In 2019, the EAACI Working Group on Primary Care invited EAACI members to work with us to identify the needs of European general medical practitioners (GPs) with regards to allergic diseases management, through the distribution of an online survey. It was considered that the new knowledge gained would be critical to the development of future educational initiatives aimed at supporting the delivery of allergy services in primary care.

EAACI and European-based national primary care scientific societies disseminated the survey between September 2019 and November 2019 in eight languages (English, Dutch, Italian, Spanish, Greek, Polish, French and German) across eight countries. A total of 759 questionnaires were distributed. With 99.3% of participants reported working within Europe, the results highlighted that knowledge and confidence of GPs differed across the different countries.

The research raised some issues concerning the provision of allergy services in PC settings, and the lack of investment in allergy services leading to suboptimal recognition and management of allergy in PC. Allergy education provision for GPs was shown to be inadequate and clearly fails to empower healthcare professionals to discern between allergies requiring full investigation and management, parentally diagnosed allergy, or symptoms which clearly have no association with allergy. Progress to improve PC training for allergy needs to be optimised to prevent further unnecessary referrals and lengthening waiting lists. It is clear that there is a need to improve referrals or alternatively that assistance be provided in primary care, as the current status puts pressure on public health systems and carries the risk of reducing healthcare quality, delaying some consultations and generating others without added value.

We propose that a line of collaboration across healthcare systems be opened, to improve the prevention, management, diagnosis and treatment of allergic diseases in our areas and make systems more sustainable and accessible, with greater coverage for citizens.

It is also evident that if PC is to have a role in the diagnosis and management of allergic disease, good communication between primary and specialist care is critical, therefore scientific societies should be encouraged to strengthen their own collaboration with PC, and support their training needs. It is expected that this would reduce unnecessary referrals and lengthy specialist care clinic waiting lists. In addition, there would be considerable benefit in establishing mechanisms for a more integrated PC–specialised care approach, especially in this new digital era precipitated by COVID-19. This would clearly benefit the care received by allergy patients on a broader scale.

In conclusion, with this study the EAACI Working Group on Primary Care have collected and reported on the concerns of partners in the scientific community, in health systems and in society in general. Current provision of resources and challenges faced in the implementation of allergy educational activities within PC healthcare systems need to be analysed in the COVID-19 era. Certainly, we believe that, through teaching activities such as those offered on EAACI’s recently launched e-learning platform, we can improve the quality of PC practice and increase the significance of the role of GPs in the diagnosis and management of allergic diseases.

Finally, strategies to support PC in the diagnosis and management of allergic disease should be consolidated within a consensus document for stakeholders. This would be key to ensuring that a unified, collaborative and symbiotic approach is applied to support the delivery of high quality allergic disease care within primary care.

The results of this research have been included in a Position Paper submitted for publication in the journal “Allergy”.

Martha Cabrera, MD, PhD
Project Lead Researcher and Task Force Chair,
On behalf of the EAACI Working Group on Primary Care