Getting to the Root Cause
by Maria Muro
Fascination — it’s what drew Michelle Korah-Sedgwick to the field of allergy and immunology, and it’s why she knows she is right where she belongs.
"Immunology is present in all aspects of our health,” she says. "Whether in uncontrolled inflammation or in keeping us well … the complex immune processes happening in our bodies all the time is fascinating.”
In medical school, the subject of immunology attracted her, and the self-proclaimed science nerd was thrilled to discover that the actual medical practice was even more rewarding. Dr. Korah-Sedgwick gets to play detective in unraveling the root cause of illness or allergy. One of her most fulfilling cases was in the diagnosis of a child with a rare immune disease who had been through years of infections and misdiagnoses. After lab work and a careful examination of all his records, she was able to put the pieces together to understand what he was facing.
"It’s going to be somewhat of a life-long process, but he’s had such a dramatic improvement,” she says. "To be able to make an impact in the short-term … it felt like we did so much for that family.”
Just beginning her practice at LSU, Dr. Korah-Sedgwick expects that, similar to her fellowship, her top three cases will likely be for asthma, seasonal rhinitis and food allergies. She is also already seeing a large number of chronic hives cases and says it has been gratifying to be able to provide quick comfort for this miserable condition. A vast number of those patients have no identifiable cause to their condition — Dr. Korah-Sedgwick likens it to an immune switch turned on in the body, possibly from a mild virus exposure — but an equally large number get fast results as soon as treatment is started.
Setting up a management protocol is all in a day’s work. For new asthma patients, it could be educating them on proper use of medications, while for existing patients or patients with difficult-to-treat asthma, it could be geared more toward treating symptoms and encouraging preventive breathing treatments so that seasonal allergies don’t tip them over in to full-blown asthma attacks.
"General practice physicians do manage a lot of asthma, so, if they’re referring to me, they’re a little more difficult case,” she says. "We can try some of the new drugs for asthma and we can work with their immune systems … it can be a long-term process.”
For allergy patients, the protocol often includes immunotherapy shots.
Common allergies (like those to pollen, dust mites, cockroaches and pets) respond well to injections of a small amount of the allergen in to the bloodstream to build up tolerance to the culprit allergen. Insect stings that can cause a life-threatening situation call for venom immunotherapy. As for dangerous food allergies, Dr. Korah-Sedgwick says, immunotherapy help is on the horizon. Not necessarily to allow patients to eat a food that could be harmful to them, but to help prevent a terrible reaction from inadvertent exposure.
"It’s research-based right now, but it’s what’s coming down the pipeline,” Dr. Korah-Sedgwick says. "It’s really exciting. Food allergies are on the rise. The reason why is the million-dollar question right now, so that’s a really important part of our field.”
The good news for most people is that there are many food allergy misconceptions. She loves to help adults and children break down what they can and cannot tolerate. Sometimes food allergy testing can be a little too sensitive, she says, and it pleases her to help people enjoy a less restrictive diet whenever possible. Sometimes an entire food group gets added back to the menu.
One thing that has surprised Dr. Korah-Sedgwick is how much she enjoys teaching. "In residency and fellowship, I realized how much I enjoyed teaching medical students and residents — it’s what made me go in to academics.” She collaborates in her practice with Sanjay Kamboj, M.D., and she works with LSU fellows now, but she looks forward to getting started with the residents and medical students as well.
She’s come a long way from thinking she might want to be a vet someday. In college she volunteered to answer a counseling hotline for college students who needed to talk to someone. "It was my first taste of patient-provider care,” she says, "and that aspect pushed me over to human medicine.”
Undergraduate: Neuroscience and Behavioral Biology, Emory University, Atlanta
Medical School: American University of the Caribbean, Cupecoy, St. Maarten
Residency: Internal Medicine and Pediatrics, LSU
Fellowship: Allergy and Immunology, LSU