The science-to-practice gap in allergology: a critical appraisal of determinants and knowledge-translation strategies across health systems

INTRODUCTION: Evidence-based medicine assumes that high-quality research, once produced, will reach the bedside. In allergology this assumption is repeatedly violated. Solid evidence accumulates while its uptake in daily practice remains incomplete and variable across health systems. AREAS COVERED: This critical appraisal characterizes the science-to-practice gap in allergology using current data, drawn from a search of PubMed, MEDLINE, Embase, and the Cochrane Library covering January 2015 to March 2026. It examines the gap's determinants across institutional and economic contexts and evaluates knowledge-translation (KT) strategies with the strongest evidence base. ARIA, GINA, and EAACI adherence is quantified for allergic rhinitis, asthma, and AIT, with AIT uptake estimates treated as setting-specific rather than universal. Four determinant domains, education, conflicts of interest, reimbursement, and local adaptation, are compared across high-income EU countries, the UK, and low- and middle-income countries, and five KT strategies are appraised. EXPERT OPINION: The gap is measurable, clinically consequential, and modifiable. Its persistence reflects structural and policy factors more than clinician knowledge. Combinations of audit-and-feedback and academic detailing, tailored to local environments and supported by clinical decision tools, offer the most durable improvement documented to date. Allergological societies should integrate implementation science and independent conflict-of-interest management into their strategic priorities.