PEDIATRICIAN AND ALLERGIST RELATIONSHIPS IN THE TREATMENT OF PATIENTS WITH SEVERE ALLERGY AND ANAPHYLAXIS

Abstract

Introduction The management of patients with severe allergies and anaphylaxis often spans multiple specialties. A research survey among pediatricians was conducted as a means of obtaining peer input to identify priorities for managing challenging cases of allergies and anaphylaxis, as well as referral relationships among specialties and rationale for patient referral. Methods An online survey was conducted among a sample of 150 US community-based pediatricians who treat >12 patients/month with severe food allergies/anaphylaxis. The survey queried general pediatricians about their consultation and referral practices as well as their frequency and reasons for referrals when treating allergy/anaphylaxis patients. Results In this survey, 87% of community pediatricians (N=131) indicated that they frequently or occasionally refer patients with severe allergic reactions or anaphylaxis outside of their practice. A majority of pediatricians (72%) reported consulting with their peers about challenging cases on at least an occasional basis. Virtually all of these patient referrals (93%) were made to allergists. Most common reasons for referral were (1) complex cases requiring more specialization and (2) the availability of resources that pediatricians may lack, eg, intradermal/skin testing. Patients most likely to be referred to outside specialists were infants with anaphylaxis (87%), patients with comorbidities (78%), and patients with peanut allergies (62%). Conclusions Most community pediatricians will frequently or occasionally refer patients with severe allergies/anaphylaxis outside their practice, most often to allergists. A meaningful percentage report consulting with their peers on challenging cases, demonstrating their willingness to reach out or refer complex cases to their colleagues.