ecause of its premierreputation, the JohnsHopkins Division of

Allergy and ClinicalImmunology attracts the mosthighly qualified fellowshipcandidates to its multi-yearclinical and research trainingprogram. After completing aresidency in general internalmedicine or pediatrics, thesephysicians seek to specialize inthe treatment allergic andimmunologic diseases in a top-notch academic setting, wherethey can learn to combinestate-of-the-art patient carewith cutting-edge research. But how does all this trainingimpact patients in theDivision’s Clinical Care Unit?We talked to the training program’s director, Dr. N.Franklin Adkinson, Jr., to findout how the patient care,research, and education puzzlereally fits together:

How do clinical fellows interactwith patients?Each clinical fellow isassigned to one of our facul-ty, also called an attendingphysician, and sees patientsduring that attending physi-cian’s scheduled clinic.Before the attending physi-cians interact with theirpatients, fellows interviewnew patients, perform com-plete medical histories andphysical exams, and thenpresent the information tothem. This allows the fel-low to become an expert inacquiring information com-pletely and efficiently.

What other kinds of traineesinteract with patients?In addition to our adult andpediatric allergy trainees,we often have internal med-icine and pediatric resi-dents, visiting physicians,and occasionally medicalstudents and other visitors,all of whom are here toobserve how we practiceallergy and immunology.

How do attending physiciansteach during patient clinics?Much of the teaching comesfrom a faculty member

serving as a role model ininteracting with patients,showing how to acquireinformation efficiently, toaddress a patient’s needs,and to develop a diagnosticand treatment plan for eachpatient. There may be for-mal teaching based on inter-esting cases later, after clin-ic or at conferences, butmost of the learning occursin the process of providingthe care.

Is it an advantage to patients tohave fellows assisting in clinics?We think that it is. Patientsget the benefit of morethorough and detailed evaluations of both theirhistories and their physicalexaminations than would bepossible without the partici-pation of fellows. In addi-tion, since multiple physi-cians filter and examinepatient histories, there is agreater likelihood of accu-rate diagnoses and thedevelopment of appropriatetreatment plans.

How much of their time do fel-lows spend taking care ofpatients vs. doing research?A typical first year allergy

fellow will spend about halfof his or her time seeingpatients, and a second orthird year fellow will spendless time with patients andmore time in research.

What kind of research training doclinical fellows receive?Our allergy and clinicalimmunology fellows canpursue their interests inclinical research, dealingdirectly with patients inclinical studies, or in thelaboratory, where they canuse cutting-edge methods toexplore the cellular andmolecular mechanisms ofallergic diseases. We expectfellows to present theresults of their research tocolleagues in divisional con-ferences, as well as at

Continued on page 2

AllergicReactions

A semiannual publication ofJ O H N S H O P K I N S M E D I C I N EDivision of Allergy & Clinical Immunology

Volume 2, Number 1Summer 2005

B

It’s Academic: Our Allergy Fellowship Program

Inside this issue

Director’s Outlook 2

Taking the Right Steps 3

Educating Patients 4

Allergy Calendar 4

Help Us Help You 5

2

Director’s OutlookBruce S. Bochner, M.D., DirectorDivision of Allergy & Clinical Immunology

In this issue of Allergic Reactions, I would liketo share a variety of ongoing education-related efforts in theDivision of Allergy and Clinical Immunology. One aspect ofour mission is training future academic allergists. In an interview with Dr. N. Franklin Adkinson, Professor of Medicineand Training Director for our division, you will learn abouthow we introduce board-certified internal medicine and pediatric doctors to our specialty. This explains why there isalmost always another doctor besides the faculty doctor whosees patients during each visit. I also hope that you will beable to better appreciate how the higher quality of carepatients receive in our teaching environment outshines theinconvenience this might occasionally cause.

Also in this issue, you will read about two key people in ourdivision, who work somewhat behind the scenes to assure that we doour best to educate our clinic patients about their diseases and treatments and to inform everyone involved in clinical research. The latter group includes the clinical trial volunteers, as well as thephysicians and staff doing the research. You will meet Mr. EdwardHorowitz, our recently appointed education coordinator, whoseefforts to enrich educational methods and materials across our training program and clinical practice should become more noticeable in the near future. You will also be introduced to Ms.Lisa Leventhal, our regulatory affairs specialist, whose job it is tohelp guarantee compliance with such critically important things assafety and confidentiality issues related to human research.

I want to thank our patients who took the time to respondto our first-ever patient satisfaction survey. We are in the process ofevaluating the responses and are actively planning for changes basedon these suggestions and concerns. I do want you to know thatwhile we were thrilled, for example, to hear that more that 95% ofrespondents said their level of confidence in their allergy doctor wasgood or excellent, it is also clear that things such as parking, waittimes for appointments, and difficulty reaching a real person on thephone were sometimes a concern. Check out the next newsletter formore details, including how we plan to improve our patients’ experi-ences in our clinic from start to finish.

