A glimpse into the future
As we celebrate our 75th anniversary, we’ve been doing a lot of looking back. During our 50th anniversary, we asked College members what they thought the future of allergy would be like in 25 years – in 2017. Now, we’re looking back to see if those predictions came true – and making a couple of new predictions. What will the future of allergy look like when the College turns 100 in 2042? College members have some ideas.
Joseph Bellanti, MD, FACAAI, College historian
“If our specialty is to survive to the year 2017 – allergists will have to embrace clinical immunology…and find new disease entities.”
Did it come true?
“This is still true today."
"I think there’s a bright future ahead for the specialty. As we move into the fields of precision and personalized medicine, I think it's important to stress that the allergist-immunologist has a much broader opportunity to embrace other fields of clinical Immunology. And we shouldn't lose sight of those opportunities for immune deficiency, for autoimmune disease, for the new advances in cancer immunotherapy with checkpoint inhibitors. So, this knowledge of immunology expanding and having clinical application, I think, is very important for a membership, and particularly our young membership, the Fellows-in-Training. So, I think this area is very important.”
Ralph Hale, MD, FACAAI, past president ACA (ACAAI’s name at the time) 1971-72, deceased
“We will develop a POTENT NON-STEROIDAL, ANTI-INFLAMMATORY drug without serious side effects for long-term use.”
Bobby Lanier, MD, FACAAI, past executive medical director
Did it come true?
“Dr. Hale is partially correct in that montelukast has been developed. While it is not as potent as we hoped – it is very safe. Currently, for long-term treatment, we have developed a series of biologic medications attacking the basis of inflammation. Monoclonal antibodies have been developed which get closer to both preventing the inflammation as well as the accumulation of damage.”
"Allergists will drift from concentration on antibody E to a broader consideration of all antibodies and cellular messengers. Subcutaneous allergy injections, the current standard of care, will become rare as advanced methods of influencing the immune system become possible."
Susan Bailey, MD, FACAAI, Speaker of the AMA House of Delegates
“In the year 2017 – clinical allergy will STILL be a rewarding area of practice. Improved understanding of rhinitis and asthma will result in superior medications…as immunotherapy evolves into GENE THERAPY.”
Did it come true?
"Clinical allergy is still a very rewarding area of practice; although it has changed with allergy medications going OTC, our allergy and asthma patients still very much need our partnership in developing safe and effective management plans. It is as rewarding as ever to see a child with poorly controlled asthma become active and athletic with good allergy care. Immunotherapy is still our primary disease modifying therapy for allergic disease and asthma. Biologics are playing a rapidly increasing role, which I never would have guessed 25 years ago. We are becoming better at identifying asthma phenotypes, but gene therapy seems quite distant given the increasing complexities we discover."
"In 25 years, there will still be a need for allergists. I believe telemedicine can help us reach patients that have not had access to us before. Food desensitization will be routine. Pharmacogenomics will help us decide which medications or biologicals are best suited to our patients, without having to go through trial and error like we do now."
Jack Selner, MD, FACAAI, past president 1992-93, deceased
“We’ll have to adapt to drastic changes in technology for diagnosis and treatment…or fade into the sunset.”
James Sublett, MD, FACAAI, past president and executive director of advocacy and governmental affairs for the Advocacy Council
Did it come true?
"This may surprise our readers, but I feel the single most significant technologic advancement was hard to visualize in 1992 – the power of high speed internet and the resulting connectivity. This, along with the rapid development of personal devices have empowered our patients to want to understand more about allergic diseases. The ability for allergists to communicate electronically has not only opened the door to increased professional education (access worldwide to peer reviewed literature, webinars, the College Learning Center, virtual meetings) but also enhanced patient engagement to provide better education and communication for our patients.
"For more than the last decade the College has been working to enhance electronic communication through continuously improving delivery of information, to our members, and our current and future patients. Our strength is in the processing of information. The immune system is as complex as the most sophisticated supercomputer, and we are the only specialty trained to diagnose and treat diseases of the immune system."
"We are currently moving out of the symptomatic treatment era to the era of “biologics.” Currently, in our field, they have been developed for difficult-to-treat asthma, urticaria and atopic dermatitis, but I expect application to other disease states in the future. For the last 100 years, we have had allergen-specific subcutaneous immunotherapy, which, if developed today, would be touted as a huge breakthrough. With increased identification of allergen components (the dust mite has over 25), we will move to using patient specific component immunotherapy as a better way of treatment. This will be applied, not only to food allergy, but inhalants.
"I hope that we will have in a significant way moved to better understanding of the gene-environmental interaction. With the use of ‘Big Data’ and personal monitoring of exposure we should be able to understand better the role of gene-environment interaction and the development and prevention of allergic diseases.
"Just as ‘brick and motor’ stores have been impacted by online shopping, adaptation by allergists to use telemedicine (already in progress), eConsults, apps, and personal electronic devices, both for real-time monitoring and communication, will dramatically change the way we interact with and treat our patients."