trends in allergy and immunology

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slenderjackalopehippo

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I am interested in IM allergy and immunology, but I am curious if anyone can share their thoughts on the trends in this field. It seems like a lot of the conditions are shared amongst other specialties (i.e. - Resp with asthma). How is this field defining itself in the future?

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The field is relatively young. The cost burden of allergy alone is second to none. The respiratory aspect is shared with pulmonology. We work with ENT for sinus problems. ID consults us all the time for antibiotic hypersensitivity status. Immunotherapy (SCIT & SLIT) is growing exponentially as the globe deals with environmental changes and our homes are more "sterile." Lots of new biologic treatments in development. Not to mention immunodeficiency, which is often overlooked....even by other allergist/immunologist. Also, lots of pediatric dermatology management in AI as there is a dearth of pediatric-trained dermatologist. The leaders within the field tend to be sub-,sub-specialist (ie, allergist vs immunologist). The AI field is growing and with a majority of AI attendings approaching retirement, the already severe shortage is going to be significantly worse. It's a great field and I am so fortunate to be a part of it.
 
As in many smaller, subspecialty fields you will probably have a lot of latitude to tailor a practice to your interests.

It will particularly depend on
  • what kind of setting you choose to work in, i.e. urban vs suburban/rural, private vs VA vs employed, academic vs community, research vs clinical
  • what kind of patients you are more interested in seeing, i.e. allergy/asthma vs immunodeficiency, kids vs adults, complicated vs simple
  • and how you choose to cultivate your referral base
In training I worked with several A/I folks and even that limited experience illustrates the variety. One for example did 2 half-day clinics at the VA seeing almost exclusively vets with chronic rhinosinusitis and asthma, and spent the rest of his time doing experimental vaccine research. Another worked in a more "private" adult type of setting and basically all he did 5 days a week was skin tests and explain to people that their inhalers don't work if they don't use them :sleep:; he would occasionally do hospital consults for desensitization protocols for needed drugs and that at least was pretty interesting. Yet another did mainly pedi immunodeficiency treatment and research and would also do inpatient consults on weird stuff like macrophage activation syndrome/HLH in kids with cancer and autoimmune diseases at the university hospital.

So if you're interested in the field there's lots of directions you can go. Your profile says you're a "pre-health" student, though; if that's true a lot may change by the time you actually get your "first" job!
 
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The field is relatively young. The cost burden of allergy alone is second to none. The respiratory aspect is shared with pulmonology. We work with ENT for sinus problems. ID consults us all the time for antibiotic hypersensitivity status. Immunotherapy (SCIT & SLIT) is growing exponentially as the globe deals with environmental changes and our homes are more "sterile." Lots of new biologic treatments in development. Not to mention immunodeficiency, which is often overlooked....even by other allergist/immunologist. Also, lots of pediatric dermatology management in AI as there is a dearth of pediatric-trained dermatologist. The leaders within the field tend to be sub-,sub-specialist (ie, allergist vs immunologist). The AI field is growing and with a majority of AI attendings approaching retirement, the already severe shortage is going to be significantly worse. It's a great field and I am so fortunate to be a part of it.
AI is a growing field with severe shortage? That's news to me.

To be honest, immunology is being dominated by hematology/oncology, and not allergy (certainly not rheumatology). All the high impact work that will come out in the next 1-2 decades in immunology will be cancer related and will be coming out of oncology labs. Sure, some allergists and rheumatologists put out respectable stuff, but it pales in comparison... maybe they should call it hematology, oncology, and immunology.
 
AI is a growing field with severe shortage? That's news to me.

To be honest, immunology is being dominated by hematology/oncology, and not allergy (certainly not rheumatology). All the high impact work that will come out in the next 1-2 decades in immunology will be cancer related and will be coming out of oncology labs. Sure, some allergists and rheumatologists put out respectable stuff, but it pales in comparison... maybe they should call it hematology, oncology, and immunology.
But that's not really A/I's field, no? The immunology of A/I that isn't directly related to allergy is basically just immunodeficiency, and I would guess it's the allergy side of things where most of the field's growth is occurring.

