Undergraduate And Postgraduate Education For Primary Care Physicians And Pediatricians

Identified Need: 

There is a need for undergraduate and postgraduate training in allergy, asthma and clinical immunology for general practitioners and pediatricians such that primary care physicians and pediatricians may appropriately assist patients with allergic diseases. 

Recommendation: Allergic diseases are a major cause of morbidity and mortality. Suitable undergraduate and postgraduate training for medical students, physicians, pediatricians and other healthcare professionals will prepare them to recognize allergy as the underlying cause of many common diseases. It will also enable them to manage mild, uncomplicated allergic disorders by targeting the underlying inflammatory mechanisms associated with these diseases. They will learn when and how to refer the more complicated cases for a specialist consultation. Such education at the general practice level is of paramount importance since the vast majority of patients with allergic diseases are cared for by primary care physicians and pediatricians. These clinicians will also be required to comanage such patients with an allergy specialist and should be aware of the role of the allergist/clinical immunologist in investigating, managing and caring for patients with complex allergic problems.

Recognition Of The Specialty And Training Programs

Identified Need: Globally, medical education providers need to recognize allergy / clinical immunology as a specialty or sub-specialty, resulting in adequate training programs for optimal patient care. 

Recommendation: Expertise in allergy and clinical immunology should be an integral part of the care provided by all specialty clinics. Where allergy/clinical immunology training is not presently available or recognized as a specialty, training and national accreditation programs should be instituted to enable selected physicians to receive formal training and the qualifications required to become certified allergists/clinical immunologists. Such programs will also enable general practitioners, including pediatricians, to enhance their capacity to provide for the routine care for patients with allergic diseases.

Public Awareness Of Allergy, Asthma And Clinical Immunology

Identified Need: In most populations around the world, there is a lack of adequate education about, and awareness of, the morbidity and mortality associated with allergic diseases; the often chronic nature of these diseases; the importance of consulting a physician trained in allergy, asthma and clinical immunology; and the medications and treatments available to appropriately treat and prevent these diseases. 

Recommendation: Public health authorities should target allergic diseases as a major cause of morbidity and potential mortality. They should collaborate with national allergy, asthma and clinical immunology societies and patient support groups to publicize the necessity for general awareness and appropriate care for these diseases. 

The practice of allergology

Allergy is a very common ailment, affecting more than 20% of the populations of most developed countries. The major allergic diseases, allergic rhinitis, asthma, food allergies and urticaria, are chronic, cause major disability, and are costly both to the individual and to their society. Despite the obvious importance of allergic diseases, in general allergy is poorly taught in medical schools and during post-graduate medical education, and many countries do not even recognize the specialties of Allergy or Allergy and Clinical Immunology. As a consequence, many or most allergic patients receive less than optimal care from non-allergists. The World Allergy Organization has recognized these needs and developed worldwide guidelines defining What is an Allergist?1 , Requirements for Physician Competencies in Allergy: Key Clinical Competencies Appropriate for the Care of Patients with Allergic or Immunologic Diseases2 , and Recommendations for Competency in Allergy Training for Undergraduates Qualifying as Medical Practitioners3 . These important position papers have been published worldwide over the past few years, but it is far too soon to see whether they will influence the need for more, better and improved training in allergy worldwide.

An allergist is a physician who, after training in internal medicine or pediatrics, has successfully completed a specialized training period in allergy and immunology. As part of allergy training, all allergists are trained in the relevant aspects of dermatology, pneumonology, otorhinolaryngology, rheumatology and/or pediatrics. Subject to national training requirements, allergists may be also partially or fully trained as clinical immunologists, because of the immune basis of the diseases that they diagnose and treat. In most countries where the allergy, or allergy and clinical immunology, is acknowledged as a full specialty, the duration of the training is four/five years (including the common trunk in internal medicine and/or other disciplines, and two/three years of allergy and clinical immunology); where it is a subspecialty the approved period of training in allergy and clinical immunology will be two/three years after completion of the main specialty. Depending on national accreditation systems, completion of this training will be recognized by a Certificate of Specialized Training in Allergy, in Allergy and Immunology, or in Allergy and Clinical Immunology, awarded bya governing board. In some countries this will follow successful completion of a certification test or a final exam and in other countries by competencies being signed-off by a training supervisor. In some countries the allergist treats both adults and children while in some others, pediatricians, with specialty or sub-specialty in allergy, are competent to treat children