After allergies, which department number will you choose?
Respiratory, otolaryngology, ophthalmology, dermatology...... These departments are now responsible for the diagnosis and treatment of allergic diseases, but the allergy department specializing in allergic diseases is extremely rare, and even when hospitals want to build a new specialty, they will face the problem of finding a doctor.
In contrast, the incidence of allergies has been increasing in recent years. Among them, many patients who have systemic multisystem allergic reactions need to travel to many places to receive effective treatment. How can this impasse be resolved?
Allergies, who to see?
Year after year, people with allergies flock to various departments.
Zhang Qi's rhinitis is more severe, and as soon as spring comes, the nasal water will flow non-stop. She went to the tertiary general hospital near her unit to see a doctor, and hung up on the otolaryngology department, and the allergy department was attached to it.
Xiaojing took the child to pediatrics, dermatology, and gastroenterology, because the child had obvious food allergies and often had rashes on his body.
For Guo Qiang, who has been allergic for many years, the patient circle is the biggest source of information. When her nose is blocked, she will buy drugs from patients online to use by word of mouth, and before coming to Beijing, she also ordered a folk "miracle drug" with unknown composition, which she guessed should be hormones.
Respiratory, otolaryngology, ophthalmology, pediatrics, dermatology, folk medicine, ...... In spring and autumn, these places are a place of recourse for people with allergies.
"Recently, we saw 20 or 30 children in the morning, and 1/5 of them had runny nose, sneezing, and conjunctivitis. As soon as spring comes, children come into contact with pollen and catkins, and there are more allergic symptoms. Song Lin, an attending physician in pediatrics at Beijing Tsinghua Changgung Hospital, said. Another doctor from the respiratory medicine department of the hospital also said that there are many patients with allergies recently, and the department of dermatology for allergic asthma and atopic dermatitis is a 'nightmare' for allergy patients. ”
Song Lin's research direction is digestive diseases, so she has also dealt with the problem of digestive allergies. She had seen a six-month-old baby who vomited frequently after eating eggs, because there was no fever and diarrhea, Song Lin ruled out acute gastroenteritis, and considered it to be a food allergy, and told the parents to stop feeding eggs, and the child's symptoms disappeared.
Cases with a single symptom, such as the above-mentioned infant or Zhang Qi, can be controlled in various specialties. However, if there is a complex situation of multi-system superposition, the treatment path of "symptomatic registration" will face limitations, and it is even more difficult to further screen for allergens and carry out desensitization treatment.
Yin Jia, Chief Physician of the Department of Allergology at Peking Union Medical College Hospital and President of the Allergist Branch of the Chinese Medical Doctor Association, shared two cases from Suqian, Jiangsu Province.
The picture is from the official website of Peking Union Medical College Hospital
The first child had severe allergic asthma, which could not be solved by local multi-disciplinary medical treatment, and was found to be sensitized by multiple allergens in Beijing, and needed desensitization treatment; the second child suffered from asthma, atopic dermatitis, food allergy, rhinitis and conjunctivitis at the same time, and was registered for treatment in five specialties of a well-known children's hospital in Shanghai, but failed to solve the comprehensive problem, and was later found to be multi-allergic to mold and dust mites in the allergy department of Peking Union Medical College Hospital, and needed to undergo multi-allergen desensitization treatment to avoid cross-allergic food.
Both children's parents are doctors, and one of them is also the chief physician of a local tertiary hospital. It is so difficult for the doctor's child to see allergies, and other patients can imagine it. Yin Jia said: "There are too few allergy departments. ”
A young and niche discipline
Just this year, the First Affiliated Hospital of Tsinghua University in Chaoyang District, Beijing, set up an allergy department, which can be opened after the final process is passed, and in the future, allergens can be checked, biologics can be used, and desensitization treatment can be carried out.
The allergy department is very niche just by hearing the name.
In fact, it describes the pathogenesis of allergies: the body's immune system loses its normalcy and overreacts to external substances such as pollen, food, and dust mites, which is medically called "allergic reaction".
From head to toe, from the inside out, allergies are a disease that can affect all systems of the body, and can also occur in multiple systems at the same time. The Department of Allergology is a department that specializes in allergies.
There are more and more people with allergies. Song Lin has been engaged in pediatric diagnosis and treatment for ten years, and feels that the incidence of allergies is increasing year by year, including seasonal pollen allergies and perennial food allergies. In the department's weekly self-sharing classes with doctors, many doctors focus on allergies.
