Various specialties of medicine and surgery may overlap in anatomic or disease categories. For example, surgery in the anatomic area from the nose to the chin may be considered the responsibility of otorhinolaryngologists, plastic surgeons, maxillofacial surgeons, or oral surgeons depending on individual training or experience, institutional or regional tradition, and other factors. The consideration for this review is two specialties of internal medicine, allergy-immunology, and pulmonary medicine, which have mutual interests in similar clinical problems, primary diagnosis and treatment of asthma and environmental lung diseases.
This overlap with another specialty is not unique for allergy-immunology because allergy also overlaps with such specialties as dermatology and otorhinolaryngology. A major reason for the diverse anatomic areas of interest to the specialty of allergy-immunology which results in this overlap is that the specialty is oriented to immunologic mechanisms of disease rather than to an organ system. Although allergic rhinitis and asthma are such common afflictions that the allergist in practice devotes a majority of time to these diseases, the breadth of the specialty of allergy-immunology is typified by the range of diseases from anaphylaxis to serum sickness and Stevens-Johnson syndrome. The focus of allergy-immunology then, is immunologically mediated diseases, particularly those resulting from the IgE antibody-mast cell system.
Pulmonary medicine focuses on diseases of the lung with the specialty evolving in this century from a clinical base with major emphasis on pulmonary tuberculosis when this disease was such a major cause of morbidity and mortality. As knowledge of pulmonary physiology developed, pulmonary physicians became diagnostic experts in lung function. More recently, advances in technology led to the use of flexible fiberoptic bronchoscopy as a major diagnostic tool of the pulmonary physician. This technique was previously restricted to thoracic surgeons using rigid bronchoscopes. The evolution of critical care medicine with acute respiratory failure as a major cause of morbidity and mortality and the recognition of breathing abnormalities during sleep are more recent expanding areas of pulmonary medicine. These recent changes have not resulted in any loss of expertise of pulmonary physicians in tuberculosis and pulmonary physiology.
Research in Academic Programs of Allergy-Immunology and Pulmonary Medicine
It is not possible to cover the broad scope of research in both specialties, but some points deserve emphasis. Although clinical allergy arose from empirical, poorly controlled clinical trials and pulmonary medicine, at least in part, arose from description and measurement of lung damage, current research in both specialties utilizes the technology of the disciplines of molecular and cellular biology and pharmacology.
The training and research of the academic allergist-immunologist will emphasize immunology, in particular, the IgE anti-body-mast cell systems, immunoregulatory mechanisms, and immunomodulation through immunopharmacology. The pulmonary physician must continue to have a strong scientific base physiology, but mechanisms of cell damage, inflammatory processes, and their control are an increasing focus of research for understanding and preventing lung disease. Is there and will there continue to be overlap in investigative areas between pulmonary medicine and allergy-immunology? Obviously!
For example, this is an exciting decade of research on bioactive mediators which result in acute and chronic reactions. Major advances in the understanding of arachidonic acid metabolism and the pharmacologic activity of the metabolic products of arachidonic acid will result in greater understanding and control of the pulmonary disease. Similar statements are applicable to the bioactive mediator, platelet activating factor (PAF). The role of PAF as a potent, endogenous mediator of acute or chronic inflammatory reactions is under intensive study by many investigators in disciplines such as biochemistry, pharmacology, hematology, pulmonary medicine, allergy-immunology, and pathology. Cooperative research among investigators in these disciplines will result in far greater advances in knowledge and application to prevention and treatment of human disease than will isolated investigations.
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