Telehealth After the Surge: What It Means for Allergy & Immunology

The telehealth expansion that COVID-19 forced upon allergy and immunology practices is not simply reversing, it is settling into a more considered, durable shape, and the practices that understand where virtual care fits will hold a meaningful structural advantage.

From Emergency to Normal

The spring of 2020 compressed years of adoption into a matter of weeks. Allergists who had never conducted a video visit suddenly found themselves managing anaphylaxis follow-ups, inhaler technique counseling, and new-patient consultations entirely through a screen. Regulatory waivers made it possible; necessity made it mandatory.

Eighteen months later, the picture is different. Many waivers remain in place, but the urgency is gone. Patients have returned to in-person care for a wide range of conditions, and practices are no longer operating in crisis mode. The question is no longer "how do we keep patients out of the office?" but "which of these visits genuinely belong outside the office?"

That is a better question, and answering it carefully, rather than defaulting to either full reversion or unlimited virtual access, is what distinguishes a well-run practice from one still reacting to events.

What Allergy & Immunology Actually Requires In Person

The specialty has non-negotiable physical requirements that no video platform can replicate. Allergy skin testing, percutaneous and intradermal, requires a patient in the chair, trained staff, and emergency equipment within reach. Subcutaneous immunotherapy (allergy shots) requires the injection, the 20-to-30-minute observation period, and the capacity to treat systemic reactions on site. Spirometry and bronchoprovocation testing for asthma require calibrated equipment and direct supervision.

These services are not candidates for telehealth. They are also among the highest-value services an allergy practice provides, both clinically and financially. Any telehealth strategy that inadvertently discourages patients from coming in for testing or initiation of allergen immunotherapy is working against the practice's core purpose.

Biologics administration, dupilumab, omalizumab, mepolizumab, and others, occupies a middle ground. Some patients self-inject at home after training; others require in-office administration. Telehealth can support monitoring, symptom review, and shared decision-making around biologic therapy without replacing the moments that require physical presence.

Where Virtual Care Adds Genuine Value

Within those constraints, telehealth addresses real needs efficiently. Follow-up visits for patients already established on immunotherapy maintenance, patients managing mild-to-moderate allergic rhinitis or controlled asthma between seasonal peaks, and post-procedure check-ins after testing or procedures all translate well to video.

Food allergy counseling, reviewing avoidance strategies, emergency action plans, and epinephrine auto-injector use, is another example where a structured video visit is often as clinically effective as an in-person encounter and considerably more convenient for families. Parents managing children with peanut, tree nut, or milk allergies frequently struggle to carve time from work and school schedules; removing that barrier increases adherence.

Medication reviews and prior authorization conversations, which consume clinician time without requiring physical examination, are natural fits for brief telehealth encounters or even asynchronous messaging through the patient portal. Routing these efficiently protects appointment slots for the work that genuinely needs them.

The Referral Relationship and Telehealth

A less-discussed dimension is what telehealth does, or does not do, for the practice's relationship with referring primary care physicians. For years, a central challenge in allergy and immunology has been the gap between the number of patients PCPs suspect would benefit from specialist evaluation and the number who actually arrive for an appointment. Transportation, schedule conflicts, and patient inertia all contribute to that gap.

Telehealth narrows it selectively. A patient who hesitates to drive 45 minutes for an initial consultation may accept a 20-minute video visit for a preliminary discussion and testing triage. Once the relationship is established and the patient understands the value of in-person testing, compliance tends to improve. Practices that communicate this pathway clearly to referring physicians, "we can do a virtual intake, then bring them in for the panel", often find PCPs more willing to refer patients they would otherwise have managed empirically.

The practical implication is that telehealth intake, when designed thoughtfully, can actually increase testing volume rather than substitute for it.

Payer Policy and the Revenue Picture

Through most of 2021, Medicare and many commercial payers have continued reimbursing telehealth at rates comparable to in-person visits, supported by ongoing public health emergency declarations. That parity is not guaranteed to persist. Practices building telehealth into their care model should do so with realistic assumptions about what reimbursement looks like when full parity ends.

