Obstetricians Infrequently Refer Pregnant Patients to Allergists: Bridging the Gap for Comprehensive Care

Obstetricians Rarely Refer Pregnant patients to Allergy specialists, Survey Finds

SEATTLE, WA – december 4, 2025 – A new study reveals a important gap in care for pregnant patients with allergies or asthma: obstetric physicians infrequently refer them to allergy or immunology specialists. The cross-sectional survey, presented at the 2025 American College of Allergy, Asthma, & Immunology (ACAAI) Annual Scientific Meeting (November 6-10), found that over 23% of physicians at the University of Washington never make such referrals.

“Pregnancy can change how a womanS immune system reacts to allergies or asthma,” explains Miriam Al-Saedy, MD, internal medicine resident at Virginia Mason Franciscan Health and lead author of the study. “An allergist can definitely help confirm true allergies, guide safe medication use, and create a care plan that supports both maternal and fetal health.”

The findings highlight a potential area for improved collaboration between specialists to optimize care for expectant mothers. Referral to an allergy or immunology specialist can be crucial for managing existing conditions and ensuring the safety of both mother and baby during pregnancy.

What strategies could obstetricians implement within their existing workflows to more readily identify pregnant patients who would benefit from an allergist referral?

The Overlooked Connection: Pregnancy & Allergies

Pregnancy induces significant physiological changes, impacting the immune system and often exacerbating existing allergies or triggering new ones. Despite this, referrals from obstetricians to allergists remain surprisingly low. This gap in care can lead to suboptimal management of pregnancy allergies, possibly affecting both maternal and fetal health. Understanding why this happens and how to improve it is crucial for comprehensive prenatal care. Common pregnancy-related allergies include allergic rhinitis (hay fever), asthma, eczema, and food allergies.

Why the Referral Gap Exists

Several factors contribute to the infrequent collaboration between obstetricians and allergists:

* Lack of Awareness: Many obstetricians may not fully recognize the impact of allergies on pregnancy outcomes or the benefits of specialized allergy treatment during pregnancy.

* Time Constraints: Busy obstetric practices frequently enough prioritize core prenatal care, leaving limited time for in-depth allergy assessments.

* Perceived Severity: Allergies are sometimes viewed as minor inconveniences rather than conditions requiring specialist intervention, especially if symptoms are mild initially.

* Limited Access: Access to qualified allergists can be challenging in certain geographic areas, creating logistical hurdles for referrals.

* Siloed Healthcare: Traditional healthcare models frequently enough operate in silos, hindering dialog and collaboration between specialists. Maternal allergy management requires a team approach.

Impact of Untreated Allergies During Pregnancy

Ignoring allergies during pregnancy can have several adverse consequences:

* Increased Risk of Preeclampsia: Studies suggest a link between allergic diseases, particularly asthma, and an elevated risk of preeclampsia, a serious pregnancy complication.

* gestational Diabetes: Allergic inflammation may contribute to insulin resistance, increasing the likelihood of developing gestational diabetes.

* Preterm Labor & Delivery: Severe allergic reactions or poorly controlled asthma can trigger preterm labor.

* Fetal Growth Restriction: Chronic inflammation associated with allergies may impact fetal growth.

* Eczema & Atopic Dermatitis in Infants: Maternal allergies significantly increase the risk of the baby developing eczema and other allergic conditions. Allergic sensitization can occur in utero.

* Asthma Growth in Children: Children of mothers with asthma are at a higher risk of developing asthma themselves.

Identifying Patients Who Need Allergy Evaluation

Proactive identification of at-risk patients is key. Obstetricians should consider referring pregnant patients who exhibit any of the following:

* History of Allergic Disease: Prior diagnosis of asthma, allergic rhinitis, eczema, or food allergies.

* New-Onset or Worsening Allergy Symptoms: Development of new allergy symptoms during pregnancy or a significant worsening of existing ones. Symptoms like persistent nasal congestion, skin rashes, or wheezing warrant investigation.

* Severe Allergic Reactions: History of anaphylaxis or severe allergic reactions to foods, medications, or insect stings.

* Family History of Allergies: Strong family history of allergic diseases.

* Uncontrolled Asthma: Asthma that is not well-controlled with standard medications.

* Suspected Food Allergies: Concerns about food allergies impacting nutritional intake or causing allergic reactions.

Collaborative Care: Obstetrician & Allergist Partnership

Effective management requires a collaborative approach. here’s how obstetricians and allergists can work together:

1. Early Screening: Incorporate allergy screening into routine prenatal assessments.
2. Clear communication: Establish clear communication channels for sharing patient facts and treatment plans.
3. Shared decision-Making: Involve both specialists in developing a comprehensive care plan tailored to the individual patient’s needs.
4. Medication management: Carefully review all medications, considering their safety during pregnancy and potential interactions. Antihistamines in pregnancy and other allergy medications require careful consideration.
5. Allergen Avoidance Strategies: Develop strategies to minimize exposure to allergens, such as dust mites, pollen, and food triggers.
6. Immunotherapy Considerations: Discuss the potential benefits and risks of allergy immunotherapy (allergy shots) during pregnancy. While generally avoided during pregnancy, it might potentially be considered in specific cases.

Safe Allergy Treatments during Pregnancy

Many allergy treatments are considered safe during pregnancy, but careful evaluation is essential:

* Antihistamines: Certain antihistamines (like loratadine and cetirizine) are generally considered safe for use during pregnancy.

* nasal Corticosteroids: These are frequently enough the first-line treatment for allergic rhinitis and are considered safe.

* Decongestants: Use with caution and only when necessary, as some can raise blood