Finally, this newsletter includes our first-ever direct appealto our patients for their financial support. We hope that you appre-ciate the care that our doctors, nurses and staff provide, and one wayto show your appreciation would be to make a donation to the JohnsHopkins Division of Allergy and Clinical Immunology. Our abilityto accomplish many of our ambitious goals, both in research andpatient care arenas, depends on your support.

Contact us at (410) 550 - 2300 for appointments and referrals.

Allergy Fellowship ProgramContinued from page 1

national and international meetings, and to publish their findings in appropriatejournals.

Do all allergy doctors train in a similar program?There are other allergy programs,committed to the training of high qualityspecialists, who can treat patients well butwho do not plan to have a career inresearch. At Johns Hopkins, we havedesigned our program to be attractive toprospective fellows who are interested inacademic careers that combine the care ofpatients suffering from allergic diseaseswith an effort at discovering ways toadvance the treatment of these diseases.

Do fellows have to prepare for a board exam atthe end of their training?Yes, all allergy and clinical immunologypractitioners should be certified by theAmerican Board of Allergy andImmunology. Board certification assuresthe acquisition of the knowledge and skillsnecessary to be an expert in the practice ofallergy and immunology. This requires aone-day written examination at the end oftheir training. You might be interested toknow that, over the years, several of ourfaculty have served on the panel thatwrites questions for the exam.

Where do they work when they have completed the program?Some of our fellows will join the facultyhere and develop their careers where theytrained. Others will go to other academicmedical centers or the pharmaceuticalindustry, and a few will end up in the community practice of allergy. If you lookat where our former trainees are today, youwill find them on virtually every continent.

Taking the Right Stepsedical researchers eagerly discover,invent, and publish—all in thename of advancing medical sci-

ence and health care. However, medical researchisn’t all fun and games; it’s exacting and highly regulated. A career in medical research requiresa great deal of knowledge and training—not justin science and methods, but also in profes-sional ethics, guidelines, and protocols.

Following ProtocolsIn fact, researchers can become bogged downby red tape, since each step in every researchproject must follow a pre-approved protocol,and protocols take time to develop, submit,and revise. Of course they understand thatregulations and review boards are meant toprotect research participants, research organizations, and data integrity. But find-ing time to keep up with constantly evolv-ing guidelines and requirements, whileactually doing research and seeing patients,can be a daunting task. That is why Dr.Bruce Bochner, Director of the Division ofAllergy and Clinical Immunology, hiredregulatory affairs specialist Lisa Leventhalsoon after he became director in 2003.

A Helping HandMs. Leventhal helps the division’sresearch faculty, trainees, and staff tominimize regulatory burdens, whilereviewing human subjects research protocols for compliance with local andfederal policies. She supportsresearchers by helping them to develop

M safety-monitoring plans, consent forms, and privacyprotection procedures. In addition, she acts as a liai-son between division employees and the JohnsHopkins Medicine Institutional Review Board (JHMIRB), a panel of health professionals, ethicists, andlaypersons that reviews and approves all human sub-jects research projects conducted.

Keeping Us InformedAn important part of Ms. Leventhal’s job isto educate everyone involved in the division’smany research projects about issues relatedto the safety of volunteers, confidentiality,ethics, and regulations. This has includedholding Allergy and Clinical Immunologyresearch coordinator training sessions, notifying employees about required institu-tionwide training courses, and sendingreminders when paperwork needs to beupdated and submitted. Ever supportive,Ms. Leventhal originated a regulatoryaffairs electronic newsletter for our division’s researchers, which began as aquarterly publication and later developedinto a monthly format—just to make keeping up with those constantly evolvingrules and deadlines a little easier. She iscurrently working on educational materials specifically for those who areconsidering volunteering for studies,which should be available soon.

If you are interested in seeing whatstudies are currently ongoing, pleasevisit our website homepage under thelink “Volunteer Study Opportunities.”

For more information about indoor allergens, talk to your doctor or visit us at www.hopkinsmedicine.org/allergy.

3

In an unprecedented effort to deliver model care to ourpatients, Mr. Edward Horowitz has been namedEducation Coordinator for the Division of Allergy andClinical Immunology. Mr. Horowitz has been a valuedmember of our division for over fifteen years. He hascoordinated community adolescent and adult asthma studies, and he continues to research the role of the environment in respiratory disease. He also has developed and implemented many of our division’s technological innovations.

As Education Coordinator, Mr. Horowitz will work toenhance our patients’ experiences and treatment by:

• evaluating and improving interactions with our clinical care unit services, based on patient satisfaction survey feedback.

• working directly with patients to assure that they understand how to best use medicines and devices prescribed for treating their allergies and asthma.

• helping our patients to consider how their home and work environments might be aggravating their disease and recommending practical solutions.

• expanding our educational services to include new tools such as personalized written and online patient action plans.

