Faculty Bibliography

There has been substantial growth of advanced practice practitioners (APPs) in health care since their inception in the 1960s with APPs providing high-quality and cost-effective care in a variety of medical settings. Although most of the growth is in primary care, APPs are becoming increasingly leveraged in subspecialty care, including allergy and immunology (A&I). At present, there is limited literature on APPs in A&I specifically, but there is growing literature on APP utilization and training in other specialties. Structured transition-to-practice programs (including onboarding programs and formal residency/fellowships) for APPs in other specialties are increasingly common and are associated with improved clinical productivity, practice autonomy, expertise, confidence, and decreased turnover. It would benefit A&I to adopt a similar approach, as at present, the training and educational experiences APPs receive in A&I are quite varied. This article will review the training/certification of APPs, lessons learned from other specialties, what is known about the role of APPs in A&I, and next steps for the future.

The field of allergy and immunology (A/I) has transformed modern medicine with the development of diagnostic and therapeutic advances in all areas of health. This Work Group Report from the Division Directors Committee of the American Academy of Allergy, Asthma & Immunology describes the current state of 5 mission areas (clinical, educational, research, equity, and advocacy) within the A/I divisions/subdivisions of academic medical centers (AMCs) in the United States. The current states of the clinical and educational mission areas in AMCs in A/I are strong, with an increasing prevalence of atopic/immunologic disorders and novel therapeutics, solid trainee interest, and tremendous potential for research, equity, and advocacy efforts. The interest in the field of A/I has outpaced the creation of new positions, leading to an increase in unmatched applicants yearly. Weaknesses and threats include decreasing federal research and educational funding, changing health care insurance policies, the dynamic legislative environment, and the negative impact of the business focus in academic institutions. The future of A/I will depend on the preservation of a strong academic foundation with improved recruitment to academic positions, increased training positions, and greater incentives for development of career opportunities in research and education, utilizing artificial intelligence tools and strong advocacy strategies.

BACKGROUND:Food allergen immunotherapy (FAIT) is a consolidated treatment included in clinical guidelines that has shown efficacy in terms of researcher-defined variables, but little work has been done yet to evaluate patient´s perspectives. OBJECTIVE:We aimed to understand and explore the relevance of different patient-reported outcomes (PROs) METHODS: An EAACI Taskforce designed a questionnaire to prospectively collect information from parents or caregivers of patients below 18 years on FAIT. Participants from North America and several European countries were invited to provide data regarding socioeconomic aspects, allergic background, FAIT modality, burden, safety and food allergy quality of life (FAQoL). As primary outcome, 19 proposed PROs were ranked according to their relevance (5-point Likert scale). A descriptive and cluster analysis of the data was performed. RESULTS:84 FAIT prescribers recruited 857 patients suitable for analysis, 41.5%, 39.7% and 18.8% were on milk, peanut, and egg AIT, respectively. Patients were grouped into regions, South Europe (46.2%), North America (24.3%), Western Europe (20.7%) and United Kingdom (8.9%). Total FAQoL questionnaire score was 4.1 (±SD1.4), significantly higher among South Europeans [4.7 (±SD1.3), p<0.0001]. Worse FAQoL scores were found for milk and egg FAIT vs peanut. Cluster analysis identified 5 different phenotypes of patients considering similar replies to the proposed PROs, labeled: "High expectations", "Beyond protection", "Social Functioning", "Aiming at normalization" and "Low motivations". CONCLUSIONS:The data-driven analysis provided novel information on the level of complexity and personalization that patient´s desires display and opens the field to future research lines to improve FAIT patient-perceived value.

Allergic diseases, particularly food allergy, can be associated with significant psychosocial impairment. Allergist-immunologists can provide evidence-based information to correct misperceptions and misunderstandings regarding food allergy that may perpetuate cycles of fear and anxiety. While motivational interviewing can be an empathetic approach to empower patients to actualize health goals, cognitive behavioral therapy (CBT) aims to provide disease-state insight to facilitate an understanding of risk which can facilitate transformation of health beliefs and behavior. Brief CBT (bCBT) is a clinical approach that can help address ineffective management paradigms through conversations that begin with curious questions. In this review we discuss evidence supporting implementation of an integrated method of CBT in the allergy-immunology clinic and provide resources for this approach.