Insect Allergy: Barriers in Training and Practice: A Work Group Report of the AAAAI Anaphylaxis Committee

The evaluation and management of insect sting allergy is a complex core competency taught in Allergy and Immunology fellowship programs. It is unclear if current training on insect allergy is sufficient to meet the needs of the field, and what training barriers exist. To investigate the extent of training on stinging insect allergy, and factors currently impacting stinging insect allergy clinical practice through a pilot needs-assessment survey. A web-based questionnaire was designed and sent to a 20% random sample of American Academy of Allergy, Asthma & Immunology member categories. Data were analyzed for descriptive frequencies. A total of 78 responses were received (11% response rate). Respondents’ mean age was 53.7 years, 52% were female and 92.3% were physicians. The mean time since training completion was 18.4 years. During fellowship training, 95.7% were educated on stinging insect allergy, 87.1% reported conducting testing and 82.6% ordered venom immunotherapy (VIT). During training, 50% of respondents managed 1-5 patients with venom allergy, (38% managed >5, and 12% none). After fellowship, 97.3% reported evaluating patients with stinging insect allergy, 90.3% report evaluating 1-5 patients per month and 93.2% and 87.5% offer testing and VIT (respectively). A patient’s decision to not start VIT was the most common barrier reported by 81.8%. In this pilot needs-assessment survey, the majority reported training and education on insect allergy during fellowship, though patient exposure was low for most. After fellowship, insect allergy evaluations increase up to 24-fold compared to fellowship training and patient-driven decisions are the most common deterrent for VIT.