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Junior Member News - May 2015

Allergists without frontiers?

An ordinary day at an allergist’s practice is composed of a series of patients walking in to be diagnosed using a selection standardized ready-to-use investigative processes (skin prick tests, skin patch tests, spirometry, specific serum IgE determination, provocation tests, exhaled NO, nasal endoscopy, etc.) then a specific –as individualized as possible - therapeutic option will be selected depending on the patient’s needs and preferences, further immunological studies are at hand to deal with specific hard to crack problems (Immunoblotting, microarrays, etc.).

At least, this is the modus operandi I was taking for granted after years spent at internationally renowned institutions during my years as a fellow, practitioner and researcher in Europe and the USA. Of course, I was expecting differences in patient handling processes from one country to the next, but I was assuming that all-in-all the challenges, opportunities and miseries of an allergist remained the same regardless of where she or he would be located.

Last year, I had the opportunity to travel to 14 countries in both Latin America and the South East part of Asia and met with as many allergists as possible. They gracefully took some time out of their busy agendas to show me their departments and practices, introduced me their colleagues and answer a series of questions on their experiences as allergy practitioners.

Some of the issues discussed included: Which difficulties they had to face in day-to-day clinical praxis? Did the allergy praxis provide them with enough satisfaction and rewards? Were they proud to be an allergist? What advice they gave to junior physicians regarding this specialty?

In this column, I would like to share with you what I believe are the probably the two most striking findings:

First, in most of the countries visited, the resources for allergy diagnosis and treatment were scarce. The commercial extracts for the skin prick tests, for example, were not widely available. The immunotherapy options were very limited, if any. The possibility of choosing sublingual or subcutaneous immunotherapy was so remote, that this debate seemed unreal for the majority of allergists interviewed. The reality is that, as you read this column, some allergists are taking personal risks smuggling both diagnostic and treatment extracts in their own luggage, on their way back home from holidays abroad or international congresses because they simply have no official way to have access to them otherwise. Can you picture yourself crossing borders with a suitcase full of treatments, vaccines and provocation material? The sweat pearling on your forehead, while knowing the fate of your patients depending on you getting this material into your country?

The limitations did not only impact the aetiological treatment, but the symptomatic treatment as well. For example, in some countries only one inhalator and one active substance was available for asthma treatment. Even when the products were available, many allergic patients couldn’t afford them… At the end of the day, all these issues impact the way allergists practice allergy, and how allergic patients are taken care of.

The second thought I would like to share with you is that allergists from the countries visited were extremely enthusiastic and well aware of the latest innovations and treatments in the allergy field. They considered the specialty as fascinating, with promising future treatments, and the possibility to make a difference in patients’ lives.

They were proud of being allergists. They were even surprised by the question. They are what they wanted to be. They encouraged fellows-in-training in becoming allergists. After each interview, I had the feeling of belonging to a greater community.

In conclusion, my trip has allowed me to realize that frontiers do exist in the allergy world, in terms of extracts and treatment availability (which I imagine it’s a great opportunity for manufacturers and distributors), but that allergists all over are great professionals, full of the energy needed to make this specialty move forward, all together.

Countries visited: Argentina, Chile, Bolivia, Peru, Equator, Costa Rica, China (Hong Kong), Thailand, Indonesia, Nepal, Malaysia, Vietnam, Cambodia and Laos.

Dr. Iris Rengganis (left) and Dr. Prasna Pramita (right), with Dr. Andrea Vereda, at the Kencana-Cipto Mangun Kusumo Hospital, Jakarta, Indonesia.

Andrea Vereda Ortiz
WAO Junior Member