Allergist the specialty of medicine that studies allergy and its treatments. Specialty function, it focuses on the functioning of the body itself. It thus supports diseases caused by a response specifically different from the body to its environment. Transversal discipline, affecting the whole organism as an entity, allergists must manage the difficulties of person’s relationship with all that surrounds him and changes more and more quickly: the nature, food, housing, technical developments. Consultations are geared towards diagnosis and treatment, but also to environmental counseling. Doctor, general practitioner or specialist, the allergist has followed a specific complementary training in allergies. In France, there are exclusive-activity allergists and others who jointly practice another specialty (pneumo-allergist, dermato-allergist.). The allergist’s diagnosis of allergy is based on the interview, the patient’s examination and the practice of skin tests, which may be accompanied by provocation (skin) tests and blood tests to confirm the diagnosis.
To establish his diagnosis, the allergist proceeds in different stages. He begins by talking with the patient to confirm the hypothesis of the allergy and establish a first list of allergens potentially responsible for the allergy. He then carries out a clinical examination and performs skin tests. All of the information gathered will enable him to determine what the best treatment for the patient is. Faced with obvious signs of an allergy, the opinion of an allergist is still essential to know the type of allergen involved, and the treatment to adopt. Any consultation with an allergist begins with an Allergology survey, to find out the agent responsible for the condition. The purpose of such an interview is also to put in place the preventive measures as well as the appropriate treatments. After the allergy survey, the tests begin. Among the best known are skin tests and molecular diagnosis.
How Allergists in France Operate
The interview is the first step in the diagnosis of allergy. It must make it possible to confirm the hypothesis of allergy and to establish an initial list of allergens potentially responsible for the signs/symptoms presented.
The history of the symptoms (their age, their nature, their periodicity), the existence of triggering factors identified
Family history (a close relative allergic), as well as personal history (an allergy in childhood), smoking.
The general environment (in what environment the person lives and in what climate)
Lifestyle, living areas (home, office, pets, eating habits)
Activities (professional, leisure)
Consultation with Allergist in France
Interrogation is a fundamental step in the first consultation. It makes it possible to evoke the allergic nature of the manifestations. An initial list of allergens that may be involved is established. He must be rigorous and meticulous: he is often called a policeman. The interview allows to search the reasons of the consultation, the family history of allergy (parents, uncles, aunts, cousins), the personal antecedents of other allergies, or other diseases and the precise description of the manifestations allergic, from the first symptoms to the day of consultation. The criteria for unit time, season, week, week end are then reviewed during the appearance of the various events, the factors of improvement or aggravation, the influence of holidays and week for example towards a probability of professional cause as well as those of the climate and the unit of place, the way of life, the environment and the habits of the allergic person: the environment of the house must be described of precise way. The allergist must know if there are feathers in the pillow and duvet, carpet, wall hangings, know the temperature of the room and the nature of the heating, the presence of animals or plants. Professional or private trips, hobbies, diets and eating habits, as well as the effectiveness of previously prescribed anti-allergic treatments ( allo-dentiste-garde.fr ), are reviewed.
The skin tests are quick and cause very little pain, reimbursed by the health insurance fund, reliable and done in 15 to 25 minutes and in most situations will know the allergens responsible. The reading of the test: a positive allergic reaction triggers a redness of the skin that resembles the pimple of a mosquito bite accompanied by itching. The principle of skin tests is to reproduce on the skin an allergic reaction. A drop of the suspected allergen is deposited on the skin then in the center of the drop, it is pierced with a small tip. A mosquito bite-like reaction at the test site indicates that the allergen tested may be responsible for some symptoms. This technique is well accepted even by very young children. 10 to 20% of positive skin tests do not necessarily mean that the person tested is allergic to the allergen tested. These tests can be performed in young children, contrary to the popular belief that it is not possible to do skin tests in young children. Waiting for a child to reach the age of 5 or 6 before performing the first tests causes a delay in the diagnosis and implementation of the treatments and aggravates the symptoms. The current consensus all agree to it that it is possible for these tests to be performed early, even before reaching the age of one year, that is if there are respiratory symptoms that are severe or even waves of urticarial or edema in children.
Facts in Education Info about allergies in France
According to the French Society of Allergology, allergies will be 20 to 30% of the population. And it is not over: the WHO predicts that 50% of the world’s population will be reached in 2050. However, care is not yet developed. The screening still leaves something to be desired, as for the treatments, there is a threat today on their reimbursement by the health insurance. An allergic rhinitis taken for a simple cold, a start of asthma mixed with a small cough, wandering can last. It takes an average of seven years to be diagnosed with an allergy. It’s long. In case of severe allergies, there is a lack of expert centers. Those who have both a respiratory allergy, a food allergy and skin allergy, there are hospital expert centers that exist, but in a very minor way, and this is why France needs referral centers for severe allergies that are rare diseases.
