Top Docs Q&A: Daniel Steinberg

The allergy and immunology expert explains why we should brace ourselves for this season's 'pollen vortex.'

This post is part of our Top Docs Q&A series where we ask a physician who was selected as one of our Top Docs questions about their field, life as a doctor, and practicing in the Greater Boston area. 

Name: Daniel Steinberg

Hospital Affiliations: Beth Israel Deaconess Medical Center, Newton Wellesley Hospital

Title: Director of the Allergy & Asthma Center of Massachusetts; Assistant clinical professor at Tufts University School of Medicine.

Field: Allergy and Immunology

Specialty: Asthma, pediatric and adult allergy & immunology

Daniel Steinberg is an allergy and immunology doctor with an interest in how allergic and respiratory disorders are influenced by the environment. Steinberg has also been involved in initiatives to make treatments for asthma and allergic disorders more affordable.

How did you decide to go into the allergy and immunology field?

I had spent some time working in a cancer hospital taking care of patients with immune disorders. After doing that for a while, I realized there were several other applications of immunology that transcend into forms of care other than cancer immunology, and so I decided to get involved in that.

What’s your favorite part of practicing in the field of allergy and immunology?

I like that you get to work with children, adolescents, young adults, middle-aged people, and elderly patients, all with a wide variety of immune diseases. Also, I like that the immune system is connected to virtually everything; the skin, lungs, ear, nose, throat, gastrointestinal fluids, etc.

In the time you’ve been practicing, how have you seen the field change?

When my career started in the 1980s, much of the the field, particularly regarding asthma therapy, was about treating symptoms. In the last 25 to 30 years though, we are now working to address the underlying causes of allergic illnesses.

What are the latest advancements happening right now in the field?

Since 1911, there have been forms of immunotherapy injections, which desensitize people to their allergies. Now, though, there are new oral forms of these therapies. Some of these treatments have already been out in Europe for several years now, but in the U.S. they are currently in the process of being approved. The FDA has already approved some of these tablets, and they are about to be launched. However, it remains to be seen which patients might be candidates for these types of treatments.

Why have these treatments been out in Europe but not yet in the U.S?

The regulatory process in the U.S. and Europe differ. Also the FDA was looking at these for quite a long time and had some questions about the efficacy and safety of these tablets. Any forms of desensitization involves exposing someone to something they’ve previously been sensitive to, so there’s a risk-benefit decision that needs to be weighed for every individual patient.

What do you hope for the future of your field?

As patients get more exposed to environmental triggers and urban populations grow, I would hope that we would have be able to fight these triggers more effectively. To do this, first we need to make the environment a little cleaner in terms of air, water, and food. Then people need understand the easy lifestyle interventions they can make to their indoor environments.

According to the Massachusetts Department of Public Health, asthma rates are increasing in the state. Why? 

There’s something called the “hygiene hypothesis,” which suggest that people who live in agrarian environments have less allergies then those in urban environments. Immunologically, dirty environment can be protective because your immune system learns how to fight certain infectious agents. If you aren’t exposed to these elements early in life then that can later translate into an allergy. The theory suggests that as we are getting more modernized, these allergies are becoming more common. We have also been vaccinated for many viruses now, so instead of getting certain viral infections we are getting allergies.

The media is saying that this season will be a “pollen vortex.” If this is true how can people with allergies get through it?

That’s kind of a buzzword the media created, because it sounds sort of scary. However, this season there has been an uptake in pollen and the correlated diseases that go with it. In my practice we set patients up with various apps where they can follow seasonal indicators like pollen counts. We also post information about these indicators on our Facebook page and website. A person who follows the pollen levels and knows that they’re going to be sick is more apt to take their medicine and less apt to end up in the emergency room.

You were involved in initiatives to make treatments for asthma and allergic disorders more affordable, what did this work entail?

A big problem now is that people aren’t being covered for their allergy medications so they can’t afford them. We have patients going to the emergency room when that could have been avoided if they had access to the medicines that control their allergies or asthma. A lot of the work I did with the American College of Allergy and Immunology was educating insurers about why they should cover these medicines.

What’s your favorite part of practicing in Boston?

I grew up in Boston, so I know a lot of people here from since I was a kid. In fact, some of those people even bring me their children and grandchildren, so I’ve known some of those people for two or three generations.