Why I Became An Allergist




“Dr Schreiber, We have a 25 year old female inbound by EMS with hives, shortness of breath, and hypotension. They will be here in two minutes. Do you have any orders for the paramedic prior to arrival?”
“Start two IV’s and run fluids in wide open. Start supplemental oxygen. We will be waiting in trauma two.”

As the patient was hustled down the corridor to trauma two, I listened to the paramedic tell the ER Nurse the history. “She is 25 years old with a history of being allergic to red dye. She was eating at a restaurant and ordered cheese soup after confirming with the waiter that it did not contain red dye. Within minutes of eating the soup she started feeling funny and asked the waiter to call 911.Currently her vitals are: heart rate 125 beats per minute, blood pressure 70 over palpable, respiration 80 per minute with an oxygen saturation of 90% on room air. She is covered in hives form head to toe, semi alert due to her low blood pressure and in extreme respiratory distress.”

As the paramedics and ER nurses were transferring the patient from the gurney to the emergency room bed, I reached into the crash cart and grabbed a dose of Epinephrine 1:1000, drew up .3 cc and injected the patient with the Epi. I massaged the shot site to increase the speed of uptake while I ordered IV steroids and Benadryl. I also prepared to intubate the patient to safeguard her airway.

In less than one minute I witnessed my first medical miracle. Her hives started to fade, she went from panting at 80 breaths per minute to taking a deep breath, sighing and then she looked up at me and said “Thank you!”

I was told in pharmacology that Epinephrine worked quickly, but this was magic! From dying to thank you in 60 seconds! Wow! She did well and was released from the ER after 23 hours of observation.
These events happened in 1989 at Bexar county hospital in San Antonio, Texas when I was an Internal Medicine Intern. This was my very first exposure to anaphylaxis.

Anaphylaxis is one of the most terrifying experiences a person can have. One can transform from perfectly healthy, to near death, in a matter of moments after exposure to something they have been sensitized to. Common triggers are insect stings, medications and certain foods.

What shocked me most was how little the faculty and staff in the ER knew about anaphylaxis. They knew how to treat anaphylaxis acutely to save the patients life, but not how to prevent the next episode from occurring. This is one of the incidents that piqued my interest in allergy as a career.

After two years of internal medicine residency I knew I did not want to practice internal medicine for the next thirty years. During my third year of residency I took two immunology based electives; Rheumatology and Allergy. My impression of Rheumatology was that it was more about managing chronic pain than it was about immunology. My interest in Rheumatology quickly faded. During the first week of my allergy elective I knew I had found my specialty. Convincing my wife that she and our children would have to endure two more years of my training was not all that easy. She was tired of poverty, but nonetheless supported me like a trooper. After residency I took a two year fellowship in Allergy at UTMB in Galveston. I have never regretted my decision, as I have never found anything more rewarding than improving the quality of life of an allergic or asthmatic patient.

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