In an attempt to get rid of these allergies, there are desensitization treatments that from the experts’ point of view have proven themselves. Problem: the High Health Authority does not find them effective enough and proposes either to unregister them or to reduce their repayment rate sharply. These treatments are expensive. If the Minister of Health listens to the High Authority, it will be bad luck for some patients: The price of desensitization is on average between 500 to 1 000 euros per year. If this project is implemented instead, it means that half of the allergies would not be desensitized because they would not have the means since only half of the mutual will pay the additional desensitization.
Refund by Social Security on Some Allergist treatment in France
A mild allergy can be treated easily and cheaply. Count:
- Normal consultation with your doctor (23 euros),
- A consultation with a specialist (28 euros),
- A specific test (28.80 euros).
These expenses are reimbursed at the rate of 70% by the Health Insurance. In the presence of a more severe or difficult to identify allergy, it may be necessary to consult an allergist of a higher level, practicing most often in sector 2. This classification allows him to practice the excess of fees of which the amount is not covered by Social Security. When dealing with a complex allergy requiring frequent consultations, unsupported health costs are high expenses over the total duration of treatment. Regarding reimbursement of user fees for consultations in sector 1, it is provided by the complementary health insurance or mutual insurance. For overruns of a sector 2 allergist, only the subscription to a successful mutual can take care of them. The reimbursement rate of the excess of fees varies from one health mutual to another, which makes the comparison of offers indispensable.
Finding Specialized Allergist in France
1700 allergists practice this discipline in France. Among them, less than 600 practice exclusively this discipline, the others generally exercising 2 specialties: pneumo-allergists, allergist ENTs, pediatricians-allergists, and dermato-allergists. The national diploma allowing to mention “allergist doctor” on the plate and its prescriptions, is a capacity obtained after 2 years of study, giving the right to a competency. Doctors practicing only in allergies have a status of MEP by social security, the doctor with special exercise, not giving them a specialist status. The doctors practicing 2 disciplines obtained a specialist status through the exercise of the other discipline, pediatrics, dermatology, otolaryngology (ENT). Most major hospitals have an allergy service. Liberal allergists practice independent offices.
Common and Uncommon Allergies treated by Allergists in France
The determination of the tariffs of an allergist for clinical acts is free. However, it is fixed by the public authorities in the case of technical acts. By these we mean the tests that the specialist allergist makes to the patient. The proposed tariffs for these acts come out of an agreement between the insurance companies and the unions or associations of doctors. We talk about exceeding fees when the patient has a particular requirement or when the selected allergist is part of sector 2. It is therefore free to set its rates.
Some allergic diseases are common:
“Hay fever” and another allergic rhinitis
Acute or chronic urticaria
Atopic eczema or contact eczema
Allergies to vaccine components, supported in our service in collaboration with the International Vaccinations Center
Certain allergic diseases, fortunately infrequent, have serious consequences:
Angioedema and Quincke’s edema; Anaphylactic shock; Allergy to the venom of Hymenoptera insects (wasps, bees.). The treatments consist of specific desensitization or immunotherapy. In the case of allergic rhinitis or asthma, several treatment modalities currently exist (sublingually or injectable). These treatments require strict rules of administration and supervision as well.
Allergists in France – Present Situation
Allergist finally recognized as a medical specialty in France. The measure was hailed by the French syndicate of allergists and should be welcomed by those with runny noses and scratchy eyes. An order published Thursday in the Official Journal allows for the first time for medical interns to specialize in Allergology, the government providing that thirty students can be trained during the year 2017-2018. Allergology is thus recognized as a medical specialty in its own right, “a necessity for a pathology that currently affects 18 million French people”.
1,200 allergists in France
France has only 1,200 allergists, general practitioners, pulmonologists or dermatologists who have followed a two-year supplementary training to “over-specialize. Nearly 30% of French (18 million) are allergic, against 2 to 3% in 1970, according to the figures of the association Asthma and Allergies. The World Health Organization estimates that by 2050, half of the Western population will be affected, including global warming and pollution.
Allergology seems to be a necessity in France. The Allergists counting only 1200 – 1700, are not enough to represent the 20% of population that suffers from allergies. Maybe 30 years ago, only 2 or 3 percent of the French population suffered from allergies, but now at 20%, 10 times more than that amount means that France need them.
In spite of that, the France government did not recognize them as a medical specialty until 2016. If that didn’t happen, patients would be at risks since they would not be able to afford the prices. To get a good body examination for a year for allergies, sometimes it costs more that 500 to 1000 euros, meaning some would abandon the treatment since they wouldn’t be afford it as a consequence of it not being refunded by the social security.
Now that France has finally recognized their medical specialty, it becomes easy for them as well as people suffering allergies, since they now they can afford the medical fees, whether it be in sector 1 or 2. The job being simple being tough, allergists are a good asset to France and should increase in the coming years.