Pediatric allergists struggle to meet growing patient demand

You may want to think twice before letting any kids eat your peanut butter truffles left over from Valentine’s Day: Childhood allergies are on the rise, but there are currently not enough pediatric allergists to meet the demand.

More than a quarter of US children were reported to have some kind of allergy in 2021, according to the most recent statistics from the CDC. In particular, rates of food allergies in children have steadily risen over the past few decades, with 5.8% of US children reportedly showing food allergy symptoms in 2021, up from 3.4% between 1997–1999, CDC reports show.

Patients are turning to already overwhelmed primary care providers and pediatricians, or they’re being referred to other specialists for treatment if no pediatric allergists are available.

“We would benefit from having staff to be able to treat and manage a lot of these patients so that they’re not being sent elsewhere, and so the patients can be managed under one healthcare facility,” Devang Doshi, a pediatric allergist at Beaumont Health-Royal Oak in Michigan, told Healthcare Brew.

The situation could get worse in coming years: Consulting firm Merritt Hawkins estimates that there may be a supply and demand deficit of about 480 allergists by 2025 nationwide.

Allergists, unlike other specialists, are trained to handle both pediatric and adult patients. But that does not mean all allergists may be comfortable treating all ages. Medical students in allergy programs, which are housed under internal medicine, may not get as much exposure to pediatrics and vice versa, Doshi said. As a result, they may choose to only treat adult patients in their practices and refer pediatric patients elsewhere.

Depending on the condition, related specialists can see children with allergy symptoms. Dermatologists, for example, can see patients with eczema. Telehealth is helping address specialist shortages across the board, but allergy tests and treatments still require a “human touch,” said Edwin Kim, a pediatric allergist at the University of North Carolina-Chapel Hill School of Medicine.

There’s no shortage of interest in allergy and immunology, but there is a shortage of residency programs for these areas—especially those focusing on pediatrics. Kim estimates that, each year in the US, only around 160 trainees come out of the 78 accredited allergy and immunology programs.

“That’s not enough for the number of patients out there,” Kim said.

Most allergists who treat children are based in pediatric academic centers in major cities, too, leaving rural patients with fewer options, said David Stukus, a pediatric allergist at the Ohio-based Nationwide Children’s Hospital.

While patients across the US drive an average of 22.7 miles to see a pediatric allergist, patients in New Mexico, for example, travel an average of 170.2 miles, according to data from the American Board of Pediatrics. The University of New Mexico Children’s Hospital in Albuquerque has the state’s only pediatric allergist.

The lack of specialists means rural primary care physicians (which are also short in numbers) then have to step up to fill the gap.

Children with allergies often grow up to be adults with allergies, Stukus said. Pediatric allergists, compared to primary care physicians, can build longitudinal relationships and spend more time with each patient, Kim said.

“Because a lot of specialties, it’s sort of one and done. You know, you see [a patient once and] never see them again,” Kim said. “For us, we get to follow their asthma long-term, get to follow their seasonal allergies—we get to develop relationships, get to know the patient and their families.”