Barriers Limit Allergy and Immunology Referrals in Pregnancy
A survey of obstetric physicians has found that referrals to allergy and immunology (A/I) specialists for pregnant patients remain uncommon despite evidence supporting their safety and clinical value, according to an abstract presented at the American Academy of Allergy, Asthma & Immunology annual meeting November 6-10.
The study, conducted at a large academic medical center, identified key barriers, including limited knowledge of referral indications and long appointment wait times.
Study Findings: Referral Practices and Barriers Identified
The cross-sectional study distributed to obstetric attending physicians, fellows, and residents asked 20 questions about experience, comfort in managing allergic conditions, referral frequency, perceived barriers, and educational needs.
Of the respondents, 59.3% were attending physicians with more than 10 years of experience, and 92.6% practiced in inpatient and outpatient settings. They reported low rates of referrals to allergy/immunology specialists; 23.1% of respondents never referred pregnant patients to A/I specialists, and 42.3% made only one referral per year.
The most common reasons for referral were drug allergy (83.3%), urticaria (38.9%), and asthma (33.3%). Just over half of respondents (51.8%) reported feeling completely or mostly comfortable managing drug allergies independently.
The most frequently cited barriers to referrals were limited knowledge of referral indications (55.6%) and long wait times for A/I appointments (44.4%). Physicians expressed strong interest in educational interventions: 76% wanted institutional guidelines, 72% requested provider resources, and 64% sought workshops to strengthen competence in allergy management during pregnancy.
Clinical Implications: Need for Education and System Support
The study highlights a disconnect between the established benefits of A/I consultation and current obstetric practice patterns. Allergic and immunologic disorders such as asthma, urticaria, and drug allergy are prevalent during pregnancy and can influence maternal and fetal outcomes; however, referrals remain inconsistent and underutilized.
Improving awareness of referral criteria, establishing streamlined pathways, and providing clear institutional support could enhance both physician confidence and patient outcomes, the study investigators concluded. Educational initiatives that include guidelines and accessible resources may help integrate A/I consultation more effectively into obstetric care, particularly in complex cases involving medication allergies or respiratory conditions.
The findings point to an unmet need for structured educational and institutional strategies, according to the authors. The results suggest that increased training opportunities and standardized referral systems could help bridge current gaps in maternal allergy management.
Strengthening institutional education and referral infrastructure may improve quality of care, ensuring that allergy-related conditions in pregnancy are managed with greater confidence and consistency.
Reference:
Al-Saedy M, Colas K. Barriers to allergy and immunology referral in pregnancy: a survey of obstetric physicians. Presented at: American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting; 2025; Seattle, WA.
