Global assessment of the knowledge and confidence in managing allergic disorders amongst primary care paediatricians across Europe: An EAACI Task Force Report.
Authors: Cabrera Martha , Ryan D , Erlewyn-Lajeunesse Michel , Levin Michael , Martínez-Cañavate Ana , Carmen Villaizán Pérez , Angier Elizabeth , Trujillo Juan , Cárdenas-Rebollo JM. , L Reali 
Published: April 2024

Background Paediatricians are often the first point of contact for
children in Primary Care (PC), but still perceive gaps in their allergy
knowledge. We investigated self-perceived knowledge gaps and educational
needs in paediatricians across healthcare systems in Europe so that
future educational initiatives may better support the delivery of
allergy services in PC. Methods A multinational survey was circulated to
paediatricians who care for children and adolescents with allergy
problems in PC by the EAACI Allergy Educational Needs in Primary Care
Paediatricians Task Force during February to March 2023. A 5-point
Likert scale was used to assess level of agreement with questionnaire
statements. 30 surveys per country was the cut-off for inclusion and
statistical analysis. Results 1,991 respondents were obtained from 56
countries across Europe and 210 responses were from countries with a
cut-off below 30 participants per country. Primary care paediatricians
(PCPs) comprised 74.4% of the respondents. The majority (65.3%) were
contracted to state or district health services. 61.7% had awareness of
guidelines for onward allergy referral in their countries but only
22.3% were aware of the EAACI competencies document for allied health
professionals for allergy. Total sample respondents versus PCP’s showed
52% and 47% of them have access to allergy investigations in their PC
facility (mainly specific IgE and skin prick tests); 67.6% and 58.9%
have access to immunotherapy, respectively. The main barrier for
referral to a specialist was consideration that the patient’s condition
could be diagnosed and treated in this PC facility, (57.8% and 63.6%
respectively). The main reasons for referral was the need for hospital
assessment, and partial response to first line treatment (55.4% and
59.2%, 47% and 50.7%, respectively). Learning and assessment methods
preference was fairly equally divided between: Traditional methods
(45.7% and 50.1% respectively) and e-Learning 45.5% and 44.9%,
respectively. Generalist Physicians (GP’s) have the poorest access to
allergy investigations (32.7%, p=0.000). The majority of the total
sample (91.9%) assess patients with allergic pathology. 868 (43.6%)
and 1,117 (46.1%), received allergy training as undergraduates and
postgraduates respectively [these proportions in PCPs were higher
(45% and 59%), respectively]. PCPs with special interest in
allergology experienced greater exposure to allergy teaching as
postgraduates. GP’s received the largest amount of allergy teaching as
undergraduate. Identifying allergic disease based on clinical
presentation, respondents felt most confident in the management of
eczema/atopic dermatitis (87.4%) and rhinitis/asthma (86.2%), and
least confident in allergen immunotherapy (36.9%) and latex allergy
(30.8%). Conclusion This study exploring the confidence of PCP’s to
diagnose, manage and refer patients with allergy, demonstrated knowledge
gaps and educational needs for allergy clinical practice. It detects
areas in need of urgent improvement especially in latex and allergen
immunotherapy. It is important to ensure dissemination of allergy
guidelines and supporting EAACI documents since the majority of PCPs
lack awareness of them. This survey has enabled us to identify what the
educational priorities of PCPs are and how they would like to have them
met.