Medical causation and expert testimony: allergists at this intersection of medicine and law

Clinical practice always necessitates proper diagnosis and correct treatment. For most clinical fields, determining the cause of the illness is irrelevant to the intervention. An oncologist, for example, has no need to explore the "cause" of the patient's lymphoma. Allergists, by contrast, have tools and the need to examine the relevant allergen which is the putative "cause" of the patient's allergic symptomatology. In the context of a legal claim, the "cause" of the symptoms or disorder is central, because it determines financial responsibility. However, in the case of an allergic disorder and identified allergen, a claim requires more. Whose allergen? Where did it come from? These are crucial questions that must be answered. This paper explores the approaches to causal assessment which are important for the clinical allergist as he/she navigates the interface between clinical practice and legal proceedings. Its purpose is to help the allergist understand that interface, and to be prepared to enter an unfamiliar legal arena.