Clinical Training

Allergy & Immunology Fellowship Training

Overview

Adult Allergy/Immunology Clinics:

The Adult Allergy/Immunology Clinic experience will provide the opportunity for the A/I Fellow to broaden their knowledge base, hone critical thinking and develop effective communication skills that are necessary for an A/I consultant. Through the varied patient population, the A/I Fellow will learn about a multitude of A/I diseases and their various presentations. Fellows will learn first-hand about the diagnosis and management of both common and unusual A/I diseases. They will further their skills in interpretation of allergy skin tests (inhalant, venom, drug), in vitro diagnostics (e.g. allergen-specific IgE (ImmunoCAP)), quantitative immunoglobulins, complement levels, pulmonary function tests, chest plain radiographs, and CT scans of the chest and sinuses.. The rationale and implementation of specific immunotherapy (SIT) are mastered primarily in this setting. In addition, fellows will become competent in administering immunoglobulin replacement therapy and treating advanced atopic disease with biologics and immunomodulators (omalizumab, mepolizumab, dupilimab, mycophenalate, cyclosporine…), as well as deciding and executing clinic-based challenges of foods and medications.  These clinics are situated at Boston Medical Center and the West Roxbury Veterans Affairs Medical Center.

Pediatric AIR (Allergy Immunology and Respiratory) Clinic:

The goals and objectives are similar to the Adult Allergy Clinic except that fellows will have much greater exposure to food allergy, atopic dermatitis and immunodeficiency evaluations, in addition to evaluation and management of pediatric allergic rhinoconjunctivitis and asthma. Fellows will further their skills at taking a pediatric history and physical; will learn the medications and doses used in pediatric allergy and asthma treatment; and will learn about skin testing and immunotherapy techniques and procedures in pediatric patients. Fellows will also participate in food challenges in a dedicated pediatric procedure unit.

Adult and Pediatric Consult Services:

Fellows will see inpatient allergy and asthma consultations on both the adult medical and pediatric services, with appropriate attending guidance. Fellows will see patients with drug allergy (antibiotic, ACE inhibitor, latex, anesthetic and aspirin), urticaria, angioedema, and anaphylaxis. They will learn about and design, as indicated, specific drug desensitization protocols and guide evaluation and management of patients with severe angioedema and anaphylaxis, typically in the Critical Care setting and in collaboration with their Pulmonary/CCM co-fellows. On the pediatric side, consultations will be similar, but will also include more patients with asthma exacerbations. Communication with and education of the consulting service are important parts of these rotations.

Adult and Pediatric Procedures:

Fellows will spend dedicated time learning the practical and theoretical aspects of skin testing (to aeroallergens and medications), patch testing for delayed hypersensitivity, drug desensitization, administration of biologics, and oral food and medication challenges, all in adult and pediatric patients.

Adult and Pediatric Asthma Clinics:

The Adult and Pediatric Asthma Clinic experiences provide the opportunity for the fellow to focus on an important subset of A/I disease, asthma, in the context of clinics focused on management of more severe cases of asthma and other obstructive lung diseases. Fellows will learn to obtain a full history of environmental exposures, asthma duration and severity, medication adherence and technique and comorbid conditions. They will learn the role of peak flow, spirometry and full pulmonary function testing in the management of asthma, and learn about other diseases that may mimic asthma. In addition, fellows will learn the step-wise approach to asthma therapy and the advantages and disadvantages of the spectrum of asthma medications. The importance of an ongoing case management approach will be evident.

ENT Rotation:

Fellows will learn about the surgical approach to the evaluation and treatment of nasal polyposis, chronic rhinosinusitis, hoarseness, vocal cord dysfunction and GERD. Trainees will be experienced with rhinolaryngoscopy from hands-on training with patients. (Our recent A/I graduate logged >50 rhinolaryngoscopies and will be fully competent to ‘export’ this skill to his next career move.)

Dermatology rotation:

Residents will learn about the history, physical exam, diagnostic testing and treatment of patients with atopic dermatitis, contact dermatitis and their mimics. This includes the management of patients with complex skin conditions needing advanced treatment including biologics and immunomodulatory therapy.

Brigham and Women’s Hospital Fellowship Collaboration (NEW):

Starting in the 2023-2024 academic year, we have initiated a collaboration with the BWH Allergy/Immunology Fellowship Program. BU/BMC fellows will rotate at BWH in their second year attending advanced subspecialty disease-specific clinics eg AERD, complex mast cell disorders, advanced drug allergy/desensitization, and food allergy. BU fellows can select which of these valuable opportunities to attend as they align with their clinical and career interests. BWH fellows will rotate at BU/BMC Adult and Pediatric Allergy/Immunology clinics to enhance their learning of and exposure to A/I disorders with a focus on our culturally and socioeconomically diverse, safety-net patient population.

Quality Improvement and Patient Safety/CLER:

During training, under mentorship from Program Faculty and Quality Leads at Boston Medical Center, fellows will design and execute a QI/PS project. Preparation for this endeavor will be accomplished by completing the Institute for Healthcare Improvement Open School modules on Quality Improvement.