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Editorials |

Becoming a Complete “Asthmologist”

Lee R. Choo-Kang, MD
Author and Funding Information

Affiliations: St. Louis, MO
 ,  Dr. Choo-Kang is Director, Division of Pediatric Pulmonary and Sleep Medicine, St. John’s Mercy Medical Center, and a member of the Speakers’ Bureau for Pharmacia Diagnostics.

Correspondence to: Lee R. Choo-Kang, MD, Pediatric Pulmonary and Sleep Medicine, St. John’s Mercy Medical Center, 621 S. New Ballas Rd, Suite 382A, St. Louis, MO 63141; e-mail: choolr@stlo.mercy.net



Chest. 2005;128(5):3093-3096. doi:10.1378/chest.128.5.3093
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Perhaps because allergic sensitization is seen in as many as 75% of children and 50% of adults with asthma,1 pulmonologists have long shared the role of “asthma specialist” with our allergy colleagues. Important contributions to the understanding and treatment of asthma have undoubtedly been made by both disciplines, but allergy testing and immunotherapy have more traditionally been a part of the clinical allergist’s tools. In fact, several pulmonary fellowship training programs, both pediatric and adult, do not include formal allergy testing in their curricula. There may be several reasons for the difference in approach, but expertise in managing obstructive airway disease processes has likely contributed to the pulmonologist’s focus on lung function assessment and pharmaceutical therapies. In addition, the commonly used in vivo allergy tests, such as skin-prick testing (SPT) and intradermal testing (IDT), are time consuming, while radioallergosorbent testing, introduced clinically in the 1970s, lacked adequate credibility due to poor sensitivity. However, several changes in our understanding of the pathophysiology and role of allergy in asthma indicate that allergy testing should be part of a comprehensive asthma evaluation. From a patient’s or referring physician’s perspective, one-stop shopping is also preferred. Fortunately, significant improvements in the reliability of newer-generation in vitro testing can level the playing field with regard to allergy evaluation and permit the average pulmonologist an opportunity to be a more complete “asthmologist.”

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