Immunology is the medical specialty devoted to the immune system. A complex system, made up of different types of cells and antibodies, this allows the body to protect itself against infections and other conditions, such as cancer (to a certain extent).

Disorders of the immune system (weakening or, on the contrary, hyperreactivity) can be associated with a multitude of diseases and clinical signs. Among the most common are allergies, which correspond to an abnormal response of the immune system to elements of the environment (food, pollen, animals, etc.) which should be considered harmless. Autoimmune diseases, too, are caused by an abnormal reaction of the immune system that “attacks” the body rather than defending it. These diseases are numerous, affecting in total about 8% of adults to varying degrees.

In Quebec, “clinical immunology and allergy” is a recognized medical specialty.

In France, the specialty “immunology” does not exist as such., but many physicians have extensive training in immunology, including:

• general practitioners (or of various specialties) having followed training (DESC) in immunology and clinical allergology;
• internal medicine specialists or internists.

Immunology specialists take care of people with an immune deficiency, or those with, on the contrary, a very reactive immune system.

The list of conditions treated in immunology is therefore long, but among the most frequent disorders, let us quote:

• the allergies ;
• congenital or acquired immune deficiencies;
• autoimmune diseases, such as systemic lupus erythematosus, scleroderma, rheumatoid arthritis, Hashimoto’s thyroiditis…;
• transplants or grafts, which require taking immunosuppressive drugs for life;
• chronic infections, such as HIV, which weaken the immune system and other infectious diseases;
• cancers of the blood cells, such as leukemia or lymphomas, which jeopardize the body’s defenses.

Some people are more prone to infections or immune system disturbances.

Among the recognized risk factors:

• being a woman (this increases the risk of autoimmune diseases);
• being asthmatic or having an atopic condition (which increases the risk of allergies);
• having relatives with an autoimmune disease or severe allergies in your family;
• being infected with HIV (which increases the risk of various infections);
• chronic diseases, such as diabetes or kidney failure, associated with an increased risk of infections;
• having a disease of the blood cells, including leukemia, lymphoma or bone marrow depression.

To arrive at a diagnosis, the immunologist:

• questions his patient to find out the nature of the symptoms, their date of onset, their evolution;
• it is most often based on biological analyzes which make it possible to assess the number of immune cells in the blood and possibly identify the presence of abnormalities (abnormal antibodies, for example, or deficit in white blood cells);
• once the diagnosis is made, treatment will be offered.

Depending on the pathology, the management may call for:

• immunomodulatory drugs, which regulate the immune response (biotherapies)
• immunosuppressants, for example after a transplant, to reduce the immune response
• anti-allergy medications, such as antihistamines which are most commonly prescribed
• to a desensitization treatment in case of allergy
• hospital management with isolation in the event of a severe immune deficiency (which may give rise to various treatments, such as a bone marrow transplant for example).

The consultation with an immunologist does not involve any particular risks for the patient. If the goal is to test certain allergic reactions, it can happen that coming into contact with the allergen causes a significant reaction. However, this type of test is performed in a hospital or clinic environment under medical supervision and the team is trained to manage this type of situation. Likewise, the administration of drugs having an action on the immune system may cause side effects, which will be discussed with the doctor.

Training to become an immunologist in France

To become an immunologist, the student must obtain a Diploma of Complementary Specialized Studies (DESC) in Clinical Immunology and Allergology (DESC type I, lasting 2 years). Before that, the student must hold a specialized studies diploma (DES), namely the diploma obtained at the end of the internship:

• after having completed 6 years at the Faculty of Medicine;
• and after having passed the national classifying tests, which allow access to the boarding school.

Finally, to be able to practice and carry the title of doctor, the student must also defend a research thesis.

Note that with a DESC type I, the young doctor retains his title of specialist in the specialty of his DES.

Training to become an immunologist hasu Quebec

After college studies, the student must:

• follow a doctorate in medicine, lasting 1 or 4 years (with or without a preparatory year for medicine for students admitted with a college or university training deemed insufficient in basic biological sciences);
• then specialize by following a residency residency in clinical immunology and allergy (3 years in internal medicine or pediatrics, followed by 2 years in allergology and immunology) (3).

Before going to the appointment with an immunologist, it is important to take any biology exams (blood tests, allergy tests, etc.) already carried out.

To find an immunologist / immunologist:

• in Quebec, the site of immunologists and allergists of Quebec (4) offers help to find a specialist;
• in France, via the website of the National Council of the Order of Physicians (5) or via the Health Guide website (6), which offers a directory of immunologists and immunopathologists.

The immunology consultation is covered by the Health Insurance (France) or the Régie de l’assurance maladie du Québec.