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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.
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:
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 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.
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.
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.
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