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Allergist Interview: Dr. Amin Hetal on Allergy/Immunology as a Multi-System Approach

Allergist Interview: Dr. Amin Hetal on Allergy/Immunology as a Multi-System Approach

Dr. Amin Hetal This month, we're pleased to bring you an interview with Dr. Hetal Amin of Oak Brook Allergists, located in the Chicago suburbs. As has been evident with the other allergists we've interviewed, Dr. Amin is a physician who truly enjoys her work and finds being an allergist particularly rewarding in that she helps her patients find a better quality of life. She loves that allergy/immunology takes a unique multi-system approach to medicine. Furthermore, Dr. Amin champions the need for "detective" work in getting to the root of her patients' problems and emphasizes patient education as a crucial component of an allergist's work.

Please tell me a little bit about yourself and your history as an allergist.

"I did my medical school training and residency in internal medicine at the University of Illinois, Chicago. I completed my fellowship in allergy/immunology at the University of Cincinnati Medical Center and the Cincinnati Children's Hospital. I have been in private practice since 2006.

"I originally became interested in allergy/immunology as a medical student during my allergy clinical rotation because it incorporates not just environmental and food allergies, but also management of chronic sinus problems, asthma and other chronic respiratory conditions, and allergic dermatologic, rheumatologic, and gastrointestinal disorders. It is one of the few fields that incorporates a multi-system approach in understanding the complexity of the immune system and the diseases associated with it.

"When I was doing my fellowship training, I came to appreciate the field even more and became fascinated with the cutting-edge research in immunology in such conditions as eosinophilic eosophagitis (EE) and hereditary angioedema (HAE). For example, just 20 years ago, no one knew what EE was or how to treat it. These patients were thought to have "irritable bowel disorder.

"I love how the field of allergy/immunology is constantly changing. We have learned so much more about the role of immunomodulators and how we can better target treatment to help our patients. But there is still so much we do not know about the immune system. I enjoy being an allergist because I don't feel outdated; it is a field that changes so rapidly."

How big is your practice?

"Our group is a single specialty private practice group in the western suburbs of Chicago. We have five offices and a total of five allergists with the group. I see patients at all the locations in the practice, which covers a large patient population."

Is there a particular type of allergy or treatment your practice specializes in?

"Our group sees the full spectrum of allergy, asthma, and immunology patients. We have a very busy practice and see patients of all ages and conditions. We get a lot of referrals to see patients with common seasonal and perennial allergies, recurrent upper and lower respiratory infections, asthma and chronic cough, food allergies and intolerance, angioedema, and allergic skin disorders such as eczema and acute or chronic idiopathic urticaria (hives). Having trained as an internist, I do see my share of unique patients with the atypical presentation of allergies and a concurrent non-allergic condition, making the diagnosis and treatment quite complex and interesting."

What do you love about your job?

"I love the fact I get to play detective and problem-solve. I was taught early in my training that not every patient fits a textbook diagnosis. A good physician has to think outside the box. I love how every patient presents so differently in terms of symptoms. Treatment response varies as well.

"I also enjoy the fact that I can see how quickly patients in my field respond to treatment, whether it is environmental or food avoidance measures, medication options, or immunotherapy. The majority of my patients have successful control of their allergic disease state and it is very rewarding as a physician to see how well your patients are doing with their treatment."

If you could suggest one thing for your patients what would it be?

"It is very important to find a doctor who will listen and be your advocate. Patients should feel comfortable with their doctor. My patients are always a part of the decision-making process and I make sure I spend enough time to allow them to understand their diagnosis and treatment plan.

"I firmly believe that patient education is the most important part of my job. Patients need to understand their medical conditions and how they can impact their overall health. Many physicians spend a great amount of time ordering sophisticated tests and providing state-of-the-art treatment; however, it is even more invaluable to provide the proper medical resources and information to our patients. An excellent physician is one who knows the standard of care in his or her field, and uses evidence-based medicine for the proper diagnosis and treatment."

What is your favorite allergy relief product?

"Most of my patients requiring treatment always emphasize "less is better" when it comes to taking multiple medications. I usually try most sinus allergy products on the market myself so I can best advise my patients on usage. I like saline sinus irrigation rinses. They are suitable for pediatric and adult patients and serve as a natural decongestant to cleanse the sinuses of allergens, mucus, and any airborne particulates."

Where do you see allergy treatment going in the near future?

"Immunotherapy (allergy injections) have been the gold standard of treatment for patients with allergic rhinitis and asthma who have had inadequate response to medications. SLIT (sublingual immunotherapy) is having an increased role in the treatment of allergic patients. The treatment is a therapy they can administer at home. In the future, we may even see SLIT for the treatment of food allergies, a therapy which is being used in Europe.

"Xolair (anti-IgE) is a medication being used for severe steroid-dependent extrinsic asthma and now there are preliminary studies looking at the use of Xolair for chronic sinusitis, eczema, hives, even food allergies. Anti-IL-5 therapy has proven effective for the treatment of eosinophilic eosphagitis, but there are studies looking at the role of anti-IL-5 therapy in allergic disorders as well.

"We will also see doctors using an integrative approach to treating allergies using natural alternatives or supplements (antioxidants) that regulate the immune system and provide disease control."

In the distant future?

"We have various medication options that target symptom control, but we are still limited in treatment modalities that target the mechanisms of the immune system. Regardless, as an allergist, this is definitely an exciting time for our field. There is currently cutting-edge research looking for therapies targeting specific receptors on the mast cells, eosinophils, and IgE receptors or blocking the response of cytokines and chemokines that are involved in allergic inflammation. Studies of the past five years are also looking at actual SNP (single nucleotide polymorphisms) to understand which individuals will develop a certain allergic disease and how they will respond to a specific treatment based on their DNA."

Is there anything else you'd like to add or discuss?

"As the prevalence of allergies increases, more patients are in need of an allergist. We have the ability to improve quality of life for patients' suffering from allergies. Patients should not hesitate to seek care from an allergist to obtain proper diagnosis, management, and education for their allergy concerns. As an allergist, I take pride in offering quality patient care and an excellent bedside manner while staying up-to-date with the most recent medical information in my field."