Pediatric Allergy & Immunology Fellowship

The ACGME-accredited University of Colorado Denver/National Jewish Health Allergy & Immunology Pediatric Program

Goals of the Fellowship Program
Overview
Rotations at NJH, RMHC and UCH
Research and Other Academic Assignments
Application Process
Faculty
Current and Former Fellows

Goals of the Fellowship Program:

The primary goals are to:

Provide comprehensive state-of-the-art clinical training in allergy and immunology with emphasis on evaluation and management of atopic disorders, such as asthma, atopic dermatitis, food allergy, rhinitis, and sinusitis as well as primary immune deficiencies.
Develop a solid foundation in the principles of basic immunology fundamental to understanding and managing clinical disorders.
Initiate a solid experience in the fundamentals of basic and clinical research.

Fellows who successful accomplish these goals will be positioned to pursue future careers in academic medicine or subspecialty clinical practice.

Overview

Fellows in the University of Colorado/National Jewish Health Pediatric Allergy & Immunology program receive most of their experience at National Jewish Health (NJH) through 4 different assignments. NJH is a tertiary care medical and research facility that specializes in allergic, immune, and respiratory diseases. For more than 120 years, NJH has been recognized as the leading respiratory hospital in the nation. This reflects our expertise in medical care and research accomplishments in pulmonary, allergic, and immune diseases. Fellows spend half of their 2 year fellowship program in the clinical rotations described below. The majority of clinical rotations occur in Year 1 of the fellowship.

Clinical assignments include the Pediatric Day Program and Care Unit at NJH, Inpatient Consultation at Rocky Mountain Hospital for Children (RMHC), Pediatric and Adult Outpatient Clinics at NJH, and an Adult Allergy Consult service at the University of Colorado Hospital (UCH).

Clinical Rotations at National Jewish Health

Pediatric Day Program and Care Unit

Pediatric patients, both local and out-of-state, with severe allergic, pulmonary, and immune disorders are admitted to this service for in-depth multi-disciplinary outpatient team evaluations. Fellows are the primary providers for these patients, under attending faculty supervision. The disease severity and complexity of the patients admitted to this program are comparable to patients seen in an inpatient setting.

This rotation provides a primary patient base for the understanding of the diagnosis, treatment, and pathophysiology of, but not limited to:

Severe chronic refractory asthma, its detailed differential diagnosis, recognition and evaluation of the iatrogenic aspects of its management, and alternative treatments
Severe allergic disease including chronic rhinosinusitis, nasal polyposis, food allergy, including the use of double-blind, placebo-controlled food challenges, anaphylaxis, atopic dermatitis, urticaria, allergic bronchopulmonary aspergillosis, eosinophilia, and drug allergy
Immunodeficiency diseases
Pediatric pulmonary diseases, such as chronic pneumonias and pneumonitis, aspiration, hypersensitivity pneumonitis, bronchiolitis, bronchitis, congenital pulmonary anomalies, obstructive pulmonary disease, interstitial lung disease, bronchopulmonary dysplasia, cystic fibrosis, vocal cord dysfunction, bronchiectasis, and immotile cilia syndrome

This rotation also has a strong focus on understanding and helping to manage the psychosocial aspects of chronic disease together with behavioral therapists that are seen by every patient and their families. The development of specific allergy and immunology clinical skills, such as complex disease management, patient education, home management strategies, and interacting with the referring physicians and tertiary consultants, will be a focus of these months. Expertise in methods and interpretation of pulmonary function testing, pH and impedance probe studies for gastroesophageal reflux, and various allergen, food and airway provocation challenges will be acquired. The basic application of rhinolaryngoscopy and bronchoscopy will also be addressed during this rotation.

During this rotation, fellows also see acutely ill pediatric patients with allergic, respiratory, and immune disorders in an urgent care setting, under attending faculty supervision. Most of the pediatric patients seen in this rotation have exacerbations of their asthmatic, respiratory, allergic, and/or immune disorder(s) that benefit from specialty care. Some of the patients evaluated in urgent care require hospitalization at NJH, and continue to be followed by the admitting fellow and attending.

