Should I see an allergist vs ENT?

Do you know whether you should see an allergist vs ENT?

Many medical providers don’t either.

Or worse, sometimes you are left to figure it out for yourself… which is great if you went to allergy fellowship like me, but a pretty difficult if not.  Until today.

I helped create MyAllergyFriend to get you these answers and more.  Consider this your roadmap to feeling better while trying to navigate the hassles of the medical system.

Should I see an allergist vs ENT?
An answer to your question: “should I see an allergist vs ENT?”

“Should I see an allergist vs ENT? Or someone else?”

 

In Part 1, I began to show why I created MyAllergyFriend:  to help answer the question whether or not you need to see an allergist.

This is a great question, but many medical providers think they can appropriately treat allergies and asthma.

Most primary care providers are great.  And some are especially great at allergies and asthma.  But I went through so many additional years of training and work every day ONLY in the treatment of allergy and asthma care, that I can definitely answer your questions better than other providers.

By reading MyAllergyFriend, you can begin to see what is expected of good care and decide for yourself whether to see an allergist vs ENT (or have me help you directly)!

 

But first, how good are primary care providers at treating allergy or asthma?

Before we can even ask whether or not you should see an allergist vs ENT (or other specialist), we need to answer the question we left off with in part 1:  how good are medical providers at treating allergy or asthma?

This is not a negative comment against primary care providers.  Why would it be?  A good primary care provider needs to have such a wide knowledge base that you want a primary care doctor who has not specialized in allergy and asthma, but rather knows what treatments to start and when to appropriately refer.

My biggest concerns are providers (primary care, allergy, ENT, or otherwise) who think they know proper treatment but actually do not.

A great example where providers think they know proper treatment but actually don’t comes from the REACT study of 1800 patients with asthma:

  • After both patient and medical provider said their asthma was well controlled…
  • OVER HALF (55%) were actually NOT WELL CONTROLLED!

The picture for allergies is not any better:

  • 88% of primary care physicians INCORRECTLY thought seasonal allergy symptoms were caused by food allergy.
  • Less than 30% of primary care physicians know how to correctly interpret food-allergy labs.

Again, I would expect this.  I would be willing to bet that over 88% of allergists do not know the proper treatment for lung cancer.  Or >88% of dermatologists don’t know how to properly treat chronic kidney failure.

What I am trying to find is the solution to the problem of people doing allergy and asthma treatment without knowing they are even wrong!

Insurance companies are NOT coming to the rescue!

I have heard the argument that an insurance company will monitor and make sure you are getting the best care.

This is not true.

As much as I believe there are good people looking after your health, the purpose of an insurance company is to make money.  So if you’re getting wrong care but it’s cheaper than the right care… how do you think that will turn out?

Well, the answer is starting to show itself:

  • I have been told there are insurance companies who are rewarding primary care clinics for NOT sending their patients to allergy specialists.
    • I have been told this is because allergy is easy and a primary care doctor can do it without needing a specialist.
    • Apparently a 45% success rate for your health is “good enough?!”
  • I have heard of another insurance company who gives a clinic “a pot of money” for referrals and then says that they can keep what they don’t use.
    • In this case, the insurance company is not denying any referral.  It’s up to your primary care provider.
    • So if a provider thinks they can do allergy correctly… and they get to make money for keeping the referral… how will the problem ever fix itself?

 

The solution is to see an allergist, right?

I’m an allergist and I love my job.  I would happily take care of everyone if I could.

But what I want more than anything is to make sure you get the right care.

I have had many patients who come to see me and after talking with them I tell them an allergist is not their best step, I make it a “no charge” visit and I give them the names of the correct person to see.  If they were asking whether or not they should see an allergist vs ENT and an ENT is more appropriate, then I tell them ENT.

In my opinion, this is good medicine and takes care of the patient.

Not everyone needs an allergist.  In fact, I would bet most people DON’T.

What people need is for an allergist to ensure they are getting the proper care and then work with them and their primary care to ensure they are getting the best care.

What people need is for someone like me to treat you like a friend, to review your questions and to either tell you what to ask your primary care OR to suggest an appropriate consult.

What people need is to have an allergy friend.

And I plan to do the same for you.

At any time, if you are unsure of your next step in your care, ask me and I will try to help.
But even with that offer of help, you should know that not all “allergists” are equal.

Should you see an allergist vs ENT?

 

First, let me explain what a board certified allergy/immunology specialist goes through:

  • A full internal medicine or pediatric residency (3 years)
  • Then an additional 2 years dedicated only to the study of allergy/immunology based problems.
  • There are only about 4000 board certified allergy/immunology specialists across the US and it is predicted that by 2020 this number could decrease by 20%!

