents, relatives and teachers about ways to optimize the prevention and treatment of allergies in children. 

In order to apply all these treatments properly, the allergist must have current and ongoing knowledge of national and international guidelines for the management of allergic and immunologic disorders in adults and children, with particular emphasis on safety and efficacy of all therapies. 

The membership of WAO is approximately 35,000 allergists worldwide representing the bulk of the trained allergists globally. In some developed countries such as Japan, Germany and the US, there are 4,000-8,000 trained allergists per country, representing about 1 allergist per 25,000 to 75,000 patients. It is estimated that ideal care would be provided by about 1 allergist per 20,000-50,000 patients, provided that the medical community was trained and competent to provide first and second level care by primary care physicians and other organrelated specialists. On the other hand, there are countries such as Costa Rica with less than 10 allergists and others with even fewer. Thus, the huge number, diversity and importance of patients with allergic diseases is overwhelmed by the inadequacy of the training of the medical community to provide care to these sick and needy patients. It is in part from this pressing need that this White Book on allergy was developed.