Entry Id: TP-3

Allergy and Immunology Training Program
Kelly D. Stone, MD, PhD, Program Director
Dean D. Metcalfe, MD, Associate Program Director

Overview
The National Institute of Allergy and Infectious Diseases (NIAID) offers a three-year training program in Allergy and Immunology. This program, open to physicians who are well-grounded in clinical internal medicine or pediatrics, is designed to provide trainees with the high-quality clinical and laboratory skills that will enable them to pursue careers in academic medicine.

Structure of the Clinical Training Program
The majority of the first year of training is dedicated to clinical activities with intensive exposure to the broad spectrum of allergic and immunologic diseases in children and adults. Clinical rotations covering outpatient and inpatients aspects of the specialty are completed at the National Institutes of Health (NIH) Clinical Center (outpatient clinics, inpatient ward, and allergy and immunology consultation service), the Walter Reed Army Medical Center, the Children's National Medical Center, The Johns Hopkins Pediatric Allergy Clinic, and a local practice.

Patients seen at the NIH under research protocols have a wide variety of disorders, including allergic diseases, asthma, inherited and acquired immunodeficiencies, mast cell disorders (including mastocytosis), idiopathic eosinophilias, autoimmune diseases; and HIV/AIDS. In addition, fellows in training are the Allergy and Immunology consultants for the NIH Clinical Center and rotate through NIH diagnostic immunology laboratory, the pulmonary function laboratory in the National Heart, Lung, and Blood Institute (NHLBI), and the adult asthma clinic of the NHLBI. 

In the second year, fellows are engaged in both clinical care (limited continuity clinics and consultation service) and in research.  The third year of training is devoted exclusively to research. Fellows have the option, with approval, for a fourth and occasionally a fifth year of research training. 

Fellows also receive broad instruction in allergic and immunologic disorders and attend conferences designed to prepare trainees for the American Board of Allergy and Immunology (ABAI) examination. Conferences include a basic and clinical immunology lecture series, case conferences, journal clubs, and NIAID Grand Rounds.  Residents are generally fully qualified to take the ABAI examination after two years in the program.

Structure of the Research Training Program
The core of this clinical fellowship program is the effort devoted to research training and performance of original basic, translational, and/or clinical research. Fellows work under the direct supervision of one of the NIAID investigators. The research experience is characterized by close daily contact with the preceptor, individual instruction, and continuity during the training period. The goal of the research training is to provide a productive experience leading to the development of successful independent investigators.

Fellows work in the laboratory for about ten percent (10%) of the time during the first year, 60% percent in the second year, and almost exclusively in the third year. Allergy and Immunology fellows may request to work in any of the laboratories within the intramural NIAID program. Research opportunities involve a wide range of investigations in various aspects of allergy and Immunology. These vary from clinical to the most basic aspects of cell and molecular biology. Trainees have pursued research projects in the following areas:

• The biology of the mast cell, basophil, and eosinophil.
• Pathophysiology and treatment of anaphylaxis, and other allergic disorders.
• Effect of cytokines on cellular responses.
• Diagnosis of host responses to infectious agents.
• Diagnosis, molecular characterization, and treatment of primary immunodeficiency disorders.
• Biology and treatment of systemic mastocytosis.
• The role of antibody and cellular immune systems in inflammation and autoimmunity.
• The function of cellular receptors for immunoglobulin, cytokines, and matrix components.
• The basis of mucosal immunity.
• Humoral and cellular immunoregulation and immunoregulatory defects.
• The biology of polymorphonuclear leukocytes, monocytes, and macrophages.
• Aspects of the pathogenesis of HIV.
• Vaccine immunology.

