What constitutes a good allergy practitioner

The Practitioner (doctor or nurse) needs to have plenty of time available for the consultation and a keen interest in allergy is paramount. In Allergology (the study of Allergy) the patient’s description of their allergy and careful questioning by the doctor goes 90% of the way to a correct diagnosis. This is usually followed by a brief examination of the relevant organs such as nose, eyes, lungs, glands and skin. Allergy tests should only be done to confirm the suspected allergy detected from the history. Tests should not be used as blind searches for an allergic component to the patient’s symptoms.

Once diagnosed, the patient needs to have the implications of their allergy explained to them in detail. They should be given some "easy to read" educational material to take home and digest. Understanding the nature and causes of the allergy will make future allergy control by the patient much more successful. A follow-up consultation is helpful as it provides an opportunity to discuss problems associated with the allergy and to reinforce the need for treatment.

What are those telltale signs that alert the doctor to probable allergy as the patient walks in the surgery door?

Allergic "shiners" are often a give-away – these are darkened areas of skin around the eye sockets, which are a result of increased venous congestion in the sinuses. They often resemble "Black Eyes" or look like "Mascara" around the eyes. There may be characteristic Dennie-Morgan infra-orbital folds or linear creases under the eyelids. The typical transverse nasal crease across the bridge of the nose is from constant nose itching and rubbing. The "allergic salute" is seen when the person’s hand constantly rubs the nose and is associated with facial grimacing or so called "Pulling of Faces" because the nose, eyes and ears are so itchy.

After many years of Nasal Allergy, the sufferer develops a so-called "Long Faced" appearance with constant open-mouth breathing, nose blockage, a high arched palate and dental malocclusion with "Buck Teeth".

The allergy sufferer’s skin has a dry and rough sandpaper-like texture which is called Keratosis Pilaris. In children, this is commonly associated with eczematous rashes on the face, in the elbow creases and behind the knees. In adults Eczema tends to affect other areas such as the neck, wrists and back of hands.

The nose’s internal mucus membranes are usually swollen and oedematous with a pale blue appearance. The lower-eyelid conjunctival lining has a thickened "cobblestone" appearance and the eyes may be red, watery and itchy. Chronic middle ear mucus or "Glue ear" often accompanies nasal allergies. Other common allergic manifestations are a wheezy chest, constant sneezing, itchy watery eyes and "Nettle " rashes on the skin.

Case Histories to illustrate typical Allergy.

Here are 3 short case histories to illustrate common allergy presentations.

Kevin

First is Kevin, a 7 year old who has a chronic dry rash, constant "cold" symptoms and an irritating cough at night.

He is an only child in a professional family, his mother smokes. There is a family history of asthma and hayfever. And he is unable to tolerate eggs.
On examination, he had typical allergic facial features with allergic rings around the eyes, Dennie Morgan folds under the eyes, a long face with mouth breathing and the nasal membranes were swollen. There was eczema on his legs and arms and his chest examination revealed slight wheezing.

We performed an exercise test and triggered asthma, which was reversed by inhaled salbutamol. He had inhalant Skin scratch tests and a food allergy screen. These read more