The use of electronic consultations (e-consults) in allergy and immunology practices has increased, in particular for historical adverse drug reactions and immunodeficiency, leading to reduced in-person patient wait times despite an increase in overall consult volume, according to results published in the Journal of Allergy and Clinical Immunology: In Practice.

To determine the frequency of e-consult use in allergy and immunology academic practices, investigators reviewed e-consult data from 2016 to 2018 and in-person consult data from 2014 to 2018.

Of the 321 e-consults ordered, the majority of the 306 completed were ordered by obstetricians and gynecologists (43.5%), followed by internists and internal medicine subspecialists (42.5%). In-person consults were recommended by 59.8% of the completed e-consults; 26.8% provided education and advice without additional recommendations for diagnostic testing, therapeutic change, or subspecialist referral.

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Only 13.4% of completed e-consults included recommendations for diagnostic testing, therapeutic changes, and/or subspecialist referrals, with 73.2% of these recommendations followed.

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Less than 2% of the 183 patients who required an in-person allergy or immunology consult saw an allergist without an e-consult recommendation. Consults for adverse drug reactions were significantly more often e-consults than in-person, mainly for penicillin allergy and immunodeficiency.

For allergists, the median e-consult completion and turnaround times were 11 minutes and 22 hours, respectively. In addition, the use of e-consults decreased the median in-person consult wait time by 1.5 calendar days.

“[M]uch of the burden of allergic disease diagnosis and management falls on nonallergist clinicians,” the authors noted. “In our growingly complex health care system, a model of care that places a patient’s primary care physician at the forefront of care with easy access to specialist guidance is ideal. E-consults meet this challenge, providing safe and efficient patient care in a manner that prevents unnecessary office consults and maximizes patient, referring provider, and subspecialist satisfaction.”


Phadke NA, Wolfson AR, Mancini C, et al. Electronic consultations in allergy/immunology [published online June 3, 2019]. J Allergy Clin Immunol Pract. doi:10.1016/j.jaip.2019.05.039