Representative NIH Clinical and Research Faculty

• Melody Carter, MD, Staff Clinician, Laboratory of Allergic Diseases, NIAID, NIH
• Anthony Fauci, MD, Director, NIAID and Chief, Laboratory of Immunoregulation, NIAID, NIH
• Thomas Fleisher, MD, Chief of Laboratory Medicine, NIH Clinical Center
• John Gallin, MD, Director, NIH Clinical Center and Chief, Clinical Pathophysiology Section, Laboratory of Host Defenses, NIAID, NIH
• Steven Holland, MD, Chief, Laboratory of Clinical Infectious Diseases, NIAID, NIH
• Ashish Jain, MD, Chief, Clinical Immunology Unit, Laboratory of Host Defenses, NIAID, NIH
• Amy Klion, MD, Staff Clinician, Laboratory of Parasitic Diseases, NIAID, NIH
• Hirsh Komarow, MD, Staff Clinician, Laboratory of Allergic Diseases, NIAID, NIH
• Clifford Lane, MD, Clinical Director, NIAID and Chief, Clinical and Molecular Retrovirology Section, Laboratory of Immunoregulation, NIAID, NIH
• Stewart Levine, MD, Chief, Lung Inflammation Section, National Heart, Lung, and Blood Institute, NIH
• Harry Malech, MD, Chief, Laboratory of Host Defenses, NIAID, NIH
• Dean Metcalfe, MD, Chief, Laboratory of Allergic Diseases, NIAID, NIH
• JoAnn Mican, MD, Staff Clinician, Division of Clinical Research, NIAID, NIH
• Joshua Milner, MD, Staff Clinician, Laboratory of Host Defenses, NIAID, NIH
• Thomas Nutman, MD, Deputy Chief, Laboratory of Parasitic Diseases, NIAID, NIH
• William Paul, MD, Chief, Laboratory of Immunology, NIAID, NIH
• Calman Prussin, MD, Chief, Adverse Reactions to Biologics and Vaccines Unit, Laboratory of Allergic Diseases, NIAID, NIH
• Koneti Rao, MD, Staff Clinician, Laboratory of Clinical Infectious Diseases, NIAID, NIH
• Helene Rosenberg, MD, PhD, Chief, Eosinophil Biology Section, Laboratory of Allergic Diseases, NIAID, NIH
• Ethan Shevach, MD, Chief, Cellular Immunology Section, Laboratory of Immunology, NIAID, NIH
• Kelly Stone, MD, PhD, Staff Clinician, Laboratory of Allergic Diseases, NIAID, NIH
• Warren Strober, MD, Chief, Mucosal Immunity Section, Laboratory of Host Defenses, NIAID, NIH
• Helen Su, MD, PhD, Chief, Human Immunological Diseases Unit, Laboratory of Host Defenses, NIAID, NIH
• Gulbu Uzel, MD, Staff Clinician, Laboratory of Clinical Infectious Diseases, NIAID, NIH
• Todd Wilson, DO, Staff Clinician, Laboratory of Allergic Diseases, NIAID, NIH

Faculty at affiliated training sites

• Michael Nelson, MD, PhD, Chief, Department of Allergy and Immunology, Director, Allergy and Immunology Training Program, Walter Reed Army Medical Center
• Cecilia Mikita, MD, Associate Director, Allergy and Immunology Training Program, Walter Reed Army Medical Center
• Terry Fry, MD, Chief, Division of Blood and Marrow Transplantation and Immunology, Children’s National Medical Center
• Naynesh Kamani, MD, Division of Blood and Marrow Transplantation and Immunology, Children’s National Medical Center
• Brett Loechelt, MD, Division of Blood and Marrow Transplantation and Immunology, Children’s National Medical Center
• Hemant Sharma, MD, MHS, Division of Immunology, Children’s National Medical Center
• Robert Wood, MD, Chief, Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine
• Elizabeth Matsui, MD, Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine
• Michael Kaliner. MD, Institute for Asthma and Allergy
• Mark Scarupa, MD, Institute for Asthma and Allergy

