Adult & Pediatric Allergy & Immunology Cheat Sheet 2026: One-Page Review of Must-Know Facts

Exam Snapshot: Format, Timing, Fees

The Adult & Pediatric Allergy & Immunology subspecialty exam (PAAI) is administered by the American Osteopathic Conjoint Examination Committee on Pediatric and Adult Allergy and Immunology under the AOA. Before you touch a single practice question, memorize this operational skeleton - it shapes how you pace your prep and your test day.

• Question count: 250 multiple-choice items
• Sections: four sections of 90 minutes each, containing 63, 62, 63, and 62 questions respectively
• Breaks: 10 minutes, 30 minutes, 10 minutes - scheduled between sections
• Total appointment length: 6 hours of answering plus 50 minutes of breaks = 6 hours 50 minutes
• Delivery: remote-proctored through MonitorEDU on the PARADIGM examination platform
• Initial exam fee: $1,700; retake fee: $1,400
• Cancellation policy: written cancellation at least 15 full days before the exam qualifies for a refund minus a $300 processing fee

For a fuller walkthrough of how these pieces fit together, see the exam dates and scheduling guide and the certification cost breakdown.

Domain Breakdown at a Glance

The initial-examination blueprint has eight content areas that total 100%. This is the blueprint you should study against - the separate OCC blueprint used for longitudinal assessment is different and not the focus of this cheat sheet.

Notice that four domains - pulmonary diseases, hypersensitivity/mast cell disorders, upper respiratory tract diseases, and skin disorders - each sit in the 10-13% range. Collectively they outweigh basic science, so don't let the single largest domain crowd out balanced review of these four. A domain-by-domain walkthrough with sub-topics lives in the complete exam domains guide.

Basic Science: The 30% You Cannot Skip

Because basic science carries nearly a third of the exam's weight, it deserves the first and most repeated study pass. Many candidates under-invest here because it feels "textbook" rather than clinical - that's a mistake given the scoring math. Treat it as the foundation domain in your first-attempt study guide plan, not an afterthought.

Clinical Domains: Quick-Reference Table

The remaining seven domains are clinically oriented. Use this table as a rapid recall check during your final review pass - if you can't state two or three high-yield topics per row from memory, that domain needs another pass.

Eligibility and Registration Mechanics

Before you can register, confirm you meet the underlying eligibility structure:

• AOBIM or AOBP primary certification
• An active, unrestricted medical license
• Professional and ethical standing consistent with board requirements
• Completion and verification of qualifying allergy/immunology fellowship training

Senior fellows get a limited exception: you may sit for the exam after completing at least 80% of required clinical rotations, but the certification itself is not finalized until your training completion is fully verified. If you're mapping out timing between fellowship graduation and exam eligibility, the requirements and eligibility guide covers this in more depth, and the main certification overview is a good starting reference if you're still confirming pathway details.

Remote Test-Day Logistics

Because delivery is remote-proctored through MonitorEDU on the PARADIGM platform, your test-day checklist looks different from a testing-center exam:

• A suitable computer and a smartphone with a working camera
• Valid identification matching your registration
• A private, quiet test space free of prohibited materials
• Electronic lab values, an on-screen calculator, and a digital scratchpad are all provided within the platform - you don't need to bring your own

Run a full technical check well before your appointment window; remote proctoring failures are avoidable but only if you test your setup in advance. For a broader discussion of what makes this exam demanding beyond logistics, read how hard the exam actually is.

Scoring, Retakes, and Certificate Terms

Passing is determined by a scaled score of 500 on a 200-800 scale - this is not a raw percentage-correct cutoff, so don't try to reverse-engineer a "70% equivalent." The scaling accounts for item difficulty across the form you receive. For a deeper explanation of what that scaled score actually represents, see the passing score breakdown.

If a retake is necessary, the fee drops to $1,400 versus the $1,700 initial fee. Certificate terms also matter for long-range planning:

• Certificates issued before 2025 carry a ten-year term
• The 2025 cohort receives a shorter two-year term

This distinction affects when you'll first engage with maintenance requirements, so confirm which cohort you fall into rather than assuming the standard ten-year cycle applies.

Maintenance and OCC Basics

Once certified, ongoing maintenance (Osteopathic Continuous Certification, OCC) runs on its own separate track from the initial exam blueprint discussed above. Key mechanics to know:

• 16 untimed, open-resource PAAI questions annually
• A 70% annual passing criterion on that component
• A $250 annual assessment fee
• The 2026 assessment cycle is delivered through the AOA Learning Portal
• New diplomates begin OCC participation after one full calendar year of certification - the 2025 cohort starts in 2027
• Maintenance also requires active licensure, primary-board CME compliance (no separate conjoint-subspecialty CME quota), and one quality-improvement activity every ten years

Because OCC uses a different content structure than the initial exam, don't conflate the two blueprints while studying for your first attempt - focus your PAAI prep entirely on the eight-domain initial exam breakdown above.

Final-Week Review Sequencing

With basic science carrying 30% of the weight, your final review weeks should be sequenced deliberately rather than reviewed alphabetically or randomly.

This weighting-first sequencing (not a generic spaced-repetition template) is the fastest way to align study hours with the actual scoring math. For a complete week-by-week strategy built around this same logic, see the full study guide.

Want to gauge your baseline before locking in a date? Run a timed practice session on the main practice test platform to see how your pacing and accuracy hold up across all four 90-minute sections. You can also revisit the practice test homepage periodically as you move through each study week to track improvement across domains.

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