Survey reveals limited allergy referrals in pregnancy due to lack of guidance and long wait times, highlighting need for better education.
Pregnant patients frequently experience allergic or immunologic conditions such as asthma, urticaria, or drug allergies, which can have implications for both maternal and fetal health outcomes. However, a new study presented at the 2025 American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting found that obstetric physicians infrequently refer pregnant patients to allergy and immunology (A/I) specialists, despite the availability of safe and beneficial consultation.1,2
The study, Barriers to Allergy and Immunology Referral in Pregnancy: A Survey of Obstetric Physicians, assessed referral practices and perceived obstacles among clinicians managing pregnant patients at a large academic medical center. A 20-question cross-sectional survey was distributed to attending physicians, fellows, and residents to evaluate experience, comfort level with allergic conditions, frequency of referrals, and educational needs.
Among 27 respondents, 59.3% were attending physicians with more than 10 years of clinical experience. Most participants (92.6%) practiced in both inpatient and outpatient settings. Yet, nearly one in four respondents (23.1%) reported that they never referred a pregnant patient to an allergist, while 42.3% said they made a referral only once a year.
Drug allergy was the most common reason for referral (83.3%), followed by urticaria (38.9%) and asthma (33.3%). Despite these frequent conditions, only about half of respondents (51.8%) reported feeling completely or mostly comfortable managing drug allergies on their own. The findings suggest that obstetricians encounter allergic conditions regularly but often handle them independently rather than seeking specialty input.
The most frequently reported barriers were limited knowledge of when to refer and long wait times for specialist appointments. More than half of respondents (55.6%) said they lacked clarity about referral indications, and 44.4% cited delays in obtaining appointments as an obstacle.
According to lead author Miriam Al-Saedy, MD, an internal medicine resident and ACAAI member, “Pregnancy can change how a woman’s immune system reacts to allergies or asthma. An allergist can help confirm true allergies, guide safe medication use, and create a care plan that supports both maternal and fetal health.”
Dr. Al-Saedy noted that clearer institutional guidance could help bridge the gap between obstetric care and allergy management. Most respondents (76%) said they would welcome institutional guidelines, while 72% requested provider resources and 64% expressed interest in educational workshops.
The study authors emphasized that collaboration between obstetric and allergy specialists can improve outcomes for both mother and baby. Effective management of allergic disease during pregnancy can reduce risks related to uncontrolled asthma, inappropriate medication avoidance, or untreated allergic reactions.
“Allergy and immunology care in pregnancy is safe and can make a real difference in how women feel,” said Al-Saedy. “Don’t hesitate to ask for a referral if you think you need one.”
Kelly Colas, DO, PhD, allergist and ACAAI member, added that an allergist can “confirm or rule out medication allergies so you can safely take what you need during pregnancy,” “help control asthma to keep both you and your baby breathing easier,” and “manage hives, eczema, or other allergic conditions safely with treatments appropriate for pregnancy.” She also emphasized the importance of coordinated care, stating that allergists can “work closely with your OB to coordinate your care before, during, and after delivery.”
The researchers concluded that targeted educational and institutional interventions may enhance physician confidence and streamline access to specialty care. Developing local referral pathways, integrating allergy management guidance into obstetric protocols, and promoting awareness of the benefits of A/I consultation may help close existing gaps.
As Al-Saedy summarized, “An allergist can help confirm true allergies, guide safe medication use, and create a care plan that supports both maternal and fetal health.”
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