The residents see patients of various ages, males and females, and include a wide range of racial/ethnic and socioeconomic backgrounds.
They are exposed to a broad spectrum of allergic and immunologic disorders include:
- allergic and non-allergic rhinitis
- ocular allergies
- sinusitis
- nasal polyposis
- asthma
- atopic dermatitis
- contact dermatitis
- urticaria
- idiopathic, hereditary, and acquired angioedema
- anaphylaxis
- food and stinging insect allergy
- adverse drug reactions including drug allergy
Immunology problems include the diagnosis and treatment of:
- primary immunodeficiency disorders
- collagen vascular diseases
- vasculitis
- immune hypersensitivity disorders
- systemic mastocytosis
- mast cell activation disorder
- hypereosinophilic syndromes, etc.
Finally, with the admixture of the programs at Children's Hospital of Philadelphia, the residents see children with both allergic and immunodeficiency disorders.
Patients are also diverse in their backgrounds, experiences and beliefs. The resident under supervision of the attending will take these factors into account in communicating with the patient to satisfactorily address their concerns and medical questions.
All fellows learn how to perform the following procedures:
- Diagnostic allergy skin testing (prick and intradermal)
- Skin testing for adverse drug reactions - e.g. influenza vaccine, local anesthetics; desensitization where risk of anaphylaxis exists and no validated skin test procedures exist
- Spirometry, peak flow assessment and full pulmonary function testing (including plethysmography)
- Inhalational (e.g. methacholine) challenge
- Food/drug/latex challenges, as indicated
- Delayed hypersensitivity (patch) testing; in dermatology clinic
- Diagnostic flexible and rigid rhinopharyngolaryngoscopy; in ENT clinic
- Allergy injection treatment - preparation of extracts, administration of injections (including emergency treatment of any systemic reaction)
All Fellows are thoroughly instructed in all these techniques by faculty and nursing staff.
Participation by A&I Fellows in research is a core part of training at Penn. In research projects, the Fellow is instructed in, and leads study design, data acquisition and analysis, and writing of abstracts and manuscripts. Fellows are encouraged and expected to present their work at national meetings, and to submit manuscripts for peer-reviewed publication
Recent examples of such activities include:
- Asthma inhaler devices and techniques
- Asthma control in the inner city setting
- Eosinophilic esophagitis presentation in adults
- Retrospective study of clinical outcomes in hematologic malignancy patients with beta-lactam allergy label
- Association of reported penicillin allergy and diagnosis of chronic idiopathic urticarial
- Description of patients with specific antibody deficiency
- A quantitative and qualitative assessment of adherence to steroid inhaler treatment in patients with asthma
- An evaluation of the internet as a source of information about steroids for asthma patients
- Laboratory approach to the patient with hypogammaglobulinemia
- Association of monoclonal gammopathy of undetermined significance with humoral immune deficiency
All fellows are expected to participate in a quality improvement (QI) project, as required by the ACGME. There is a formal workshop series designed to guide both fellows and their faculty mentor in planning and doing QI work in their division. Attendees present their quality problem or topic to be addressed and will be guided through the appropriate use of QI methods and tools. The process and outcome of the QI project will be presented at a Friday conference in the second year.