Is an allergy causing that irritating skin rash, or is something else behind it?
There’s a good chance that Paul Bigliardi, MD, could tell you. Bigliardi is a a dermato-allergologist—an expert in the identification and treatment of allergy-related skin reactions. Bigliardi recently joined University of Minnesota Health, and is now seeing allergy patients at our Clinics and Surgery Center.
We caught up with Bigliardi to ask him about his medical experience and a new treatment program he is launching to improve our comprehensive allergy care.
I bring an international and multiethnic perspective to my care. I received training at the University of Basel in Switzerland and have served as the head of academic allergology and dermatology at National University Hospital in Singapore. By comparing my experiences in Switzerland and Singapore I can observe interesting differences and make connections that another provider may not see. For example, in Singapore peanut allergies were not a major problem. Peanuts are often used in cooking there and children are exposed to them early and often, which perhaps leads to tolerance. These insights can be helpful for the diagnosis and management of allergies because they show that we—as physicians—have to constantly challenge and adjust our own recommendations to patients. I hope to build networks in the United States, Europe and Asia to standardize and validate our research and care all over the globe.
Misdiagnosed allergies are a significant issue in medicine. Roughly 35 percent of people who receive hospital care claim to have a drug allergy. But many of these allergies may have been misidentified. In Singapore, we found that 88 percent of these allergy claims were not accurate. This has an impact on costs and mortality because it affects what medications or therapies we can use to treat certain patients.
As patients get older, they may begin to use more medications—possibly multiple drugs at the same time. This complicates the drug allergy issue, and proper investigation is crucial. It is important to identify the drugs causing the allergies or intolerances, and define safe alternative treatments for the future.
Then there are food allergies. Diagnosis of a food allergy is complex and difficult. We cannot always rely solely on skin or blood tests. Sometimes, a food allergy has to be proven or disproven by using placebo-controlled food challenges. I plan to develop a program at the Clinics and Surgery within the next year that enables us to conduct these diagnostic steps. Food allergies can affect a person’s diet by dictating what they can and can’t eat. If possible, we want to avoid imposing unnecessary and cumbersome dietary restrictions upon a patient by identifying clinically relevant allergies with a clear need for avoidance.
This is particularly important for children during development to avoid malnutrition. Collaborations between different clinicians, pharmacists, dietitians and researchers are crucial to develop reproducible, safer and more reliable tests for drug and food allergies or intolerances.
Our program will provide comprehensive testing and treatment for a range of allergies. The program is truly multidisciplinary; we have deep partnerships with other University of Minnesota Health specialists so that we can offer our patients a “one-stop-shop” experience. This concept is novel—only a few medical centers in the United States offer something like this.
Currently, we have a wide range of allergy patch tests available for diagnosis. Soon, we will develop a drug and food allergy clinic for patients. Eventually, we also want to conduct allergy provocation tests in a safe setting. Allergy provocation tests are considered to be the “gold standard” for diagnosis. They are particularly helpful when previous allergy tests have not provided clear results. During a provocation test, a patient is given a small amount of a substance and then monitored for an allergic reaction.
My goals also include physician education. I want to develop a residency program at the University of Minnesota for allergy diagnosis, treatment and research.
My father was one of the first allergologists in Switzerland. That experience, and my training under Mark Dahl at the University of Minnesota really inspired me to pursue this path. The more experience I have treating allergies, the more interesting it gets. Each patient is different, and the field involves a lot of personal and interdisciplinary medicine. Allergy treatment is a prime example of personalized medicine. Finally, I think the translation of research from the laboratory to the clinic is fascinating and important. Working together with patients, we can identify needs and gaps in the diagnosis and treatment of allergies—and then develop new solutions. That’s where my passion comes from.