As noted in that position statement, 22% of the global population experiences allergic and immunologic disease. The World Allergy Organization is an alliance of 74 national and regional allergy societies which created this consensus document to establish educational guidelines to help identify and correct allergy education and training deficiencies. It will be used to define appropriate competencies.

•    The burden of allergic diseases represents a significant morbidity in both adults and children. It is estimated that allergic disease affects at least 20% of the population in the U.S.

• Allergic diseases are the sixth most common chronic illness in the US

• Allergic diseases account for in excess of $18 billion a year in healthcare costs

• 50 to 60 million people in the US suffer from allergic diseases

• in data from the 2014 National Health Interview Survey,

  • 8.4% of US children under 18 suffered from hayfever

  • 10% from respiratory allergies

  • 5.4% food allergies

  • 11.6% from skin allergies

• Immunotherapy (allergy shots) helps ameliorate the symptoms of hay fever in approximately 85% of people with allergic rhinitis

• 80% of allergy patients can be handled at the primary care level

There are only about 4000 boarded allergists in the US. Primary

The World Health Organization outlines a knowledge base for the first level of care of allergic patients. 

1. Adequate clinical knowledge about the main allergic diseases, including rhinoconjunctivitis, rhinosinusitis, otitis, asthma, urticaria, angioedema, eczema, food allergy, insect allergy, anaphylaxis, drug allergy, and immunodeficiency, so that the diagnosis and treatment of both acute and chronic diseases are possible. Where feasible, such care should be carried out in collaboration with or with access to an allergist or an allergy referral center.

2. Adequate knowledge in the interpretation of the main diagnostic allergy tests, skin prick tests, and serological tests for IgE and an understanding of pulmonary function test interpretation. Such training generally would not include competency in performing skin tests or the more sophisticated pulmonary function tests.

3. Sufficient training to recognize patients with a level of persistence or severity, who experience exacerbations that are life affecting or who have difficult-to-manage allergic or immunologic disease who should be referred to an allergy specialist for evaluation and initiation of treatment before the disease advances to a severe or life-threatening stage.

4. Immunotherapy (injective, sublingual) is performed by first-level physicians and other health care professionals in some countries. The WAO suggests that this is only appropriate as follows:

   1. The immunotherapy has been prescribed by a specialist.

   2. The first-level physician and other professionals have had adequate training in allergy and the recognition and management of anaphylaxis to provide this service safely.

   3. The location where immunotherapy is performed fulfills all the conditions for patient safety.

It is recommended that immunotherapy be initiated by an allergist or in a referral center and that a suitably trained first level physician should provide maintenance treatment only.

   There are only about 4000 boarded allergists in the US. Primary care must be a resource to meet the needs of the allergic population. It is my opinion based on my experience in the past 40 years that 80% of allergic patients can be handled at the primary care level with the appropriate support and oversight. Ancillary Allergy Care Organizations provide an appropriate patient selection process for testing which is performed by a skilled trained provider. The results of testing are reviewed by an Allergist who then  provides the treatment plan which the PCP will implement with consent of the patient. If immunotherapy is appropriate the composition is formulated based on the comprehensive history, physical and in vitro and in vivo test results. The extract prescription is signed off by me. Allergy extracts are compounded in compliance with USP 797 regulations by trained personnel.

   Ancillary Allergy Companies comport with "in office ancillary services" exception under 42 U.S.C. §1395nn(b)(2)) (or if the practice is actually a group, then the "group practice" exception under 42 C.F.R. § 411.352 is applied.