In an effort to bring variety to our blog readers, we are posting an article every month from an outside allergy blog. This two part article is reprinted with permission from a blog called The Renaissance Allergist.

An Open Letter to a Young Allergist,

Congratulations! After two years of Fellowship Training, you're about to be done and to be certified as an Allergist. The whole "World of Allergy" awaits you and you're about to take the big step forward into directly caring for patients on your own. As someone who has been "in the trenches" for nearly 30 years in treating allergic diseases, I have a few words of advice.

This letter could be entitled many things, but perhaps the best title would be, "Mistakes I've made and Lesson's I've learned". For you see, I've found that not everything you've learned in your training program applies to the “Real World” of allergy. Naming and learning leukotrienes is one thing, but dealing with patients is quite another. Here are four things to think about when you begin to see patients—four lessons I've learned in the last 28 years that have helped me in my practice:

Lesson 1: In the Real World of Allergy, patients don't give a damn whether they're sick because it's "IgE-mediated allergy" or not--they just want to get well. You'll see many, many patients with adverse reactions to foods and molds where your prick test is negative, and telling the patient "they don't have an IgE mediated allergy" is very cold comfort to them. They want answers, and telling them what it ISN'T is not nearly as satisfying to the patient as telling them what it IS. A practical point--they're not likely to refer you a whole lot of future patients, either. Here's the clinical pearl: In the Real World of Allergy, you've got to get comfortable with non-IgE mediated reactions--and fast--if you want to be a superior allergist.

Lesson 2: You've got to get experienced in delivering immunotherapy regularly in your practice, and preferably in a well tolerated, safe and effective form: SLIT. If the only thing you're interested in is treating asthma and allergic rhinitis with only drugs, you'll be a very lonely--and poor--Allergist. Face it: we have a lot of competition for treating the asthmatic patient, and the allergic rhinitis patient. We've got good symptomatic drugs too--which the family physician and pulmonologist and otolaryngologist can all deliver. You've got to deliver something the family physician and the pulmonologist and the otolaryngologist can’t deliver--and that's immunotherapy. SLIT is the wave of the future. Bone up on it. Fast.

Be sure to check out Achoo the Blog next Wednesday for the exciting conclusion to this posting.