Expert second opinions for complex allergic and immunologic conditions

Consultations for challenging diagnoses and treatments that have not worked as expected

When standard treatments fall short or a diagnosis remains unclear, specialized expertise can change the direction of care. Dr. David I. Bernstein provides unhurried, fee-for-service consultations for adults with difficult, rare or treatment-resistant allergic and immunologic disorders.

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Portrait of Dr. David I. Bernstein — **David I. Bernstein, MD**FAAAAI, FACAAI, FACP
Emeritus Professor of Medicine, University of Cincinnati

Board certification: Allergy & Immunology; Internal Medicine
Former Chair: American Board of Allergy and Immunology
Peer-reviewed publications: 300+
Appointments: 513-931-0775

Is a second opinion right for you?

Many patients seek a consultation when one or more of these apply.

Symptoms continue despite following the treatment plan
You have needed repeated courses of oral steroids
A diagnosis has been given but does not seem to fit
You have seen several physicians without a clear answer
A biologic or other advanced therapy is being considered
You avoid foods or medications based on an allergy label that was never confirmed
Symptoms seem linked to your workplace
You want an expert review before a major treatment decision

Why a specialist's second look matters

Published research shows how often allergic and respiratory diagnoses deserve a careful second review, and what more time with a physician can change.

21%

Diagnoses can change on expert review

Among 286 patients referred to Mayo Clinic for a second opinion, the final diagnosis was distinctly different from the referral diagnosis in 21% of cases and refined in another 66%.¹

33%

Asthma is not always asthma

When 613 Canadian adults with physician-diagnosed asthma were retested, current asthma could not be confirmed in 33%, and 2% had a serious heart or lung condition that had been misdiagnosed as asthma.²

19%

Food allergy labels deserve testing

In a national survey of more than 40,000 U.S. adults, 19% believed they had a food allergy, while about 10.8% reported reactions consistent with a true food allergy. The authors call for confirmatory testing so foods are not avoided unnecessarily.³

<5%

Most penicillin allergies are not

About 10% of Americans report a penicillin allergy, yet clinically significant penicillin hypersensitivity is uncommon (under 5%). Evaluation can safely restore first-choice antibiotics.⁴

4,166

Specialist care improves asthma outcomes

In a matched study of 4,166 pairs of adults with asthma, those who saw an asthma specialist used fewer rescue inhalers and oral steroid courses and had fewer hospitalizations in the following year than those treated only in primary care.⁵

8.1M

Time with your physician matters

An analysis of 8.1 million U.S. primary care visits found that shorter visits were associated with more inappropriate antibiotic prescribing. A fee-for-service consultation is scheduled for the time a complex case requires.⁶

These findings come from published studies of other patients and settings. They describe why expert review can help; they do not predict the result of any individual consultation.

Areas of clinical focus

Advanced diagnostic evaluation and targeted treatment strategies across a full range of complex conditions.

Mast cell activation

Mast cell induced symptoms related to hypermobility, Ehlers-Danlos syndrome (EDS), POTS and dysautonomia.

Severe and refractory asthma

Evaluation of steroid-resistant asthma and occupational asthma, and selection of advanced biologic therapy.

Allergic lung disorders

Diagnostic clarity for overlapping environmental allergies and atypical hypersensitivity, including immunologic lung disease.

Chronic urticaria and angioedema

Management of treatment-resistant hives, swelling disorders and mast cell variations.

Adverse food reactions

Differentiating true IgE-mediated food allergy from non-allergic gastrointestinal intolerance.

Challenging skin disorders

Comprehensive evaluation of chronic rashes of unknown cause, including allergic contact dermatitis.

A career in allergy and clinical immunology

45+years of tertiary care experience

300+peer-reviewed publications

37years directing UC's allergy fellowship (1982–2019)

Academic leadership: Emeritus Professor of Medicine, Division of Immunology, Allergy and Rheumatology, University of Cincinnati College of Medicine. Director of the University of Cincinnati Allergy Fellowship Training Program from 1982 to 2019; now Associate Director.
Board leadership: Former Member and Chair, American Board of Allergy and Immunology. Former Board of Regents, American College of Allergy, Asthma and Immunology. Former member, Joint Task Force for Practice Parameters in Allergy.
Recognition: Distinguished Clinician Award, American Academy of Allergy, Asthma and Immunology. Distinguished Fellow Award, American College of Allergy, Asthma and Immunology. Outstanding Alumni Award, University of Cincinnati College of Medicine. Alpha Omega Alpha.
Research: Principal Investigator, Bernstein Clinical Research Center since 1982. Research in occupational asthma and allergy, the safety of allergy immunotherapy, and the effects of air pollutants on allergic disease in children. Author or co-author of more than 300 peer-reviewed publications (view on PubMed).
Board certification: American Board of Allergy and Immunology (participating in Maintenance of Certification); American Board of Internal Medicine; Diagnostic Laboratory Immunology.
Training: MD, University of Cincinnati College of Medicine. Internal Medicine residency, Cleveland Clinic. Fellowship in Adult and Pediatric Allergy and Clinical Immunology, Northwestern University.

How a consultation works

The consultative practice is fee-for-service, which allows unhurried, thorough evaluations independent of insurance visit-length limits.

Send a brief case inquiry
Email info@bernsteinallergy.com with a short description of your history and the treatment challenges you face. Please do not email detailed medical records.
Schedule your consultation
If you decide to proceed, call Advanced Allergy Services, LLC at 513-931-0775. Consultation fees are explained when you schedule, and you will receive a written Good Faith Estimate of expected charges.
Comprehensive evaluation
An in-depth review of your medical records, testing, lifestyle and environmental factors, and the treatments you have tried.
Your written recommendations
A second opinion report outlining diagnostic recommendations and treatment options, ready to share with your primary care team and other physicians.

