Allergist and Immunologist Salary Guide 2026: Immunotherapy, Biologics, and Practice Income

Allergist / immunologist salary overview 2026

Allergy and clinical immunology (A&I) is a cognitive specialty with a robust recurring revenue model driven by allergen immunotherapy, in-office diagnostic testing, and — increasingly — biologic administration. Mean total compensation in 2026 ranges from $220,000–$380,000 in academic settings, $250,000–$420,000 in employed health system or multi-specialty group practices, and $320,000–$600,000+ in private allergy practices — particularly those with mature subcutaneous immunotherapy (SCIT) patient panels and in-office biologic administration programs. The specialty's income ceiling is meaningfully higher in private practice than employed models because of the technical revenue captured through in-office allergy extract preparation, injection administration services, and drug buy-and-bill on biologics.

Income by practice setting

• Academic allergy and clinical immunology: $220,000–$380,000; research-heavy, often at NCI-designated cancer centers or major academic medical centers with primary immunodeficiency and mast cell programs; significant NIH R01 and NIAID grant supplement potential; complex cases (PIDD, CVID, hereditary angioedema, mastocytosis); lower income vs. private, offset by research exposure and fellowship training
• Employed multi-specialty group or health system: $250,000–$420,000; wRVU production bonus structure; allergy testing and immunotherapy typically included but extract preparation and SCIT billing efficiency varies by system; lower income than private due to institutional overhead capturing more of the ancillary revenue
• Private allergy practice (solo or group): $320,000–$600,000+; physician-owned; captures allergen extract preparation billing (CPT 95144–95165), injection administration fees (CPT 95115–95117), and drug buy-and-bill on biologics; mature immunotherapy patient panel of 200–500 active SCIT patients generates $150,000–$500,000+ in annual recurring injection and extract revenue alone; highest income in specialty
• Allergy franchise / PE-backed group: $280,000–$480,000; growing model; Allergy Partners, AllerVie, Integrated Allergy and Asthma and similar platforms; higher base than solo private, but partnership economics differ from legacy physician-owned practice; productivity bonuses tied to patient volume and immunotherapy enrollment

Revenue drivers: allergen immunotherapy

• Allergy skin testing (prick/scratch): CPT 95004; professional fee $8–$20 per tested allergen; comprehensive prick panel (50–80 allergens) generates $400–$1,600 per new patient diagnostic workup; high volume per hour (one tech can run multiple patients)
• Intradermal allergy testing: CPT 95010–95024; professional fee $15–$35 per allergen; used for stinging insect allergy and specific drug allergy diagnosis; performed after negative prick test
• Allergen extract preparation: CPT 95144 (single dose vial), 95145–95170 (multi-dose vials by antigen type), 95165 (allergen extract per dose); extract preparation billing generates $50–$300+ per patient per vial set; private practice allergists who prepare their own extracts capture this revenue entirely; health system employees typically do not
• SCIT injection — build-up: CPT 95115 (single injection, no office visit) / 95117 (2+ injections); $25–$60 per injection visit; build-up phase involves weekly visits for 3–6 months; a 500-patient SCIT panel with 200 patients in build-up generates 200 × 1 visit/week × $40 = $416,000/year in injection fees alone
• SCIT injection — maintenance: CPT 95115/95117; maintenance injections monthly for 3–5 years; per-patient annual injection revenue $400–$800/year; a 300-patient maintenance panel generates $120,000–$240,000 in annual recurring injection revenue with minimal physician time (nurse-administered)
• Total SCIT panel economics: A mature private allergy practice with 500 active immunotherapy patients (mix of build-up and maintenance) generates $200,000–$600,000/year in allergen extract preparation + injection fees — revenue that requires minimal physician time once patients are established and continues flowing even when the allergist is not in the office; this recurring revenue base is the primary economic advantage of private allergy practice over employed allergy practice
• Sublingual immunotherapy (SLIT) tablets: FDA-approved products — Grastek (timothy grass), Ragwitek (short ragweed), Odactra (dust mite), Palforzia (peanut); prescribed as daily self-administered tablets; pharmacy-dispensed (no physician buy-and-bill); lower revenue per patient than SCIT but lower overhead and patient adherence barrier