Compare that to an ENT specialist:

  • An ENT is trained as a head and neck surgeon.  And many are amazing surgeons!
  • Most can get additional allergy training “on the side” or with a 1-2 WEEK (not YEAR) course in the treatment of allergy.
  • Some of the allergy diagnostic techniques used by ENTs potentially over-diagnose allergies (at a cost to you)
  • And many of the allergy treatments used are not based on the national allergy and asthma best practice guidelines.
Click here to download my “Should I See an Allergist vs ENT?” questionnaire

So, the answer to the question “should I see an allergist vs ENT” is:

  1. ENTs are surgical specialists:
    • ENTs are the right first choice if you need a sinus surgery (or any other head/neck surgery)
    • ENTs are the right choice to help with structural problems (narrow passages, broken noses, etc)
    • ENTs are the first choice if medicines are not helping and there is a surgical option.
  2. Allergists are medical specialists:
    • Allergists are the right choice if you want the full range of medications options to treat you.
    • Allergists are the best choice if you want access to all types of immunotherapy and want to use the nationally standardized immunotherapy protocols.
    • Allergists are the right choice if you are unsure if you have an allergy and are curious to know your options.
    • Allergists are the right choice if you do not want surgery or want to look at other options before surgery.
    • Allergists are the best option if you have questions about asthma, about food allergy (or food allergy vs food intolerance), eczema, cough, medication allergy or insect allergies.
  3. And remember:
    • A good allergist should refer to an ENT if appropriate.
    • A good ENT should refer to an allergist if appropriate.
    • Be cautions trusting one who does not have a good relationship with the other.  The diagnoses often overlap and one cannot work without the other.

 

That may help you answer the question “should I see an allergist vs ENT.”

But what about other types of allergists?

As an allergist, I know that the sheer amount of additional schooling and experience we receive, dedicated solely to allergy/immunology, helps you get better results.

But there are many other type of providers trying to treat allergies.

Are you trusting your care to someone who isn’t trained to safely and effectively treat allergies?

Some other type of “allergists:”

  1. Are you seeing a primary care provider who has an interest in allergy but no formal training?
  2. Are you seeing a group who just shows up to give testing without true management and follow up?
  3. Possibly a holistic/alternative medicine practitioner?
    • I am a strong believer in adding natural and/or alternative treatments to medical care
    • But only if they have been shown to work

 

My biggest problem is that choosing the wrong “allergist” can cost you a lot of time and money… and still not help you!

So, while it is reasonable to ask “should I see an allergist or an ENT,” as you can see the answer is a lot more complicated.
What options are left?

What do you expect for your health?

The way I see it, the summary of this entire post comes down to the phrase “what do you expect for your health?”

Ultimately, you are in control of your health and when you think about it… that is GOOD!

  • You can ensure you get the proper treatment.
  • You can ensure that you are feeling your best and can stop accepting “good-enough” for your care!

This is why I made this website:  because I want you to get the true allergy/asthma/inflammation care you deserve.

 

Why did I make MyAllergyFriend?

The premise is simple:  You should have a doctor as a friend. Someone you can trust to give you since, unbiased medical advice (without all the complications of the medical system.)

Everyone wants a doctor as a friend. Someone you can go to in order to get trusted, sincere, unbiased medical advice.

Where you can get health answers without the hassle of insurance, of medical visits and of providers who seem to be in such a rush that they throw medications at a problem without truly trying to find the cause/best solution for you.

A friend always places your interest over everything else. A friend who is also a doctor is the perfect answer for improving your health in the best way possible.

 

  • I believe you deserve the highest level of care. I believe you, and other people with allergies, asthma or inflammation, have been told to “deal with it” or live the “good enough” lifestyle for too long!
  • I believe you should need a better source of high quality, evidence-based information so that people can educate themselves.
  • I believe you should have a place where you can ask your questions and get the best answers.
  • I believe you should expect to feel well with as few medications as possible.
  • I believe it is your time to break the cycle of “good enough” and start living with your best possible health.

If you believe the same things as I believe, then we can work together to get you feeling your very best and to have you stop accepting “good enough” allergy care.

 

 

 


Sources:
1. “The Diagnosis and Management of Rhinitis: An Updated Practice Parameter.” J Allergy Clin Immunol 2008; 122:S1-84
2. Gupta, Ruchi et al. Food Allergy Knoweldge, Attitudes, and Beliefs of Primary Care Physicians. Pediatrics. Jan 2010; 125(1): 126-32.
3. Russell WS, Farrar JR, Nowak R, et al. Evaluating the management of anaphylaxis in US emergency departments. World J Emerg Med. 2013;4(2):98-106.
4.  Peters, SP, Jones CA, Haselkorn T, Mink DR, Valacer DJ, Weiss ST.  “Real-world Evaluation of Asthma Control and Treatment (REACT):  findings from a national Web-based survey.  J Allergy Clin Immunol 2007 Jun;119(6):1454-61.
5. If you want more examples, I will send them. This is not me cherry picking the literature but rather a shocking truth about the consistency of diagnosis and treatment of allergic diseases

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