Continuing care with Dr. Bernstein

After a consultation, some patients choose ongoing personalized care through the Advanced Allergy Services membership program. It includes an annual fee as well as fees for office visits.

More time

Appointments of at least 30 minutes, with each physician's practice limited in size.

Direct access

A direct phone line or secure messaging for urgent concerns, plus telehealth visits.

Help with the details

Support with specialty pharmacies, prior authorizations for advanced therapies, and medical forms.

Laboratory testing, medications and imaging are billed through your health insurance. Membership and visit fees may be reimbursable through out-of-network benefits or a Health Savings Account, and CareCredit financing is available. Details are on the Advanced Allergy Services membership page.

Clinical research

Dr. Bernstein is a Principal Investigator at the Bernstein Clinical Research Center in Cincinnati, which conducts clinical trials of new treatments for allergic and respiratory diseases in adults and children.

900+clinical trials conducted

40+years of clinical trials

Research areas: Asthma; seasonal and perennial allergic rhinitis; eczema and atopic dermatitis; chronic hives; chronic obstructive pulmonary disease (COPD); hereditary angioedema; chronic cough; sublingual immunotherapy.
Research team: Physician investigators David I. Bernstein, MD and Jonathan A. Bernstein, MD, with a nurse practitioner, certified clinical research coordinators and research staff.
Taking part in a study: Physicians review each volunteer's medical history to determine eligibility. Study-related visits, procedures and tests are provided at no cost, and many studies compensate participants for time and travel.
Contact the research center: Call 513-728-4747 or see the studies currently enrolling at the Bernstein Clinical Research Center. Studies are held at 4665 East Galbraith Rd, 2nd floor, Cincinnati.

Study availability changes often. Please call the research center to confirm which studies are enrolling.

Expert witness and medical-legal consultation

Dr. Bernstein serves as a medical expert in legal matters involving allergic, immunologic and occupational respiratory disease, drawing on more than four decades of clinical practice, research and national board leadership.

Areas of expertise

Occupational asthma and workplace exposures; anaphylaxis and severe allergic reactions; drug and food allergy; allergen immunotherapy safety; chronic urticaria and angioedema; contact dermatitis; standard of care in allergy and immunology.

Services for attorneys

Review of medical records and case materials, independent evaluation, written expert opinions, and testimony.

Attorneys may contact info@bernsteinallergy.com or call 513-931-0775 to discuss a matter. A curriculum vitae and fee schedule are available on request.

Frequently asked questions

Does Dr. Bernstein accept insurance?

Consultations are fee-for-service and are not billed to insurance. Laboratory testing, medications and imaging are billed through your insurance. Some patients submit consultation receipts for out-of-network reimbursement or use Health Savings Account funds.

I have Medicare. Can I schedule a consultation?

Please mention that you have Medicare when you call the office. The staff will explain how fees work for Medicare beneficiaries before you schedule.

I live outside Ohio. Can I still be seen?

Include your state of residence in your inquiry. The office will explain the options available to you, which may include traveling to the Cincinnati office.

What should I send before my visit?

After scheduling, the office will tell you how to share records securely. Helpful records include recent physician notes, allergy and lab results, lung function tests, imaging reports and a current medication list.

Will my own physicians stay involved?

Yes. The written recommendations are designed to be shared with your primary care physician and specialists, who can continue your care.

Is this service for urgent problems?

No. Email inquiries are not monitored for emergencies. If you are having a medical emergency, call 911 or go to the nearest emergency room.

For referring physicians

Dr. Bernstein welcomes referrals of patients with difficult-to-diagnose or treatment-resistant allergic and immunologic conditions, including severe asthma, mast cell disorders, chronic urticaria, occupational lung and skin disease, and suspected food or drug allergy. A written consultation report is returned to the referring physician.

To refer a patient, call Advanced Allergy Services at 513-931-0775.

References

Van Such M, Lohr R, Beckman T, Naessens JM. Extent of diagnostic agreement among medical referrals. J Eval Clin Pract. 2017;23(4):870-874. doi:10.1111/jep.12747
Aaron SD, Vandemheen KL, FitzGerald JM, et al. Reevaluation of diagnosis in adults with physician-diagnosed asthma. JAMA. 2017;317(3):269-279. doi:10.1001/jama.2016.19627
Gupta RS, Warren CM, Smith BM, et al. Prevalence and severity of food allergies among US adults. JAMA Netw Open. 2019;2(1):e185630. doi:10.1001/jamanetworkopen.2018.5630
Shenoy ES, Macy E, Rowe T, Blumenthal KG. Evaluation and management of penicillin allergy: a review. JAMA. 2019;321(2):188-199. doi:10.1001/jama.2018.19283
Rosman Y, Hornik-Lurie T, Meir-Shafrir K, et al. The effect of asthma specialist intervention on asthma control among adults. World Allergy Organ J. 2022;15(11):100712. doi:10.1016/j.waojou.2022.100712
Neprash HT, Mulcahy JF, Cross DA, et al. Association of primary care visit length with potentially inappropriate prescribing. JAMA Health Forum. 2023;4(3):e230052. doi:10.1001/jamahealthforum.2023.0052

Start a case inquiry

Email Dr. Bernstein a brief description of your case

info@bernsteinallergy.com

Call Advanced Allergy Services, LLC to schedule

513-931-0775

Advanced Allergy Services office

4665 East Galbraith Rd, 2nd floor
Cincinnati, OH 45236

Please keep email inquiries brief and do not send detailed medical records, test results or images by email. Consultations are fee-for-service; fees for the initial consultation are explained when you schedule.