Clinical Training

Goals and Objectives

The goal of our program is to present an experience that will permit graduates to qualify as scholarly practitioners or investigators in an academic environment.  The graduate will acquire a clinical approach based upon a knowledge of the relationship between structural and functional abnormalities and their clinical manifestations; a critical analysis of the literature; and expert analysis of adult and pediatric respiratory and dermatological allergy.  The fellowship also provides experience and management of the diverse clinical problems seen in the Allergy Clinic and Asthma Center.  By the end of the training program, the graduate should be equipped to provide superior care to allergy and immunology patients.

Adult Allergy and Immunology

The program exposes trainees to a wide variety of experiences and a broad spectrum of adult allergy related issues due to the wide geographic referrals of the care center and the interests of the Divisional and Departmental faculty.   Allergy fellows will be exposed to patients with rhinitis, sinusitis, nasal polyposis, asthma, urticaria, angioedema, anaphylactic and anaphylactoid reactions, atopic dermatitis, contact dermatitis, insect sensitivity, drug reactions, adverse reactions to foods and food additives, primary and secondary immunodeficiency diseases, hypersensitivity pneumonitis, allergic bronchopulmonary aspergillosis, disorders of occupational exposure, autoimmune disorders, ocular allergic diseases, mastocytosis, and eosinophilic disorders, as well as to patients receiving immunomodulatory therapy.  They will gain knowledge of the etiology, immunopathogenesis, differential diagnosis, therapy, and complications of these diseases.  Patients evaluated by the allergy fellow on the inpatient service who need an allergist upon discharge will be followed in the Allergy Clinic by the allergy fellow.

Allergy fellows serve as consults for New York Presbyterian Hospital (Columbia campus).  Rounds occur daily.  We have a formal program in drug desensitization in adult medicine. Under the supervision of the attending physicians, fellows are exposed to diseases not often diagnosed in an outpatient setting.  These will primarily include drug reactions, ongoing anaphylactic and anaphylactoid reactions, complications and treatment of immunodeficiencies, autoimmune disorders, hypersensitivity pneumonitis, and allergic bronchopulmonary aspergillosis.  Under the supervision of the attending physician, allergy fellows will interact with other attendings, fellows, residents, and medical students and learn to communicate their knowledge to their coworkers as well as patients. Allergy fellows will develop skills in history and physical examination; skin testing, both immediate and delayed; interpretation of pulmonary function tests; desensitization to pharmacological agents; interpretation of in vitro methods to measure total and specific IgE antibodies; and the safe practice of immunotherapy. 

Pediatric Allergy and Immunology

Fellows also work with pediatric patients and are supervised by attending physicians from the Department of Pediatrics.  Fellows are exposed to patients with rhinitis, sinusitis, asthma, urticaria, angioedema, anaphylactic and anaphylactoid reactions, insect sensitivity, drug reactions, and primary and secondary immunodeficiency diseases. Fellows are supervised in developing their skills in history and physical examinations, skin testing, for both immediate and delayed hypersensitivity, interpretation of pediatric pulmonary function tests, desensitization to pharmacological agents, and interpretation of in vitro methods to assess immunologic diseases and the safe practice of immunotherapy. We have a formal program in drug desensitization in pediatric medicine as well.

Food Allergy

Fellows will develop excellent skills in the evaluation of adverse reactions to foods.  The Food Allergy Center at the New York-Presbyterian Hospital cares for both children and adults with food allergies. All food allergy-related conditions are evaluated including hives, swelling, eczema, anaphylaxis, eosinophilic esophagitis and food protein sensitivity. Fellows will learn how to perform challenges in a controlled environment with appropriate supervision.

John Edsall - John Wood Asthma Center

The fellow will obtain sufficient competency to provide outstanding care for patients with asthma. This includes knowledge of etiology; immunopathogenesis; differential diagnosis; therapy and complications related to asthma; and knowledge of unproven therapies used in asthma. Much of these objectives are met by the fellow’s rotation through the outpatient Asthma Center.  Fellows rotate through the pulmonary function lab and become expert at interpreting spirometry and understanding their usefulness in the diagnosis of airway and lung disease.

Dermatology

Fellows are required to complete a dermatologic rotation.  During this rotation, they will be exposed to patients with dermatologic ailments such as atopic dermatitis, contact dermatitis, urticaria, and angioedema. They will become versed in distinguishing allergic from non-allergic dermatologic diseases.  Fellows will learn the techniques of patch testing for the detection of contact dermatitis and the interpretation of laboratory tests related to dermatologic diseases.

Adult and Pediatric Rheumatology

Fellows will obtain sufficient competency to care for patients with rheumatology diseases. This includes knowledge of etiology, immunopathogenesis, differential diagnosis, therapy and complications related to rheumatological or autoimmune disorders. The objectives mostly are met by the rotation through the outpatient clinics, but also through inpatient consults.

ENT

Fellows rotate through both the pediatric and adult ENT clinics where they acquire proficiency in taking care of allergy-related Ears, Nose and Throat problems and proficiency in performing rhinoscopy.

Bone Marrow Transplantation

Fellows rotate through the bone marrow clinic where they get excellent additional experience caring for the immune deficient patients and as well as learn about the science and process of transplantation for blood and bone marrow disorders.

Immunodeficiency

The Division of Pediatric Allergy and Immunology has begun a specialized program in Immunodeficiency. Fellows will rotate through this Center and see a variety of disorders and learn the appropriate diagnostic and therapeutic modalities. The will gain top proficiency in ordering and interpreting laboratory tests appropriate for the immune deficient patient.

Curriculum

The curriculum for the Allergy and Immunology fellows provides a h2 foundation in clinical and basic molecular sciences, including the following subjects:

  • Basics of ACGME Core Competencies
  • Anatomy and Cellular Elements of the Immune System
  • Microbiology: Bacterial and Viral Structure and Replication
  • Ig and TCR Proteins and the Ig Supergene Family
  • Early B Cell Development
  • Thymic Differentiation and T Cell Surface Molecules
  • MCH
  • T Cell Activation and Functions 1: Help
  • Cytokines and Chemokines
  • B Cell Activation
  • Hypermutation, Class Switching, Ab Isotypes and Functions
  • T Cell Activation and Functions 2: Killing
  • Mechanisms of Lymphocyte Signaling
  • Gamma-Delta and NK Cells
  • Mucosal and Epithelial Immunity
  • Complement
  • Phagocytosis
  • Anatomy and Physiology
  • Pharmacology
  • Immunodeficiency Diseases
  • Immunoregulatory Disorders
  • Autoimmunity
  • Allergic Diseases and Related Disorders
  • Asthma
  • Clinical Transplantation and Transfusion
  • Immune System Related Malignancies and Cellular Disorders
  • Established and Evolving Immune-based Treatment Modalities
  • Research Principles