According to the research and estimation of the Allergy Branch of the Chinese Medical Association, the number of adult patients with allergic rhinitis in mainland China has reached 150 million. According to two longitudinal epidemiological surveys conducted by the team of Beijing Tongren Hospital, the average prevalence of allergic rhinitis in mainland China increased by 6.5% from 2005 to 2011.
Despite the increasing number of patients, the allergy department is very niche.
According to the 2022 survey of 502 hospitals in 30 provinces, autonomous regions and municipalities directly under the central government, the Allergist Branch of the Chinese Medical Doctor Association has established only 90 hospitals with independent allergology departments.
"We built this department, one is based on demand, and the other is to establish a special department. There are not many hospitals in Beijing that have an allergy department, and we are the first one that does not have an allergy department in the entire Chaoyang District. Yue Honghong, director of the allergy department of the First Affiliated Hospital of Tsinghua University, told reporters that compared with traditional departments such as respiration and digestion, the development of the "allergy department" is in the ascendant and can become a characteristic of a hospital.
Allergist, "fewer than pandas"
Talking about "why allergy is rare", Yue Honghong said that on the one hand, allergy is a disease that has gradually become "popular" in recent years with changes in economic development, lifestyle and environment.
"The number of doctors engaged in allergies in China is even smaller than that of giant pandas. Yin Jia complained seriously that in 2024, the wild population of giant pandas in the mainland will be nearly 1,900.
According to the 2022 survey, there are only 350 allergy specialists in the country, with a ratio of 1:4 million to the general population, which is far from meeting the growing demand for medical treatment. There are about 5,000 specialists active in the clinical front line of allergy in the United States, with a ratio of 1:60,000 to the general population.
When Yue Honghong recruited talents for the formation of a new department, none of the young doctors applied for the job were from allergology, but from otolaryngology, skin, respiratory and other specialties, and finally she chose a fresh graduate of the ear, nose and throat major. After the other party arrives at the post, he will go to Peking Union Medical College Hospital for advanced training in allergology to complete the transformation from dermatology to allergology.
"Allergic doctors are rarely in this specialty from the root, except for those in Union Hospital, and most doctors are interdisciplinary (specialty). We don't have allergology as a major, only internal medicine, surgery, and pediatric......s," Yue said. She also helped build an allergy department in a hospital in Inner Mongolia, and she felt that "there are definitely no people who specialize in allergology." ”
Behind this is the dilemma that the talent training channel has not yet been opened.
According to Yin Jia, most hospitals in mainland China do not have a training system for allergic specialists, and the mainland has not yet established a national training, assessment, qualification certification and management system for allergy specialists. Young doctors who are already working in the clinical work of allergy have no promotion channels and can only be promoted to other specialties, which affects the development of allergy discipline.
She said that if you want to have enough talents in the allergy department, you must answer the question of how to train doctors and how to build the department - it is to establish a unified training base for allergy specialists in accordance with the world's prevailing training model for allergy specialists, and complete the three-year training of doctors in internal medicine, pediatrics, and general medicine to enter the base training program and carry out 2~After three years of allergy specialist training, allergy subspecialties are set up under other specialties, and the training focuses on the diagnosis and treatment of specialists in a single type of allergic disease;
At this stage, the exploration of different models has its own advantages and disadvantages in terms of doctors' comprehensive diagnosis and treatment capabilities, the difficulty of hospital operation, the cost of patients' medical treatment, the talent training cycle, and the sustainable development of disciplines.
Song Lin believes that in response to the allergy wave, specialists should carry out more advanced allergy-related training, correctly identify and diagnose most allergic diseases, and strengthen cooperation with other departments to jointly manage patients and rely on the Internet to follow up patients.
From the experience of helping grassroots hospitals build allergy departments, Yue Honghong believes that the existing available doctors have diverse professional backgrounds, and the knowledge base of grassroots doctors is weak. "What songs are sung in what mountains, but the attention from the top down is not enough. ”
Yin Jia said that the direction of the high-quality development of allergy discipline at this stage is to establish a training system for allergy specialists in China, promote the coordination of government management departments to establish an assessment, access, certification and management system for allergy specialists, carry out high-quality national multi-center clinical research, form sub-centers and regional centers, realize the homogeneity of diagnosis and treatment of allergic diseases in the country, and allow patients with allergic diseases to enjoy homogeneous high-level medical services nearby. In the face of allergies, it is necessary to train qualified allergists so that patients can enjoy the same level of diagnosis and treatment as patients in developed countries around the world.