Allergy and Immunology

Allergy / immunology fellows interested in basic and experimental biology may conduct research in a broad range of immunological disorders related to: 1) allergic diseases (e.g., asthma, food allergy, eczema, eosinophilic disorders, anaphylaxis); 2) autoimmune diseases (e.g. inflammatory bowel disease); and 3) primary immunodeficiency and dysregulation. The faculty members from Cincinnati Children’s and the University of Cincinnati participate in a large consortium referred to as the Center for Immunology Research, which includes numerous NIH-funded investigators, clinical and postdoctoral fellows and graduate students enrolled in the Immunobiology Graduate Training Program.

The fellows in the basic and experimental track join a research lab where they spend the majority of their effort during research years. The fellows develop competency in performing research techniques that are pertinent to their particular research project. For example, the trainees in the laboratory may learn the following techniques: DNA cloning, sequencing, DNA chips; animal breeding, husbandry and genotyping; transgenic engineering; tissue culture; microscopy including morphometric analysis; histologic identification of lymphocytes, mast cells, eosinophils, etc.; immunohistochemistry, mRNA in situ hybridization; cytokine assays − ELISA, polymerase chain reactions; southern, northern, and western blotting; electrophoresis and data analysis: graphs, statistics and interpretation.

In addition to technical competence, the fellows develop important skills in bringing a research project to fruition, including grant writing, manuscript preparation and oral presentations of research findings. The fellows attend the laboratory meetings of the laboratory with which they are affiliated, as well as the divisional and interdivisional laboratory meetings. The faculty mentor coaches the fellow in the presentation of research data.

In addition, fellows on the basic and experimental track may choose to enroll in graduate-level courses through the University of Cincinnati’s Immunobiology Graduate Training Program, located at Cincinnati Children’s. This program was designed to meet a growing demand for well-trained immunologists, both in academic institutions and in industry.

Allergy faculty from both the adult and pediatric divisions (David I. Bernstein, MD, Manuel Villareal, MD, and Gurjit Khurana Hershey, MD, PhD) collaborate as coinvestigators with Grace LeMasters, PhD (senior epidemiologist in the Department of Environmental Health) in a prospective birth cohort study of over 700 infants in Greater Cincinnati (Cincinnati Childhood Allergy and Asthma Prospective study, CCAAPS). The principle aim of the CCAAPS study is to determine the roles of environmental factors in development of allergic disorders in childhood. Allergy clinics directed by David I. Bernstein, MD, and Manuel Villareal, MD, have conducted annual clinical and immunologic evaluations, and DNA samples have been collected in all subjects, facilitating evaluations of gene-environmental interactions and clinical outcomes. Environmental assessments have been performed by staff and trainees in the Department of Environmental Health. T32 trainees from the allergy / immunology program have directly participated in clinical evaluations of pediatric subjects participating in this longitudinal study and have utilized the CCAAPS dataset for multiple publications. This investigation has generated many research projects resulting in numerous publications authored by allergy trainees and provided the basis for the renewal of the CCAAPS grant. CCAAPS has served as the basis for theses for allergy fellows and graduate students pursuing masters and PhD degrees in epidemiology and clinical research. There will continue to be extensive opportunities of analysis of existing data through CCAAPS, as well as future longitudinal studies as the children grow older.

Trainees have the opportunity to participate in clinical trials of new therapeutic agents under development for approval by the FDA. The faculty in the Allergy and Immunology Division in the Department of Internal Medicine have established a clinical research center where multicenter clinical trials and investigator-initiated studies are performed, including numerous trials of new agents for treating acute attacks of hereditary angioedema. Trainees work as sub-investigators under direct supervision of clinical and translational faculty and are introduced to the nuts and bolts of conducting clinical studies, good clinical practice (GCP) guidelines and ethical principles guiding conduct of human research. On the pediatric side, there are over ten investigator-initiated clinical protocols ongoing and fellows can get involved at various levels, including the design of new protocols.

The adult allergy clinics have made possible a number of clinical and translational research projects that actively involve the allergy fellow trainees from both the pediatric and adult divisions. Jonathan Bernstein, MD, has established a DNA bank and database for asthma, allergic and non-allergic rhinitis and other allergic disorders. Gurjit Khurana Hershey, MD, PhD, at Cincinnati Children’s has initiated a similar DNA bank and database. Currently, there are approximately 4,000 well-characterized patients in the DNA bank. A DNA data bank has also been established to study phenotypes associated with occupational asthma, and this has been expanded to a multicenter NIOSH / CDC-funded international study of genetic markers associated with occupational asthma due to reactive chemicals (David I. Bernstein, PI, R01). Faculty member Tolly Epstein, MD, is enrolling subjects for a study on asthma in older adults that involves creation of a DNA bank and database that may be accessed in the future. Additionally, Dr. Marc Rothenberg at Cincinnati Children’s has a well-characterized database and sample databank of patients with eosinophilic esophagitis.

Allergy / immunology fellows interested in clinical research are enrolled in a master’s program offered by the Division of Epidemiology and Biostatistics at the University of Cincinnati. There are two training programs available: master’s of epidemiology and biostatistics and master’s of science in clinical research. Both master’s programs offer courses in environmental health, statistics, biostatistics and epidemiology. The master’s thesis research is drawn from the clinical research work conducted by the clinical members of both fellowship tracks in projects related to epidemiology, risk assessment for childhood asthma or allergic sensitization early in life. Alternatively, trainees may become involved in investigator-initiated research examining efficacy of new therapeutic agents in the treatment of asthma or other allergic disorders. Outcomes research would also be an option and would be conducted under the mentorship of a faculty adviser from the Division of Outcomes Research, Department of Internal Medicine, Joel Tsevat, MD.

This program is supplemented by courses and seminars offered by divisional courses including: Introduction to Clinical Research, Presenting and Writing Skills, Ethics in Research, Fellows Teaching Workshop and Grant Fundamentals. Additionally, fellows receive instruction on important issues related to human subjects, ethics and patient confidentiality as well as receive instruction on good clinical practices in human research through course work and their daily interactions with their faculty sponsors in clinical research.