More than 50 million people in the U.S. live with some form of allergic disease, but the workforce equipped to diagnose and manage it hasn’t kept pace. The Association of American Medical Colleges’ most recent workforce projections estimate a shortfall of up to 5,500 specialists, including allergists, by 2036, assuming continued investment in graduate medical education, with steeper shortfalls likely without it. Nationally, the median wait time for an allergy and immunology specialist consultation has been reported at 178 days, with only 17% of urgent cases being seen within the recommended timeframe.
That supply problem doesn’t land on every patient equally. The Institute for Healthcare Improvement’s Triple Aim framework, since expanded into the Quintuple Aim, evaluates a health system by its per capita cost, population health, and patient experience of care, along with two additions: the well-being of the healthcare workforce and the advancement of health equity. Applied to allergy care, that last dimension exposes a problem the first four alone would miss. Rural patients, Medicaid enrollees, and patients from underrepresented racial and ethnic groups are more likely to go undiagnosed, more likely to be misdiagnosed, and more likely to end up in an emergency department rather than an allergist’s office.
Where the diagnostic gap shows up
Insurance coverage is one of the clearest fault lines. A 2024 geospatial analysis of more than 5,600 U.S. allergists found that only 55.5% accept Medicaid, with state-level acceptance ranging from 13.4% in New York to 89.5% in New Mexico. Notably, the study found no independent association between rural location and Medicaid acceptance. What did predict a higher likelihood of a provider accepting Medicaid was a higher county poverty rate, suggesting that access barriers don’t fall neatly along a single line and often compound each other.
Geography adds another layer of complexity. The Health Resources and Services Administration projects that by 2035, the allergist and immunologist workforce will meet just 48% of demand in nonmetropolitan areas, compared with 99% in metropolitan areas. Rural communities also have a thinner research base for understanding how allergic disease presents and progresses in those populations, separate from insurance status altogether. A patient two or three hours from the nearest specialist faces the same diagnostic uncertainty as an urban Medicaid patient who can’t find a provider taking new patients, just for a different reason.
The cost of an uneven system
These barriers show up directly in outcomes. Black patients are about three times as likely to die from asthma-related causes as white or Hispanic patients, and Black children are hospitalized for asthma at more than four times the rate of white. Food allergy tells a similar story: an estimated 7.6% of U.S. children have a food allergy, but among children enrolled in Medicaid, the rate of a physician-confirmed diagnosis drops to just 0.6%, a gap that points less to lower prevalence and more to lower rates of detection.
Undiagnosed or delayed diagnosis doesn’t remove the underlying allergy. It just shifts where and how a patient encounters it, often in an emergency department instead of a primary care or allergy visit. Childhood food allergy alone is estimated to cost the U.S. health care system $24.8 billion annually, driven largely by inpatient, outpatient, and emergency care. When a diagnosis is delayed for a patient with fewer resources to begin with, that patient absorbs both the clinical risk of an unmanaged allergy and a larger share of the financial burden of reactive, crisis-driven care.
Building Access Where It’s Missing
None of this requires waiting for allergist supply to catch up with demand, which is unlikely to happen quickly given current training pipelines. Three approaches already in use can narrow the gap in the meantime.
Primary care integration is the most immediate lever. Specific IgE blood testing is a routine laboratory test that any primary care clinician can order, unlike skin-prick testing, which generally requires a specialist. Equipping primary care practices to order and interpret this testing, paired with a thorough clinical history, allows a meaningful share of allergy diagnosis and management to happen at the first point of contact rather than after a months-long wait for a referral.
Telehealth has already demonstrated real value for rural and regional patients who lack local specialty access, particularly since its rapid adoption during the Covid-19 pandemic. It isn’t a complete substitute for in-person specialty care, and questions remain about how to deliver certain aspects of allergy management, like in-office procedures, through a virtual visit. But for diagnostic consultation and ongoing management, tele-allergy has already narrowed distance-based barriers for patients who previously had no local access at all.
Community-based programs fill in what clinical access alone can’t reach. The Asthma and Allergy Foundation of America’s Health Equity Advancement and Leadership program, for example, has partnered with academic nursing programs on outreach efforts in rural Alabama specifically aimed at closing gaps in asthma diagnosis and management. Medicaid itself, which covers roughly 14 million rural Americans and nearly half of all children with asthma nationally, remains one of the most direct levers available for expanding access to this care, making its stability a health equity issue in its own right.
Closing the diagnostic gap in allergy care is ultimately the same shift from reactive to proactive care that improves outcomes for any patient. The difference is that for rural, Medicaid-enrolled, and minority patients, that shift doesn’t happen on its own. It requires deliberately building diagnostic capacity into primary care, telehealth, and community outreach, in the places where specialty care alone has never been enough.
Photo Credit: Estradaanton, Getty Images
Gary Falcetano, PA, is the U.S. Scientific Affairs Manager for Allergy in ImmunoDiagnostics at Thermo Fisher Scientific. A licensed physician assistant with more than 25 years of diverse experience in emergency and disaster medicine, primary care, and allergy and immunology.
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