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Consultation and Referral Guidelines Citing the Evidence: How the Allergist / Immunologist Can Help

The statistics are clear. Lack of appropriate management of allergies and asthma results in a tremendous financial burden and impacts the quality of life for millions of people with allergic disease. For many of these patients, working with an allergist / immunologist can be beneficial in managing their disease.

These consultation and referral guidelines developed by the American Academy of Allergy, Asthma & Immunology assist patients and healthcare professionals in determining when referral to an allergist / immunologist is needed. The support of an allergist / immunologist may include single or limited consultation, co-management between a primary care provider and an allergist / immunologist or ongoing specialty care by the allergist / immunologist.

Providing information based on evidence to assist in the decision-making process benefits both patients as well as our healthcare system.

The evidence included in these guidelines is based on:
• Diagnostic evidence: tests performed or interpreted by allergist / immunologists facilitate diagnosis
• Direct outcome evidence: evidence that intervention by an allergist / immunologist improves outcomes
• Indirect outcome evidence: evidence that interventions performed by allergist / immunologists improve outcomes (evidence to support established pharmacologic management will generally not be reviewed)

Included here are specific referral guidelines for 14 categories of allergic diseases, along with the rationale for the referral, scientific references and the type of evidence provided. The categories are listed alphabetically for easy navigation and do not relate to prevalence of the individual disease.

Role of the Allergist / Immunologist
An allergist / immunologist is a physician certified in either internal medicine or pediatrics, who has completed an additional two years of training in allergy and immunology at an accredited training program and passed the examination given by the American Board of Allergy and Immunology (ABAI).

The allergist / immunologist is uniquely trained in:
• Allergy testing (skin, in-vitro)
• History-allergy test correlation
• Bronchoprovocation testing (e.g. exercise, methacholine)
• Environmental control instructions
• Inhalant immunotherapy
• Immunomodulator therapy (e.g. anti-IgE, IVIG)
• Venom immunotherapy
• Food and drug challenges
• Drug desensitization
• Evaluation of immune competence
• Education (disease, medications, monitoring)
• Management of chronic or recurrent conditions where allergy is not always identified: rhinosinusitis, conjunctivitis, asthma, cough, urticaria/angioedema, eczema, anaphylaxis

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