What specialty does immunology fall under? A Comprehensive Guide to the Immunologist's Role

October 1, 2025 •

4 min read

According to the American Academy of Allergy, Asthma & Immunology (AAAAI), an allergist-immunologist completes at least nine years of post-bachelor's education to specialize in the immune system, revealing the extensive training required for this field. This deep-dive explores precisely what specialty does immunology fall under within the medical hierarchy and clarifies the crucial role these specialists play in managing a wide range of complex health conditions.

Quick Summary

Immunology is a subspecialty of internal medicine or pediatrics, with physicians completing a fellowship in allergy and immunology to specialize in immune system disorders, allergies, and autoimmune conditions.

Key Points

Subspecialty Training: An immunologist is a subspecialist, first completing a residency in internal medicine or pediatrics before pursuing a two-year fellowship in allergy and immunology.
Dual Expertise: Allergist-immunologists are trained to diagnose and treat both allergic conditions (e.g., asthma, hay fever) and immune system disorders (e.g., primary immunodeficiencies).
Immune Dysfunctions: Their expertise covers immune system overreactions (allergies), under-reactions (immunodeficiencies), and misdirected attacks on the body (autoimmunity).
Interdisciplinary Care: Immunologists often work with other specialists, like rheumatologists for autoimmune conditions or infectious disease doctors for recurrent infections.
Broad Patient Base: Immunologists treat patients of all ages, as their training in either pediatrics or internal medicine allows them to specialize in either child or adult care.
Dynamic Field: The field of immunology is rapidly advancing, with ongoing research in areas such as immunotherapy, vaccines, and autoimmune disease treatment.

The Core Specialization: A Subspecialty of Internal Medicine or Pediatrics

In the medical field, immunology is not a primary residency but rather a subspecialty. A physician must first complete a residency in either internal medicine or pediatrics before pursuing further advanced training. This foundational period provides a comprehensive understanding of the entire human body, preparing the doctor to understand how immune system dysfunction can affect various organs and systems.

The Path to Board Certification

To become a board-certified allergist-immunologist, a physician follows a rigorous educational path:

Undergraduate Education: A four-year bachelor's degree, typically in a science-related field.
Medical School: A four-year Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) program.
Residency: A three-year residency in either internal medicine (for adults) or pediatrics (for children).
Fellowship: A two-year fellowship specifically focused on allergy and immunology. During this time, they gain expertise in advanced diagnosis, testing, and treatment of immune system diseases.
Board Certification: Finally, the physician must pass a certifying examination administered by the American Board of Allergy and Immunology (ABAI) to officially become a specialist in the field.

The Range of Conditions Treated by an Immunologist

An immunologist, also often called an allergist, treats a broad spectrum of diseases stemming from an overactive, underactive, or misdirected immune system.

Conditions related to overactive immunity (allergies and hypersensitivity):

Allergic rhinitis (hay fever)
Asthma with an allergic component
Food and drug allergies
Insect sting allergies
Eczema (atopic dermatitis)
Hives and angioedema (swelling)
Anaphylaxis

Conditions related to underactive immunity (immunodeficiency disorders):

Primary immunodeficiencies (PI), which are often genetic and present from birth, making individuals susceptible to frequent infections.
Secondary or acquired immunodeficiencies, such as those caused by HIV/AIDS or certain medications.

Conditions related to misdirected immunity (autoimmune diseases):

While rheumatologists often take the lead on autoimmune diseases, immunologists are crucial in the management of systemic autoimmune and autoinflammatory conditions.

Interdisciplinary Collaboration: Immunology and Related Fields

The immune system does not operate in a vacuum. Therefore, immunologists frequently collaborate with other specialists to provide comprehensive care, especially for patients with complex conditions. The distinction and overlap with other specialties are important for understanding the scope of immunology.

Immunology vs. Rheumatology

Both immunologists and rheumatologists are subspecialists trained in internal medicine or pediatrics, and both treat conditions related to the immune system. However, their primary focus differs:

Immunologists focus on immune system dysfunctions like allergies and immunodeficiencies.
Rheumatologists specialize in autoimmune diseases and inflammatory conditions primarily affecting the musculoskeletal system, such as rheumatoid arthritis, lupus, and vasculitis.

