Every spring, I get the frantic call or e-mail from several of the graduating pediatric residents: “Dr. Assa’ad, I will be finishing my pediatric residency in a few months, and I am joining a pediatric practice in July,” they say, “I just realized I need to come to the allergy and immunology clinic, so I can learn about the majority of the pediatric diagnoses I will see in my practice.”
“Sure,” I answer. “And when you come, you will learn how to differentiate between a child with a cold and one with allergies, otherwise called allergic rhinitis. You will learn about the management of the disorder that consumes the most antibiotic prescriptions — sinusitis — and if the child is suspected to have a reaction to the antibiotic, you will learn how to evaluate and manage the allergy.” I add, “You will learn when to suspect a child with an immune deficiency and how to start and interpret the laboratory work you will order.”
“How about asthma and food allergy and eczema?” they ask.
“Sure, these are our most common diagnoses. In the allergy and immunology clinic, we not only see children with mild and moderate asthma and with common food allergies, we see those with severe and resistant asthma and with complex and multiple food allergies.”
I had this in mind when I planned the current issue of Pediatric Annals on allergy, asthma, and immunology. I asked my colleagues, who are prominent in the field, to write articles that would, for the “last-minute” pediatric resident, be in lieu of the allergy and immunology elective, and for the practicing pediatrician, a “returning scholar” brush-up.
Michelle Lierl, MD, Associate Professor of Pediatrics at Cincinnati Children’s Hospital Medical Center (see page 192), will teach you about pediatric allergic rhinitis and the most effective treatment, allergen immunotherapy (affectionately known as allergy shots for the parents and allergy “s-h-o-t-s” for the unknowing child). In her article, she discusses the mechanism of desensitization for environmental and insect sting allergy and how a pediatrician can administer the allergen immunotherapy safely in the office.
J. Pablo Abonia, MD, Assistant Professor of Pediatrics at Cincinnati Children’s Hospital and Mariana Castells, Associate Professor, Brigham and Women’s Hospital, Harvard Medical School, Boston, reviews drug allergy and device allergy, which includes antibiotics, and latex allergy, among others (see page 200). This article provides very practical approaches to their diagnosis and safe management.
Shifting to immunology, Sami Bahna, MD, DrPH, Professor of Pediatrics and Medicine and Chief of Allergy and Immunology at Louisiana State University Health Sciences Center, and his Senior Fellow in Allergy and Immunology, Chee Woo, MD, tackle in a clear, organized, and comprehensive review the practical approach to suspecting and diagnosing of immunodeficiencies in pediatric practice (see page 205).
Fanny Silviu-Dan, MD, FRCPC, Associate Professor of Pediatrics, McGill University, Canada, reviews the condition of pediatric chronic rhinosinusitis, the symptoms, diagnosis and evidence-based management with antibiotics and adjunctive therapy (see page 213).
Asthma and food allergy are among a collection of interesting diagnoses I have made in the allergy and immunology clinic (see page 224). They highlight to the resident who is considering specialty fellowship that the allergist and immunologist is the ultimate diagnostician.
I hope that you enjoy this issue, consult with your allergist or immunologist appropriately, and consider allergy and immunology for your specialty training.