Obstetric Physicians Rarely Refer Pregnant Patients to Allergists

Obstetric physicians rarely refer pregnant patients to allergy or immunology specialists, a recent cross-sectional survey revealed.1,2

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

Al-Saedy presented the poster, “Barriers to Allergy and Immunology Referral in Pregnancy: A Survey of Obstetric Physicians,” at the 2025 American College of Allergy, Asthma, & Immunology (ACAAI) Annual Scientific Meeting between November 6 – 10. The survey revealed that 23.1% of physicians at the University of Washington never referred their pregnant patients to an allergist or immunologist.

Many women during pregnancy face allergic and immunologic conditions, such as drug allergies, asthma, and urticaria, which can lead to implications for both maternal and fetal outcomes. For instance, food allergy reactions in the first 9 months of pregnancy can result in miscarriages, premature births, or birth defects. Allergies during pregnancy also increase the risk of the child getting sick after birth.

To reduce the risk of food-related complications during pregnancy, experts advise that women should avoid foods that have previously caused reactions, along with raw or undercooked items and easily spoiled leftovers.3 Staying well hydrated, exercising, and limiting spicy or bitter foods can also support overall well-being.

However, along with these dos and don’ts, the American College of Allergy, Asthma, and Immunology (ACAAI) notes that antihistamines can be appropriate during pregnancy for allergic rhinitis, conjunctivitis, urticaria, and as adjunctive treatment for anaphylaxis. Except for life-threatening anaphylaxis, clinicians should ensure that the benefits outweigh fetal risks.4 Chlorpheniramine and diphenhydramine have long safety histories, though chlorpheniramine is preferred despite its sedating effects. Newer, less sedating options such as loratadine and cetirizine have reassuring human and animal data and are recommended when indicated.

For decongestants, oxymetazoline is considered the safest due to minimal systemic absorption, while other topical agents may worsen congestion.4 Pseudoephedrine has been widely used but may be associated with a small increase in abdominal wall defects. Pregnant patients with persistent, mild allergic nasal symptoms may safely use corticosteroid nasal sprays, particularly budesonide. Allergen immunotherapy can continue during pregnancy, but should not be initiated.

Although pregnant patients can safely use certain allergy medications, referrals to allergy and immunology specialists remain low. Al-Saedy and colleagues conducted a 20-question cross-sectional survey to assess referral practices and barriers among obstetric physicians managing pregnant patients at a large academic center. The survey evaluated physician experience, comfort managing allergic conditions, referral frequency, perceived barriers to Allergy/Immunology consultation, and educational needs.

Among the 27 respondents, 59.3% were attending physicians with > 10 years of experience. In total, 92.6% practiced in both inpatient and outpatient settings, 23.1% never referred pregnant patients to Allergy/Immunology consultation, and 42.3% referred once per year. Physicians referred patients due to drug allergy (83.3%), urticaria (38.9%), and asthma (33.3%). Slightly more than half (51.8%) reported feeling completely or mostly comfortable at managing drug allergies.

Cited barriers to referring patients to allergy or immunology specialists included limited awareness of referral indications (55.6%) and long appointment wait times (44.4%). Respondents requested several educational interventions, including institutional guidelines (76%), provider resources (72%), and workshops (64%).

“Allergy and immunology care in pregnancy is safe and can make a real difference in how women feel,” Al-Saedy said. “Don’t hesitate to ask for a referral if you think you need one.”

References

1. Pregnant women often miss out on specialist allergy care. EurekAlert! November 6, 2025. https://www.eurekalert.org/news-releases/1103523. Accessed December 4, 2025

2. Saedy M and Colas K. Barriers to Allergy and Immunology Referral in Pregnancy: A Survey of Obstetric Physicians. Poster presented at ACAAI 2025 in Orlando, Florida, on November 6 – 10.

3. Food allergies during pregnancy: When is it dangerous? Vinmec International Hospital. Published 2025. Accessed December 4, 2025. https://www.vinmec.com/eng/blog/food-allergies-during-pregnancy-when-is-it-dangerous-en

4. Pregnancy and Allergies | Symptoms & Treatment. ACAAI Public Website. https://acaai.org/allergies/allergies-101/who-gets-allergies/pregnancy-and-allergy/