When to consult an immunologist

Posted on 1 April 2023

An allergy is an abnormal reaction to agents in the environment that others around you might find harmless, for example, pollen, cats or dogs, or dust mites. Certain foods may also trigger allergies, while drugs might also stimulate a response. If not treated correctly, this response can either be life–threatening (anaphylaxis) or have a drastic effect on your quality of life.  

What is an allergy? 

There are several different types of allergies. 

Asthma is the most common type of allergy by far, says immunologist  Dr Tshegofatso Mabelane of Morningside Mediclinic. “In South Africa, the number of deaths caused by asthma is the fourth highest in the world. Although little research exists to explain why this is the case, it may be because of a lack of education: often, people simply don’t understand how to use their inhalers properly. 

Food allergies, meanwhile, are the most common. Dr Mabelane estimates that allergies to foods like peanuts and eggs affect 2-5% of the population. 

Then there’s allergic rhinitis (hay fever), the itching eyes and snotty noses many of us dismiss as sinusitis that is in fact, an allergy to pollens and other irritants in the air. 

Allergies can severely affect your quality of life. Some people with hay fever may experience symptoms like coughing that worsen at bedtime, when phlegm and mucus run into the chest because of gravity.  

“Experiencing a long-term postnasal drip of this nature can be likened to waking up every morning with flu,” says Dr Mabelane. She reveals that some of her child patients battle with the resulting fatigue to the point where their teachers express concern that they have ADHD. “This tiredness is exacerbated by the fact that your airways are obstructed by mucus and phlegm, so you don’t get enough oxygen. This further impairs concentration and focus.” 

When do you need to see an immunologist? 

Most people receive a script for antihistamines or nose spray when they consult a GP about their allergic rhinitis. Sometimes, this is sufficient to control symptoms – but, warns Dr Mabelane, an antihistamine won’t actually treat the root cause of the allergy. “For this, you need to consult an immunologist for a course of immunotherapy,” she says, explaining that treatment involves ‘confusing’ the immune system, so it no longer produces a hyper-response to triggers. “You’ll be exposed to the allergen through a daily spray under your tongue, or through a monthly injection,” she adds. The treatment lasts around three years and by then, patients are cured of allergic rhinitis.  

If you have a food allergy, it’s best to start your treatment journey with an immunologist immediately. “An immunologist will investigate your condition from a number of different angles, not with blood tests alone,” Dr Mabelane explains. This is important, because if you have symptoms such as eczema, a blood test is likely to show you have a food allergy even if you don’t. That’s because your immune system is already primed to produce larger amounts of immunoglobulin E (IgE) – especially if allergies run in your family. An immunologist would conduct a food challenge to pinpoint allergens and be able to provide advice on how to navigate mealtimes. “Say, for instance, you’re allergic to eggs. We’d be able to tell you whether you should avoid eggs entirely, or whether your immune system can handle them in baked form, like in a biscuit.” 

People who are allergic to certain medication should also consult an immunologist. “The most common drug allergy we see is to penicillin. Unfortunately, there are some infections that can only be treated with this drug, so we will help desensitise the patient,” Dr Mabelane says.