These inventive educational strategies will be available only to our patients, and our new patient education coordinator will continue to look for additionalways to upgrade communications, understanding, andpatient care.

Educating Patients to Maximize Treatment

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TREE POLLENS

Juniper

Willow

Elm

Maple

Birch

Alder

Poplar

Beech

Sycamore

Ash

Oak

Hickory

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GRASS POLLENS

Timothy

Orchard

Bermuda

WEED POLLENS

Sorrel

Plantain

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MOLD SPORES

Aspergillus

Penicillium

Alternaria

Fusarium

Cladosporium

Helminthosporium

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DUST PART ICLES

Dust mites

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ANIMALS

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JAN FEB MAR APR JUN JUL AUG SEP OCT NOV DECMAY

ALLERGENS

Season Peak of season

TREE POLLENS

Juniper

Willow

Elm

Maple

Birch

Alder

Poplar

Beech

Sycamore

Ash

Oak

Hickory

Walnut

GRASS POLLENS

Timothy

Orchard

Bermuda

WEED POLLENS

Sorrel

Plantain

Lambsquarters

Pigweed

Sage

Ragweed

MOLD SPORES

Aspergillus

Penicillium

Alternaria

Fusarium

Cladosporium

Helminthosporium

Botrytis

DUST PART ICLES

Dust mites

Roaches

ANIMALS

Cats

Dogs

JAN FEB MAR APR JUN JUL AUG SEP OCT NOV DECMAY

ALLERGENS

Season Peak of season

TREE POLLENS

Juniper

Willow

Elm

Maple

Birch

Alder

Poplar

Beech

Sycamore

Ash

Oak

Hickory

Walnut

GRASS POLLENS

Timothy

Orchard

Bermuda

WEED POLLENS

Sorrel

Plantain

Lambsquarters

Pigweed

Sage

Ragweed

MOLD SPORES

Aspergillus

Penicillium

Alternaria

Fusarium

Cladosporium

Helminthosporium

Botrytis

DUST PART ICLES

Dust mites

Roaches

ANIMALS

Cats

Dogs

JAN FEB MAR APR JUN JUL AUG SEP OCT NOV DECMAY

ALLERGENS

Season Peak of season

Regional Allergy Calendar

As part of Johns Hopkins Medicine, the Division of Allergy and Clinical Immunology participatesin a legendary tradition of bench-to-bedside medicine. Through side-by-side collaborations betweenphysicians and laboratory scientists, our faculty members design new diagnostic tools and new

treatments. For example, researchers in our division invented safe and effective allergy shots to reduce life-threatening insect sting reactions. We were among the first to test inhaled steroid sprays and antibody-basedtherapies for treating hay fever and asthma.

Today, our division’s basic science researchers are exploring the underpinnings of allergies, asthma,eczema, hives, and sinusitis, with help from new technologies, such as gene chips. Now they can find thousandsof genes in cells or tissue samples and implicate hundreds of genes in a given disease process,—many of whichnever would have been suspected to be involved in that disease without these valuable research tools.

Current faculty research interests include• food, drug, latex, and insect sting allergies and anaphylaxis• genetics and epidemiology of asthma and other diseases• mechanisms of cell recruitment in allergic inflammation• diseases involving over-production of eosinophils and mast cells• molecular mechanisms of gene regulation in the immune system• skin, nasal, and lung provocation with allergens to evaluate mechanisms and treatment of allergic diseases• influence of inflammation on airway nerves and cough reflexes• control of allergic cell activation• vaccines to prevent or reverse asthma and allergies• asthma morbidity in the inner city

Traditionally, federal grants and pharmaceutical companies primarily funded our research efforts.Because of federal budget restrictions, government support for allergy and asthma research is shrinking. Because of recent high-profile pharmaceutical industry failures, funding for the discovery of new asthma andallergy treatments has declined. Grateful patients, family members and friends often ask what they can do tosupport the work of the Division of Allergy and Clinical Immunology. Now, more than ever, your financial sup-port is essential to the continued success of the Division of Allergy and Clinical Immunology at Johns Hopkins.

We need YOU to help us help you.

Yes, I would like to help the Johns Hopkins Division of Allergy and Clinical Immunology with a tax-deductible contribution.

__ $5,000 __$2,500 __$1,000 __$500 ___$100 ___$50 ______Other

Please make your check payable to Johns Hopkins Medicine and mail to:Johns Hopkins Division of Allergy and Clinical Immunology

5501 Hopkins Bayview Circle • 2B.71C • Baltimore, Maryland 21224-6801

or charge your contribution to:

__ American Express __ Discover __MasterCard __VISA

$_________Amount Name as listed on card_________________________________

Credit card # _______________________________ Exp. Date_________ Signature_______________________

For information on how to include Johns Hopkins Medicine in your will, information regarding planned gifts, or gift of securities please call (410) 516-7400.

Help Us Help You

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