For now, the economics are workable, particularly for follow-up visit codes that historically reimbursed at rates where chair time and overhead matter. The administrative overhead of telehealth, consent documentation, platform costs, technical support, is real but manageable if the practice has standardized its workflows.

Where telehealth economics become strained is at the low end of visit complexity: brief medication refill confirmations or minor symptom checks that a portal message or nurse call could handle at lower cost. Practices should resist the temptation to convert every interaction into a billable telehealth visit; that approach invites payer scrutiny and erodes the goodwill patients develop when they feel the care model is designed for them rather than for revenue optimization.

Technology and Patient Experience

The platforms that work best for allergy practices in late 2021 are those integrated, or cleanly interfaced, with the practice's existing electronic health record. Platforms that require patients to download unfamiliar applications or create new accounts introduce friction that disproportionately affects older patients, those with limited digital literacy, and those accessing video on a smartphone with a slower connection.

The front desk's role in telehealth success is often underestimated. Staff who can walk a patient through joining a video visit, troubleshoot audio issues quickly, and recognize when to reschedule rather than persist through a broken connection make the difference between a visit that builds trust and one that damages it. Training and scripting for these scenarios is an investment that pays dividends in patient retention and online reviews.

Patients who successfully navigate a telehealth visit and receive care that feels attentive and thorough are likely to mention it when asked about their experience. Patients who struggled for fifteen minutes with a login screen before giving up are equally likely to mention that. The technology is a patient experience variable, not merely a clinical delivery mechanism.

Scheduling, Templates, and Workflow

Practices that treat telehealth as a scheduling afterthought, fitting virtual visits into whatever open slots appear, tend to struggle with it operationally. Dedicated telehealth blocks, even if small, allow staff to anticipate the workflow: confirming technology access with patients in advance, preparing chart documentation, and arranging interpreter services if needed.

Template design matters as well. A telehealth follow-up for a patient on grass pollen immunotherapy at maintenance requires a different documentation structure than a new-patient video intake. Building templates that prompt clinicians to gather the right information, symptom severity, current medication list, any reactions since the last visit, reduces variation and protects against documentation gaps that create problems at audit or prior authorization.

The practices that have operationalized telehealth most effectively are those that reviewed their most common follow-up visit types, built specific protocols for each, and trained staff on the differences. That rigor is available to any practice willing to invest a few hours in process design.

Patient Communication and Online Presence

Telehealth availability is a factor patients increasingly consider when evaluating a specialist practice, particularly those in suburban and rural areas where the drive to a subspecialty office is meaningful. Practices that clearly communicate their telehealth options on their website, including which visit types are available virtually, how to schedule, and what technology patients need, receive measurable returns in inquiry volume.

Google Business Profile, still one of the highest-leverage local search tools available to a medical practice, now supports a telehealth attribute. Ensuring that attribute is populated, alongside accurate office hours and correct service categories, keeps the practice visible to patients searching for allergy specialists who offer virtual care.

Online reviews increasingly reference telehealth experiences. A practice that receives consistent praise for convenient, well-run virtual visits builds a reputation that compounds over time. Conversely, a practice that offers telehealth nominally but executes it poorly may find that negative reviews in this specific area outweigh clinical quality signals that are harder for patients to evaluate.

Looking Ahead

The trajectory of telehealth in allergy and immunology is not a return to the pre-pandemic baseline, nor is it a permanent state of maximum virtual access. It is a maturation, a sorting of visit types into the channels that serve them best, supported by workflows designed for those channels rather than improvised around them.

Practices that approach this sorting deliberately, with specific protocols for immunotherapy follow-up, biologic management, food allergy counseling, and patient intake, will find that telehealth strengthens rather than fragments their care model. The practices that either abandon virtual care entirely or continue offering it without structure will miss the operational and patient experience advantages that the better-positioned practices are quietly building.

The emergency is over. The work of doing this well is just beginning.