Outpatient Clinics

Pediatric Allergy and Immunology Continuity Clinic: These clinics focus on the outpatient diagnosis and management of asthma and allergic disease similar to the profile described for the Pediatric Day Program rotation. Each fellow participates in a Pediatric Allergy and Immunology Continuity Clinic, one-half day per week for the 2 years of the fellowship and experience one-to-one mentoring with an allergist during this rotation. These clinics facilitate the development of required skills for allergists, including the interpretation of epicutaneous skin testing and spirometry. Patient continuity allows for the development of expertise in the management of chronic disease processes over time, including implementation of step-up and step-down asthma guideline-based care, allergen immunotherapy, application of evidence-based management of atopic dermatitis, and food allergy.
Adult Allergy Continuity Clinic: This clinic provides experience in diagnosis and management of adult allergy and asthma. Fellows participate in adult clinic one-half day per week throughout the 2 years, thus providing a thorough cross-training experience in adult allergic diseases. Fellows gain expertise in managing conditions more commonly encountered in adult patients, such as aspirin exacerbated respiratory disease fixed airway obstruction, mixed COPD/asthma phenotypes.
Immunodeficiency Clinic: The major objectives of this clinic are to expose and familiarize fellows with all aspects of primary and secondary immunodeficiency as well as the use and interpretation of clinical immunologic laboratory testing. During this clinic, fellows develop expertise in the long-term management of patients with immunodeficiency and immune-mediated diseases. Fellows also acquire experience with therapeutic modalities, such as administration of intravenous gamma globulin (IVIG) and pulse steroids. Fellows participate in this clinic one-half day per week during both years of their fellowship.
Rocky Mountain Hospital for Children (RMHC): Inpatient Allergy and Immunology consultation is provided at RMHC with supervision from NJH attending physicians. Fellows are only on-call during the day on Monday through Friday. Fellows do not cover call on nights or weekends. Fellows continue to participate in their Adult and Pediatric Continuity Clinics, the Immunology Clinic, and have additional time in the Pediatric Allergy Clinic at NJH. Time is also reserved during this rotation for research and academic endeavors.
Adult Allergy Consult Service: This rotation takes place for 1 month in the second year of fellowship. Consults are performed at the University of Colorado Hospital and are staffed by faculty from the adult allergy division. Fellows are on-call at night and on the weekends during this rotation only. This month is concurrent with a research month.

*Fellows generally attend one national specialty meeting during the first year and all attend the /AAAAI/ACAAI Board Review Course, which is offered every other year.

Research and Other Academic Assignments

Research and Scholarly Activity: Each fellow works with a faculty research mentor for a high quality research experience. Fellows routinely present at national meetings each year. Past fellows have conducted research in the following areas:

Asthma and the environment
Asthma and steroid responsiveness
Food allergy and atopic dermatitis
Food allergy diagnosis
Mast cell activation syndrome
MRSA and atopic dermatitis
Molecular mechanisms of primary immunodeficiency
Human genetics
B cell, T cell, and neutrophil biology

Dermatology, Rheumatology, GI, Pulmonology, and ENT clinics: Familiarization with these related specialty disciplines can be obtained on an elective basis during the second year of fellowship.

Procedural Electives: Fellows can elect to spend additional time focused on specific procedures including performing and reading PFTs, rhinolaryngoscopy, patch testing, skin biopsies, and lab experiences.

Teaching Conferences
As part of their training, fellows regularly attend the following conferences held at NJH (most conferences run from September to May):

Denver Allergy Rounds – a weekly city-wide conference in allergy and immunology
Board Review Course – a weekly immunology review course shared with the adult fellows
Pediatric Department Noon Conference – a weekly conference consisting of case presentations, formal clinical and research presentations, and journal reviews
Pediatric Allergy and Immunology Lecture Series – a weekly series focusing on skills needed to conduct and understand clinical research methods, biostatistics
Journal Club – a monthly allergy journal club shared with the adult faculty and fellows
Adult Allergy Case Conference – an optional, weekly conference that focuses on adult allergy and immunology cases
Boot Camp Lecture Series – an introductory lecture series held in July and August that provides a broad overview of basic adult and pediatric allergy and immunology topics

3rd Year Training (Optional)

For fellows seeking a career in academic medicine, funding opportunities for continued training and research are available.

Learn about the application process.