Examples of papers authored by program fellows and faculty

• Bansal G, Z Xie, S Rao, KH Nocka, and KM Druey.  2008.  Suppression of immunoglobulin E-mediated allergic responses by regulator of G-protein signalling 13.  Nature Immunol.  9(1): 73-8.
• Arthos J, C Cicala, E Martinelli, K Macleod, D Van Ryk, et al.  2008.   HIV-1 envelope protein binds to and signals through integrin alpha4beta7, the gut mucosal homing receptor for peripheral T cells.  Nature Immun.  9(3): 301-9.
• Milner JD, JM Brenchley, A Laurence, AF Freeman, BJ Hill, et al.  2008.  Impaired T(H)17 cell differentiation in subjects with autosomal dominant hyper-IgE syndrome.  Nature.  452(7188): 773-6.
• Rothenberg ME, AD Klion, FE Roufosse, JE Kahn, PF Weller, et al.  2008.  Treatment of patients with the hypereosinophilic syndrome with mepolizumab.  N. Engl. J. Med.  358(12): 1215-28.
• Uzel G, E Tng, SD Rosenzweig, AP Hsu, JM Shaw, et al.  2008.  Reversion mutations in patients with leukocyte adhesion deficiency type-I (LAD-1).  Blood.  111(1): 209-18. 
• De Ravin SS, N Naumann, EW Cowen, J Friend, D Hilligoss et al.  2008.  Chronic granulomatous disease as a risk factor for autoimmune disease.  J. Allergy Clin. Immun.
• Akin, C, LM Scott, CM Kocabas, N Kushnir-Sukhov, E Brittain, P Noel, DD Metcalfe.  2007.  Demontration of an aberrant mast-cell population with clonal markers in a subset of patients with “idiopathic” anaphylaxis.  Blood.  110(7): 2331-3. 
• Foroughi, S, B Foster, N Kim, LB Bernardino, LM Scott, RG Hamilton, DD Metcalfe, PJ Mannon, and C Prussin.  2007.  Anti-IgE treatment of eosinophil-associated gastrointestinal disorders. J. Allergy Clin. Immun.  120(3): 594-601. 
• Sereti I, P Sklar, MS Ramachandani, SW Read, V Aggarwal, et al.  2007.  CD4+ T cell responses to interleukin-2 administration in HIV-infected patients are directly related to the baseline level of immune activation.  J. Infect. Dis.  196(5): 677-83.
• Holland SM, FR DeLeo, HZ Elloumi, AP Hsu, G Uzel, et al.  2007.  STAT3 mutations in the hyper-IgE syndrome. N. Engl. J. Med. 357(16): 1608-19.
• Milner JD, JM Ward, A Keane-Myers, and WE Paul.  2007.  Lymphopenic mice reconstituted with limited repertoire T cells develop severe, multi-organ, Th2-associated inflammatory disease.  Proc. Natl. Acad. Sci. USA.  104(2): 576-81.
• Carter MC, JA Robyn, PB Bressler, JC Walker, GG Shapiro, and DD Metcalfe.  2007.  Omalizumab for the treatment of unprovoked anaphylaxis in patients with systemic mastocytosis.  J. Allergy Clin. Immun.  119(6): 1550-1.

Representative recent program graduates

• Cem Akin, MD, PhD, Assistant Professor, University of Michigan
• Princess Ogbogu, MD, Assistant Professor, Ohio State University
• Julie Martin, DO, Deputy Chief, Clinical Trials Core, Vaccine Research Center, NIAID, NIH
• Stefano Luccioli, MD, Center for Food Safety and Applied Nutrition, FDA
• Ashish Jain, MD, Tenure-track scientist, NIAID, NIH
• Patricia Lugar, MD, MS, Duke University
• Helen Su, MD, PhD, Tenure-track scientist, NIAID, NIH
• Joshua Milner, MD, Staff Clinician, NIAID, NIH
• Soheil Chegini, Assistant Professor, Penn State College of Medicine
• Todd Wilson, DO, Staff Clinician, NIAID, NIH

Application Information
The Allergy and Immunology Clinical Fellowship Program is fully accredited by the Accreditation Council for Graduate Medical Education (ACGME). Fellows are eligible to sit for the Board of Allergy and Immunology certification examination after two years.

Candidates are selected through the National Residency Matching Program.  There are two to four positions available per year.  Candidates should apply for the program in the fall approximately 1 ½ years prior to entry via the ERAS system.

Applications must contain:
1. My ERAS application
2. Three letters of recommendation
3. Personal statement
4. Medical school transcript
5. Medical student performance evaluation/Dean’s letter
6. USMLE or COMPLEX transcript
7. ECFMG status report (for international medical graduates only)

Applicants must be on track to complete an ACGME-approved residency in internal medicine or pediatrics at the time they enter the program. Interviews are held between November and April.