JANE EL-DAHR / Allergy and Immunology, Pediatric Allergy and Immunology and Pediatric Rheumatology
The Boy With Many Allergies
CRAIG MULCAHY PHOTOGRAPH
The first thing Dr. Jane El-Dahr explains when she sits down is that being a doctor of allergy, immunology and rheumatology is an unusual combination. “There aren’t very many of us in the country who do all of that,” she says, even though the three are closely related.
Allergy is when the immune system goes off and a person develops hypersensitivity toward things in the environment that should be completely harmless. Immunology deals with immune deficiency – when the immune system isn’t working as well as it should. Rheumatology is when a person’s immune system is overactive and turned on way too much, or when that person develops autoimmune disease (where the body starts attacking itself).
El-Dahr says that she sees a lot of tough cases – sometimes kids are sent to her for one reason, but really have something else going on. For example, they’re sent to the allergy clinic but really they have rheumatologic disorder. Or they’re sent to the rheumatology clinic because they’re tired all the time but they really have an immune deficiency. That is where her three specialties fit together and help her figure out those difficult cases.
“None of the cases are straightforward; I think that’s what makes being a doctor so fun,” she says. “I don’t do just one part of it, I have the whole spectrum here. Every single day is different and most of what I do is medical detective work. It’s listening and trying to solve what’s going on without a lot of tools. It’s really being able to step back and listen to what’s going on and being a little Sherlock Holmes and trying to figure it out.”
One of El-Dahr’s toughest cases involved a boy who was sent to her for food allergies when he was around 2 years old. Most children lose food allergies over time, certainly to milk and eggs, but not always to peanuts. He had to carry an EpiPen (self-injectable epinephrine) because of his food allergies.
The boy’s family lived in the country and he got stung by a fire ant and went into anaphylactic shock. Fortunately, his mom had the EpiPen, so she was able to treat him and get help. After the incident with the fire ant, he was desensitized to fire ants successfully.
He then went on to develop asthma and eczema, which has become extremely difficult to control over the years. He also became very grass-allergic and is now undergoing immunotherapy for his grass allergy.
El-Dahr says that one of the most satisfying things that has developed in recent years is what is called “rush immunotherapy” Instead of having to give shots once a week to build immunity to an allergy, doctors can now give an equivalent of six months or so of those shots in a day.
“That’s one of the really gratifying things with pediatrics. Instead of saying, ‘OK, you have to miss school and you have to come every week,’ we can do the rush protocol, which works just as well, without increased side effects in a really short period of time. That’s what we’re doing with [this patient] and it’s really helping him a lot.”
El-Dahr explains that the little boy is one of her tougher cases, not so much because the individual problems were complicated but because he had so many different manifestations of allergies.
Specializing in allergy, immunology and rheumatology was never part of El-Dahr’s original plan when she entered medicine.
El-Dahr says that she remembers her father, a general pediatrician, picking her up from school and making house calls for sick children while she sat in the car and did homework. He would come back from treating these children and tell her about each case.
“Pediatrics always seemed really exciting and interesting. But then I fell into allergy, immunology and rheumatology by accident. The key to all of this is being able to take the time to take a really good history and listen to all the clues that are in there about what was going on.”