important that primary care physicians also assess the allergic triggers of these diseases. However, proper diagnosis and treatment for allergy and asthma are limited by the inadequate state of allergy knowledge within primary care. (The WAO estimate of allergy prevalence of the whole population by country ranges between 10 - 40%).III Allergy training at the undergraduate level is almost non-existent in several countries, paired with little exposure to post-graduate allergy training except for physicians pursuing a career in allergy. It is not surprising that allergists obtain superior outcomes with asthma sufferers compared to the primary care physicians who see the majority of the patients. Supporting Statement by the International Primary Care Respiratory Group 6 Pawankar, Canonica, Holgate and Lockey Copyright 2011 World Allergy Organization Unmet Needs • Management of Allergy: The limited data available suggest that a structured approach to care delivery has a positive impact on outcomes, and at reduced costs. A systematic approach to disease management has been undertaken in Finland in the area of asthma which has delivered decreased morbidity, mortality and, of particular interest to governments worldwide, decreased costs, both direct and indirect. This program is being further developed to reduce the impact of allergic disease.5 The United Kingdom Royal College of Physicians published a document, “Allergy the Unmet Need” in 20036 which provides descriptions of prevalence of allergic disease as well as current service delivery and training needs pertaining to allergy care. This study may be used as a model of assessment by countries wishing to adopt a structured approach to care delivery or similar solutions for optimal patient care. These solutions, of course, need to be country-specific and will depend on national health care delivery systems. • Research in Allergy: Extensive research is needed at the Primary Care level for the diagnosis, prevention, treatment and management of all types of respiratory and related allergies in both developed and developing / low and middle income countries (LMIC). The International Primary Care Respiratory Group (www.theipcrg.org) focuses on such research needs, and has produced a comprehensive document detailing the needs for developed and LMIC.7 • Awareness of allergic problems: Governments globally need to be made aware of the morbidity currently caused by respiratory and allergic disorders and associated costs. Some of these costs may as yet be poorly quantified, particularly the costs of presenteeism (when someone is present at work but with reduced productivity due to a disease or the treatment for that disease), as well as absenteeism. With the proper awareness of the scope of the problem, governments need to ensure that the training, skills and infrastructure exist with which to develop and provide effective and efficient care delivery. 1. Training in Allergy: The WAO has led the way in describing the minimum allergy curriculum requirements at the undergraduate level8 . Introducing a structured allergy curriculum into undergraduate training may, of course, take several years to make a significant impact. However, given that allergy is so prevalent, allergy training in some form, even modular, should be considered an essential part of general professional training for all physicians. 2. GPs with a special interest: A further possibility is to create a cohort of General Practitioners with a special interest in allergy with the joint task of developing and providing a clinical service in primary care at the same time as raising skills within their community9 . To date there is only one recorded incidence of this innovative proposal having reached fruition, but it was a success.10 3. Guidelines in Allergy: Regularly produced and updated international and national allergic respiratory diseases guidelines will help to promote high quality care in primary care, Primary Care physicians need to be appropriately represented on these guideline committees to ensure that they are grounded in what is realistic and achievable. References 1. Bauchau V, Durham SR. Prevalence and rate of diagnosis of allergic rhinitis in Europe. Eur Respir J. 2004