The roadmap for allergology in Europe: The European training requirements for the specialty of allergology
Authors: Roy Gerth van Wijk, Norbert Mülleneisen, Pascal Demoly, Jose Maria Olaguibel, Todor A. Popov, Peter Schmid‐Grendelmeier, Olympia Tsilochristou
Journal: Allergy (2020)

To the Editor, The development of the European training requirements (ETR) for medical specialties in Europe is regulated by the Union Europeénne des Médecins Spécialistes (UEMS), a non-governmental organization representing national associations of medical specialists at European Level. The training requirements of the specialty of Allergology were developed in 1994, amended in 1997, 2001, 2002, and 2003 and published in 2004.1 Seventeen years after, we present an update of the ETR for the specialty of Allergology as approved by the UEMS Council held 18 October 2019 in London. The ETR was developed by the authors of this article and the UEMS section and board of Allergology with the input from the EAACI Specialty Committee and National Allergy Societies Committee. The complete version of the ETR can be found on the UEMS website.2 This ETR focuses on Allergology, since at European level our specialty has been recognized only as Allergology. However, in some countries the specialty of Allergology may be associated with Clinical Immunology and named as Allergology and Clinical Immunology (specialty or subspecialty). For this reason, Clinical Immunology is presented by this ETR as optional training. Due to current UEMS regulations, a common trunk in Internal Medicine with a minimum of 2 years instead of a combination of Internal Medicine and Pediatrics in the first 2 years is included. The training requirements for trainees comprise general competences, theoretical knowledge, practical, and clinical skills. The general competences of physicians are described in the CanMEDS framework (ie, medical expert, communicator, collaborator, leader, health advocate, scholar, and professional).3 Trainees should be knowledgeable about basic immunology, genetics/epigenetics, epidemiology, allergens, clinical manifestations, diagnosis, and therapy of the disorders dealt by an allergologist (Appendix 1). Furthermore, trainees should be familiar with the principles of research. All trainees need to have detailed practical and clinical skills in the following areas (Table 1 and online repository Appendix 2). The history and diagnosis and management of allergic diseases Comprehensive and structured history taking In vivo investigations In vitro investigations Provocation tests Management Immune-deficiencies Systemic auto-immune diseases Vasculitis Other inflammatory diseases The duration of training in Allergology should be a minimum of 5 years with 2 years of Common Trunk and 3 years of specific training in Allergology and related areas (see Figure 1). Training in related specialties should be focused on achieving the competences required for the (differential) diagnosis and management of patients with allergic diseases. An integrated assessment system that measures the progress of trainees using workplace-based assessments, portfolios of procedures and knowledge-based assessment is highly recommended. The program is led by a training director, a medical specialist with at least 5 years’ experience as a registered allergologist. The training institute must have sufficient trainers registered as Allergologists. Preferably, there should be a ratio of two trainers per trainee and one educational supervisor who mentors the trainee throughout their training. The training team should meet the required competences and quality criteria as required by national boards. Training centers/ institutions should undergo initial accreditation by national authorities. Furthermore, they should have availability for consultation rooms, consumables/devices to perform necessary clinical investigations and laboratories. The centers should have constantly in- and out-patients. Moreover, they need to have established links with medical specialists covering the wide range of organ allergic manifestations to ensure robustness of the diagnosis. Finally, they should have a rapid referral system in place to implement urgent diagnostic and treatment decisions. Nurses, dieticians, and other health allies working in the facility need to be specifically trained to deal with allergic patients. Subsequent monitoring should be at least every five years based on well-defined criteria with emphasis on organization and quality of the training process, facilities, appropriate assessment methods, and measured outcomes such as trainee performance and qualification. Feedback from trainers and trainees must be incorporated in the review. This ETR replaces the requirements for training in Allergology and Clinical Immunology as defined in Chapter 6 of the UEMS Charter on Training of Medical Specialist in the EU (2003). There are however some major differences when comparing this ETR with the previous Chapter 6. The ETR can be seen as a guideline or benchmark for trainees in the specialty of Allergology. It is however up to the EU member states to adopt and implement this ETR. National Authorities keep their competence in defining the content of postgraduate training in their own State. PD reports grants from Stallergène Greer, grants from ALK, grants from AstraZeneca, grants from Bausch & Lomb, grants from Thermo Fisher Scientific, personal fees from Sanofi-Regeneron. JMO reports personal fees from ASTRA ZENECA, personal fees from MUNDI-PHARMA, personal fees from ALK. PSG reports personal fees from Allergopharma, personal fees from ALK, personal fees from AbbVie, grants from Christine Kühne Center for Allergy Research and Education CK-CARE, personal fees from EliLilly, personal fees from GSK, from LEO, personal fees from Novartis, personal fees from Galderma, personal fees from Biomed, personal fees from Stallergenes, personal fees from Thermo Fisher, personal fees from Sanofi, outside the submitted work; and Peter Schmid-Grendelmeier is outside of EAACI also member of the following societies: International society for atopic dermatitis ISAD (Board member)World Allergy Organization WAO Swiss Society for Allergy and Immunology SSAI (Board member) Swiss Society for Dermatology and Venerology SSDV European Academy for Dermatology and Venerology EADV European Dermatology Forum EDF. The other authors do not declare any conflict of interest. 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