Can't speak to what degree it truly is a growing field, but I can't see heme/onc's breakthroughs in the immunology realm having any bearing.
 
But that's not really A/I's field, no? The immunology of A/I that isn't directly related to allergy is basically just immunodeficiency, and I would guess it's the allergy side of things where most of the field's growth is occurring.

Can't speak to what degree it truly is a growing field, but I can't see heme/onc's breakthroughs in the immunology realm having any bearing.
I was more referring to AI's insistence that they are the immunologists of the medicine world. Wasn't really relevant to the point at hand, but more of a random thought...

The bottom line is if you like to treat allergies and immunodeficiencies, then go into AI. If you love immunology specifically, there are other fields with far more promise in that regard.
 
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AI is a growing field with severe shortage? That's news to me.

To be honest, immunology is being dominated by hematology/oncology, and not allergy (certainly not rheumatology). All the high impact work that will come out in the next 1-2 decades in immunology will be cancer related and will be coming out of oncology labs. Sure, some allergists and rheumatologists put out respectable stuff, but it pales in comparison... maybe they should call it hematology, oncology, and immunology.

Allergy/Immunology is growing on numerous levels (at least in our practice). Antibiotic allergy status testing saves hospital systems millions of dollars. With climate change, we are seeing more year round symptomatic AR along with patient's presenting to our office because of increasing severity of AR. More patient's are coming to our practice for immunotherapy with SLIT now that it is available, since they no longer have to come into our practice for SCIT. With food desensitization procedures we have a lot of mother's pursuing these. I can go on and on. With increasing awareness of immunodeficiencies by the rest of the medical community we are getting referrals too. Clinical Allergy/Immunology is growing.

Actually, neither AI, nor Heme/Onc dominate immunology....it is dominated by Ph.D.s at the bench.
 
But that's not really A/I's field, no? The immunology of A/I that isn't directly related to allergy is basically just immunodeficiency, and I would guess it's the allergy side of things where most of the field's growth is occurring.

Can't speak to what degree it truly is a growing field, but I can't see heme/onc's breakthroughs in the immunology realm having any bearing.

You hit the nail on the head. The immunology side of AI deals with the immunodeficiency (ID). There is a lot of awareness about ID that still needs to be done, but it is improving and we receive increasing numbers of referrals for it. We recently referred one of our ID patient's to the NIH, and they were found to have a novel genetic defect.
 
I was more referring to AI's insistence that they are the immunologists of the medicine world. Wasn't really relevant to the point at hand, but more of a random thought...

The bottom line is if you like to treat allergies and immunodeficiencies, then go into AI. If you love immunology specifically, there are other fields with far more promise in that regard.

I couldn't agree more with the above. If you have a passion for a field pursue it. You'll be doing it the rest of your life. If anyone has any specific questions about AI feel free to post them or send me a message.
 
As long as there are patients out there who refuse or don't understand how to use their nasal corticosteroids and their inhalers properly (i.e. for eternity), there will be a need for A/I at some level :laugh:
 
Actually, neither AI, nor Heme/Onc dominate immunology....it is dominated by Ph.D.s at the bench.
Actually some of the biggest names in basic research are MDs. Sure, there are more PhDs overall due to the sheer number of them, but by no means do they have a monopoly on NIH dollars.

And my bigger point isn't MD vs PhD. It's that immunology is far more pertinent to diseases such as cancer and autoimmune conditions than allergies.
 
As long as there are patients out there who refuse or don't understand how to use their nasal corticosteroids and their inhalers properly (i.e. for eternity), there will be a need for A/I at some level :laugh:
Unfortunately, it is true. No matter how many times you show them. It's almost as if they look forward to coming in again haha.
 
Actually some of the biggest names in basic research are MDs. Sure, there are more PhDs overall due to the sheer number of them, but by no means do they have a monopoly on NIH dollars.

And my bigger point isn't MD vs PhD. It's that immunology is far more pertinent to diseases such as cancer and autoimmune conditions than allergies.
I don't disagree. Thank you for your input, but let's keep discussion focused on the original topic.
 
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