Biologic administration: buy-and-bill and infusion economics

• Omalizumab (Xolair) — allergic asthma and chronic spontaneous urticaria: CPT 96372 (SC injection administration); drug J-code J2357; biweekly or monthly injection; drug cost $1,200–$2,400/dose WAC; ASP-based buy-and-bill in physician office generates $150–$500+ per dose in margin above acquisition cost depending on contract; administration fee $50–$150; Xolair was the first major biologic in allergy and remains widely prescribed
• Dupilumab (Dupixent) — atopic dermatitis and asthma: CPT 96372 (SC injection); drug J-code J0222; every 2 weeks; less commonly in-office administered (most patients self-inject at home after loading dose); in-office loading dose administration generates administration fee billing
• Mepolizumab (Nucala) — severe eosinophilic asthma: CPT 96372; J-code J3302; monthly SC injection; typically given in physician office; drug cost $2,500–$3,500/month; ASP buy-and-bill generates $200–$600+ margin per dose; 50-patient mepolizumab panel generates $120,000–$360,000/year in drug margin alone
• Benralizumab (Fasenra) — severe eosinophilic asthma: CPT 96372; every 4 weeks for 3 doses, then every 8 weeks; drug cost $3,500–$5,000/dose; similar buy-and-bill economics to mepolizumab
• Tezepelumab (Tezspire) — severe uncontrolled asthma: CPT 96372; monthly SC injection; approved regardless of eosinophilic phenotype; growing adoption for severe asthma patients who don't respond to type 2 biologics
• Canakinumab (Ilaris) — autoinflammatory diseases (CAPS, TRAPS, FMF): Subcutaneous or IV; clinical immunology subspecialty; very high drug cost ($15,000–$30,000/dose); rare but high-margin per case for clinical immunologists managing primary immunodeficiency and autoinflammatory disease

Allergy diagnostic procedures

• Bronchial provocation testing (methacholine challenge): CPT 94070; professional fee $300–$600; asthma diagnosis and asthma severity evaluation; requires spirometry equipment and protocol
• Spirometry with bronchodilator response: CPT 94010 (spirometry) + 94060 (pre/post bronchodilator); $150–$350 combined; in-office pulmonary function testing is a standard ancillary in allergy/asthma practice
• Patch testing (contact dermatitis panel): CPT 95044; professional fee $200–$500; 72–96 hour patch reading for contact allergen identification; requires TRUE Test or NACDG patch series; growing demand with increasing prevalence of contact dermatitis from personal care products, medical adhesives, and occupational exposures
• Food challenge (oral food challenge, OFC): CPT 95076 (initial 120 min) + 95079 (each additional hour); professional fee $400–$1,200 for monitored OFC; gold standard for food allergy diagnosis and tolerance assessment; growing demand driven by Palforzia OIT (peanut oral immunotherapy) patient selection
• Specific IgE blood testing (ImmunoCAP): CPT 86003 (per allergen); $30–$80/allergen ordered; supplementary to skin testing; 20-allergen panel generates $600–$1,600 laboratory billing
• Drug allergy evaluation (penicillin skin testing): CPT 95018 + 95010; penicillin allergy delabeling program; growing hospital-pharmacy collaboration generating institutional referrals; professional fee $200–$500 per evaluation session

Geographic variation in allergist / immunologist compensation

• Sun Belt private practice markets (FL, TX, AZ, GA): $350,000–$600,000+; high pollen burden, year-round allergy season, large patient population; strong private allergy practice culture; FL and TX have robust independent allergy practice markets with active SCIT programs
• Major metro employed markets (NYC, Chicago, Boston, LA): $280,000–$450,000 employed; higher cost of living, dense competition; academic center proximity; clinical immunology complex disease volume (PIDD, HAE) higher in metro markets
• Midwest and Southeast community markets: $260,000–$430,000; mix of employed and private; seasonal allergy burden moderate; rural markets have significant access gaps for allergy specialty care — telehealth allergy is growing but in-person skin testing remains the diagnostic standard
• Academic research centers (NIH campus, Johns Hopkins, UCSF): $220,000–$380,000; primary immunodeficiency and mast cell disease specialty programs; deep subspecialty case complexity; NIAID R01 funding critical for academic allergist career advancement

What we see at Ava Health

Allergy and immunology is one of the few specialties where the private practice income advantage over employed medicine is both large and structurally durable — driven by recurring immunotherapy revenue that compounds over time as a SCIT patient panel grows. Allergists in our network who have been in private practice 10+ years routinely report that their immunotherapy patient panel generates $300,000–$500,000/year in essentially passive injection and extract billing, providing an income floor that is highly resistant to changes in patient volume or insurance reimbursement. For allergists evaluating employment vs. private practice, the economic analysis almost always favors private practice over a 10-year horizon — but requires capital (equipment, lease, staff) and the discipline to build a SCIT enrollment funnel. The candidates who struggle with the private practice model are those who don't systematically convert new patients to immunotherapy; the candidates who thrive are those who make allergy immunotherapy enrollment a core workflow for every appropriate patient on day one.

Related: Pulmonologist Salary Guide, Dermatologist Salary Guide, Rheumatologist Salary Guide, Pediatrician Salary Guide.