Allergy/Immunology

You will see all new consults on the service, which you will then discuss with the fellow or allergy and immunology attending.

Through this rotation, you will gain a familiarity with how asthma, allergies and immunological disorders present clinically, including the pathogenesis and pathophysiology of important emergency conditions such as anaphylaxis and severe unresponsive bronchial asthma.

Your training will also cover triggers that can exacerbate allergic and immunological conditions, interactions between chronic and acute conditions, and the use and limitations of laboratory testing and medications.

Your training will present you the opportunity to recognize, diagnose and formulate treatment plans for disorders related to the field of Allergy-Immunology. The clinical sites will include outpatient experiences at Buffalo General Hospital.

You must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care including but not limited to: 

• patient characteristics of asthma, allergy, as well as immunologic disorders
• recall the indications, limitations, and interpretation of intradermal skin testing
• understand the pathogenesis and pathophysiology of anaphylaxis and severe unresponsive bronchial asthma, two very important emergencies
• understand the pathogenesis and pathophysiology of asthma, allergic or non-allergic rhinitis, sinusitis, and chronic urticaria; including their immunologic basis and contributory factors that can aggravate these conditions

You will acquire knowledge in disorders in the fields of allergy and immunology, which are appropriate for an internist, focusing on:

• the differential diagnosis of chronic cough and wheezing
• the diagnosis and classification scheme of asthma and subsequent treatment modalities as they pertain to the specific classifications and their side effects
• the appropriate use and interpretation of tests including pulse oximetry, peak flow meters and simple spirometry in the diagnosis and monitoring of asthma
• a step-wise pharmacological approach to the management of acute and chronic asthma for inpatients and outpatients with reference to published guidelines
• the triggers for asthma exacerbations, including exercise, tobacco smoke exposure, environmental allergens and infection
• findings on history or physical exam that suggest allergy
• clinical and laboratory tests used to identify allergic disorders including skin tests, RAST, nasal smears, total peripheral eosinophil count, IgE levels and pulmonary function tests (including cost) and their significance
• treatment of allergic rhinitis using available drugs (antihistamines, topical steroids, leukotriene modifiers)
• indications for immunotherapy for various allergens
• discuss with patients/parents allergen avoidance, environmental controls, allergenic food/drug/insect avoidance and emergency treatment (including EpiPens and medical alert tags)
• the characteristics of chronic sinusitis and its association with allergy and/or immunodeficiency, organisms involved, treatment including duration and reason for referral to allergist or ENT surgeon
• the typical presentations for food allergies and the difference between food allergy and non-allergic food intolerance
• the signs and symptoms of drug allergy and treatment of adverse drug reactions including urticaria, serum sickness and anaphylaxis 
• the etiology, work up and treatment of acute and chronic urticaria

• the normal development of the cellular, humoral, and phagocytic immune systems
• the findings on history and physical exam which suggest immunodeficiency
• the development of the B cell system with regard to antibody production and the consequences of early delivery on the premature infant’s immune response
• the clinical presentation of antibody deficiency, distinguishing quantitative problems from qualitative defects; the role of antibiotics and IVIG treatment and common side effects of the latter
• the presentation of T cell defects and how to distinguish AIDS from SCIDS; Delineate the possible consequences of therapies in primary T cell deficiencies including blood transfusions, isolation techniques and preparation for bone marrow transplantation
• the presentation of phagocytic disorders including neutropenia; the presentation and diagnosis of complement deficiency.
• clinical and laboratory tests used by primary care providers to identify immunodeficiency (e.g. complete blood with differential, screening tests for antibody deficiency and delayed hypersensitivity testing)
• immunizations for patients with immunodeficiency and their families

• PGY-2, PGY-3 or PGY-4

4 weeks