Allergy and Immunology

  • Clinical Training

    All fellows rotate as consultants during the clinical training year. This experience consists of allergy and immunology consultations in both the pediatric (Cincinnati Children’s Hospital Medical Center) and internal medicine institutions (University Hospital and Veterans Administration Hospital). The three hospitals are within a comfortable walking distance, 1-2 blocks from each other. The allergy/immunology fellows are responsible for the direct supervision of the residents caring for the allergy and immunology patients. The diagnoses seen in consultations include immunodeficiencies (mostly congenital), acute asthma exacerbations and status asthmaticus, food allergy and anaphylaxis, multiple antibiotic allergies (particularly in patients with cystic fibrosis, requiring drug testing and desensitization), other medication allergy, eosinophilic disorders, and vasculitis syndromes. On average, the allergy/immunology fellow sees 2 to 3 consultations per week while on clinical rotation.

    Outpatient Allergy / Immunology Services

    The pediatric allergy / immunology clinic meets four times a week at Cincinnati Children’s Hospital, in addition to a weekly whole day immunodeficiency clinic. The patients seen in the outpatient clinics are seen in consultation requested by the primary care physicians in pediatrics, internal medicine or family practice on the University staff, from community allergists, and from national and international referrals. Consultations are also requested by other sub-specialists, e.g. pulmonology, infectious disease, dermatology, and surgical colleagues.

    There are three major outpatient clinics on the internal medicine track. These are located at the University Hospital, Veterans' Administration Hospital, and in an off-campus private practice site staffed by one of the faculty-attending physicians (David Bernstein MD, I. Leonard Bernstein MD, Jonathan Bernstein MD, Tolly Epstein MD or Andrew Smith MD). All allergy / immunology fellows rotate through the immunodeficiency clinic, and receive cross-training in adult and pediatric allergy. Several centers of excellence constitute our clinical programs:

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    The Allergy Program

    In the allergy clinics, the fellows evaluate ample numbers of patients of all ages that cover the spectrum of allergic disorders including mild to severe asthma, allergic rhinitis, occupational asthma, urticaria, drug and venom hypersensitivity, food allergy, eczema and eosinophilic disorders. The allergy history and clinical exam are obtained on standardized forms that address all familial and environmental predisposing factors.

    The Immunodeficiency Program

    The immunodeficiency program is directed by Alexandra Filipovich, MD. A large variety of national and international referrals to the clinics enhance the clinical experience of the trainees. In addition, the rarity and complexity of these disorders have led to novel research projects conducted by fellow trainees. The diagnoses evaluated and followed by the fellows in the outpatient immunodeficiency clinics at Cincinnati Children's cover the entire spectrum of rare congenital immunodeficiencies, in addition to several that our center has developed unique expertise (e.g. Hemophagocytic Lymphohistiocytosis (HLH) and X-linked Lymphoproliferative (XLP) disorders).

    Food Allergy

    The allergy / immunology fellows acquire unique exposure to IgE and non-IgE mediated adverse reactions to foods. Patients are referred to this program from the regions surrounding the hospital and from around the country. The multidisciplinary team includes allergy / immunology, nutrition, and nursing and education. Patients are accurately phenotyped using a standardized history and physical examination form. The clinic conducts a large number of oral food challenges, averaging 2-3 per week providing a unique experience for the fellows.

    Occupational Allergy and Asthma Center

    Our faculty have established a center widely recognized for research in work-related allergies and lung disorders. David Bernstein, MD is a faculty member leading an international study evaluating genetic susceptibility for occupational asthma caused by reactive chemicals that is NIH funded. The faculty are also investigating immunologic mechanisms of these disorders funded by government and industry contracts. Trainees will have an opportunity to evaluate occupational disorders during adult rotations and may elect to participate in a variety of ongoing basic and clinical research projects.

    Enviro. Disorders / Outcomes Research

    The adult allergy clinics have a number of clinical and translational research projects that actively involve the allergy fellow trainees. Dr. Jonathan Bernstein has established a DNA bank and database for asthma, allergic and non-allergic rhinitis and other allergic disorders. This project has resulted in collaborations with investigators from the Division of Immunology (Drs. Jonathan and David Bernstein), Division of Pulmonary Medicine, Division of Allergy and Immunology (Drs. Marc Rothenberg, Gurjit Khurana Hershey and Amal Assa'ad), the Division of Immunobiology (Dr. Marsha Wills-Karp) and the Center for Environmental Health and Genetics (Drs. Daniel Nebert and Li Jin). Allergy fellows have used this database and DNA bank largely derived from patients at the University and Veteran's Hospital Allergy Clinics and the patient population of a large community allergy and asthma private practice in Greater Cincinnati, which boasts a combined patient population of 20,000. Dr. Gurjit Khurana Hershey at Cincinnati Children's has initiated a similar DNA bank and database. Currently, there are approximately 2,000 well-characterized patients in the DNA bank. A DNA data bank has also been established to study genotypes associated with occupational asthma. Dr. Marc Rothenberg at Cincinnati Children’s has a well-characterized database and sample databank of patients with eosinophilic esophagitis. A number of publications have resulted from these collaborations, several of which have involved allergy fellows.

    Center for Eosinophilic Disorders

    Over the last ten years, we have witnessed an unprecedented number of allergic patients who have presented to the Cincinnati Children’s Hospital Medical Center with recurrent gastrointestinal complaints who are eventually diagnosed with an eosinophil associated gastrointestinal disorder (EGID). This coincides with a flurry of articles published on these diseases. Accordingly, we have assembled a multi-disciplinary team of health care providers (including allergists, gastroenterologists, pathologists, research scientists, biostatisticians, epidemiologists, and nutritionists) and recently launched the Cincinnati Center for Eosinophilic Disorders (CCED) . By working together in synergy, our team aims to understand the pathogenesis and best treatment strategy for EGID.

    The CCED currently sees 3 to 5 new patients per week. The CCED has become an international leader in caring for these patients. As such, we are receiving a growing number of domestic and international patients. In fact, we have become not only a regional referral center, but a center where patients are being referred to from all over the world. We have seen patients from Canada, Australia, Europe, Israel and China, among other countries. Accordingly, we receive daily inquiries from patients that are interested in coming to Cincinnati Children's Hospital Medical Center for evaluation and treatment of their chronic medical problems. Several families have even moved to the region because of the care that we provide.

    Clinical Laboratory Experiences

    All allergy / immunology fellows on the clinical service rotate in a diagnostic immunology laboratory located at either Cincinnati Children's or University Hospital, where they receive instruction on methods and interpretation of specific IgE immunoassays, complement assays, cellular proliferation, flow cytometry and PCR.