Often, a patient with a complex autoimmune disease may see both specialists for coordinated care, as illustrated by combined training programs in some institutions.

Immunology and Infectious Disease

Immunologists and infectious disease specialists also have a close relationship. While immunologists study the immune response to infection, infectious disease specialists focus on the pathogens themselves and the treatment of the infections they cause. A patient with a severe or recurrent infection might see an immunologist to investigate an underlying immunodeficiency, while an infectious disease specialist would manage the antibiotic or antiviral treatment.

The Future of Immunology

As research in molecular and genetic discoveries continues to expand, the field of immunology is evolving rapidly. Immunotherapy for cancer, new vaccine technologies, and targeted treatments for autoimmune disorders are just some of the cutting-edge areas driving innovation. This dynamic field requires specialists who are not only clinicians but also active participants in research and discovery.


Feature	Allergist-Immunologist	Rheumatologist	Infectious Disease Specialist
Core Training	Internal Medicine or Pediatrics	Internal Medicine or Pediatrics	Internal Medicine or Pediatrics
Subspecialty Focus	Immune system function, allergies, immunodeficiency, autoimmunity	Musculoskeletal and systemic autoimmune disorders	Bacterial, viral, and parasitic infections
Common Conditions	Asthma, food allergy, hay fever, primary immunodeficiency	Rheumatoid arthritis, lupus, gout, vasculitis	Pneumonia, HIV, hepatitis, sepsis
Diagnostic Tests	Allergy skin tests, blood tests for IgE/antibodies, immune function tests	Blood tests for inflammatory markers, autoantibodies, imaging	Blood cultures, PCR tests, microbiology studies
Key Treatment Areas	Immunotherapy (allergy shots), medication for allergies and asthma, IVIG for immunodeficiency	Immunosuppressive drugs, biologics, corticosteroids	Antibiotics, antiviral medications

Conclusion: A Specialized Branch for a Complex System

In conclusion, what specialty does immunology fall under? The answer is clear: it is a subspecialty of either internal medicine or pediatrics, often combined with training in allergy. The path to becoming an allergist-immunologist is long and demanding, preparing physicians to diagnose and manage a vast array of conditions caused by immune system dysfunction, from everyday allergies to rare immunodeficiency syndromes and systemic autoimmune diseases. Their role is increasingly vital in modern medicine, with implications spanning from routine allergy care to groundbreaking cancer immunotherapies. By understanding this specialization, patients can better navigate the healthcare system and find the right expert to address their immune system-related concerns.

Learn more about this field at the official website for the American Academy of Allergy, Asthma & Immunology (AAAAI).

Frequently Asked Questions

Whether you need a referral to see an immunologist depends on your insurance plan. Many managed care plans require a referral from a primary care provider before you can schedule an appointment with a specialist. It is best to check with your insurance company to be sure.

There is no difference in the United States; the terms are often used interchangeably. Physicians who complete a fellowship in this area are board-certified in both allergy and immunology by the American Board of Allergy and Immunology (ABAI) and are referred to as allergist-immunologists.

An allergist-immunologist diagnoses and manages a wide variety of immune-related disorders, including allergies like hay fever and asthma, food and drug allergies, hives, eczema, and immunodeficiency disorders.

Primary immunodeficiency (PI) is a condition caused by intrinsic defects in the immune system, often genetic, that makes a person more susceptible to frequent and severe infections.

While both are trained in internal medicine and deal with immune issues, an immunologist focuses on allergies and immune deficiencies, while a rheumatologist specializes in autoimmune diseases that affect the musculoskeletal system, such as arthritis and lupus.

Becoming a board-certified allergist-immunologist typically takes at least nine years of training after a bachelor's degree. This includes four years of medical school, a three-year residency in internal medicine or pediatrics, and a two-year fellowship in allergy and immunology.

Your first visit will likely include a comprehensive review of your medical history, family history, and symptoms. The immunologist may conduct allergy skin tests, blood tests, or other diagnostic procedures to assess your immune function.