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Allergy and Immunology Fellowship Program

Our Saint Louis University (SLU) allergy and immunology fellowship is a single, totally integrated internal medicine-pediatric program which provides comprehensive exposure to clinical allergy, asthma and immunology in children and adults, in addition to providing research training in clinical and translational medicine.

Information for Applicants

Overview

Graduates of our program are equipped to function as clinician allergists/immunologists caring for both adults and children, physician educators, or physician scientists, depending on the individual career goals of the individual. The program is jointly sponsored by the departments of Internal Medicine and Pediatrics, and administered by the Section of Allergy & Immunology, Division of Infectious Diseases, Allergy & Immunology (IDAI), Department of Internal Medicine, in collaboration with the Pediatric Division of Allergy and Immunology.

SLU Allergy and Immunology faculty physicians are recognized national experts in treatment of asthma, allergies, and immune deficiency diseases. In addition to patient care and teaching, faculty are actively involved in research, are engaged in development of national and international patient care guidelines for improved diagnosis and treatment of allergic disorders and asthma, and serve as advisors to the FDA. Our faculty physicians are all board certified by the American Board of Allergy and Immunology.

Program Structure 

The two year program is structured in one month rotations. Each academic year, a fellow rotates through four months each of three different rotations:

  1. Saint Louis University Hospital/SLUCare Outpatient Clinics [SLUH/ SLU],
  2. Cardinal Glennon Children’s Hospital [CG]
  3. Clinical Scholar/Research Rotation, with the possibility of electives during this time.

Also note that fellows attend the same conferences (average 3.0 hours/week) during all rotations.

There is no night call. On site duty hours typically range from 44-54 hours/week. A fellow rotates on call for evenings and weekends every 3rd week.

The SLUH rotation emphasizes predominantly adult ambulatory clinical experience (5 half day clinics/week at SLU in Allergy, Asthma, Immunology (AAI) Clinic, and a clinic on the 1st and 3rd Wednesdays mornings of the month that features rhinoscopy training. Therefore, a total of 5-6 half days/week are clinic experiences. There is typically remaining time (4 half days, i.e. most of Monday, and Tuesday afternoons and Friday afternoons) to perform research and scholarly activity. Occasional inpatient consults at SLUH are seen during these half days, but the volume of these consults is relatively low. The most common requests for inpatient consultation are for drug allergy evaluation and drug desensitization.

Monday Tuesday Wednesday Thursday Friday

10:30 a.m. - 11:30 a.m.
Abbas Immunology Review or Notarangelo case reviews in immunology (twice monthly)

Remainder of Monday mornings available for SLUH Inpatient Consults, Research, Scholarly Activity

8:00 a.m. - 9:00 a.m. Pediatric A/I Conference

 

 9:00 a.m. - 12:00 p.m. Available for SLUH Inpatient Consults, Research, Scholarly Activity

8:00 a.m. - 12:00 p.m. SLU Sinus Clinic – (Borts, first and third Wednesday of month) 8:30 a.m. - 12:00 p.m. SLUCare Clinic (Dykewicz)  8:30 a.m. - 12:00 p.m. SLUCare Clinic (Dykewicz)

12:00 p.m. - 1:00 p.m.
Adult A/I Conference

12:00 p.m. - 5:30 p.m.
Available for SLUH Inpatient Consults, Research, Scholarly Activity
1:00 p.m. - 5:30 p.m. SLUCare Clinic (Dykewicz) 1:00 p.m. - 5:30 p.m. SLUCare Clinic (Dykewicz) 12:00 p.m. - 5.30 p.m. Available for SLUH Inpatient Consults, Research, Scholarly Activity

1:00 p.m. - 5:30 p.m.
Fellow Continuity Clinic
SLUCare Clinic (Slavin)

SLUH rotation 

The Cardinal Glennon (CG) rotation is a predominantly pediatric clinical rotation with extensive ambulatory clinical experience (6 half day clinics/week), with a very active pediatric inpatient service. Consequently, except for conferences, most of the time not spent in clinic is spent on inpatient service, although residents may have some limited time available for research and scholarly activity.

Monday Tuesday Wednesday Thursday Friday

10:30 a.m. - 11:30 a.m.
Abbas Immunology Review or Notarangelo case reviews in immunology (twice monthly)

Remainder of Monday mornings available for CG Inpatient Consults, Research, Scholarly Activity

8:00 a.m. - 9:00 a.m. Pediatric A/I Conference 8:00 a.m. – 1:00 p.m. Inpatient Consults 8:30 a.m. - 12:30 p.m.
Immune Deficiency Clinic (Knutsen)
 8:30 a.m. - 12:00 p.m.
IVIG Clinic/Food Challenges (Knutsen)

12:00 p.m. - 1:00 p.m.
Adult A/I Conference
CGCH

9:00 a.m. - 12:00 p.m.
IVIG Clinic/Food Challenges (Knutsen)
1:00 p.m. – 5:00 p.m.
Allergy and Asthma Clinic (Warrier - second, fourth weeks of month) (Becker - first, third, fifth weeks of month)
1:00 p.m. - 4:00 p.m.
Immune Deficiency Clinic (Knutsen)
12:00 p.m. – 5:30 p.m.
Inpatient Consults

1:00 p.m. – 5:00 p.m.
CG Allergy and Asthma Clinic
(Becker)

12:00 p.m. - 5:30 p.m.
Inpatient Consults
4:00 p.m. – 5:30 p.m. Inpatient Consults

The Cardinal Glennon (CG) rotation

Glennon Scholar & Research (GSR) rotation has clinical responsibilities limited to one half day fellow continuity SLUCare clinic on Tues AM, and one half day Weds AM Continuity Clinic at CG. Therefore most of this rotation serves as protected time for scholarly activity and research.

Monday Tuesday Wednesday Thursday Friday

10:30 a.m. - 11:30 a.m.
Abbas Immunology Review or Notarangelo case reviews in immunology (twice monthly)

Remainder of Monday mornings available for CG Inpatient Consults, Research, Scholarly Activity

8:00 a.m. - 9:00 a.m. Pediatric A/I Conference 8:30 a.m. - 12:00 p.m.
CG Continuity Clinic (Becker)
8:30 a.m. - 5:30 p.m.
Research Scholarly Activity
8:30 p.m. - 5:30 p.m.
Research Scholarly Activity
12:00 p.m. - 1:00 p.m.
Adult A/I Conference
9:00 a.m. - 12:00 p.m.
Research Scholarly Activity
12:00 p.m. - 5:30 p.m.
Research Scholarly Activity

1:00 p.m. – 5:30 p.m.

Fellow Continuity Clinic
SLUCare (Slavin)

12:00 p.m. - 5:30 p.m.
Research Scholarly Activity

Glennon Scholar & Research (GSR) rotation

Program History and Accreditation

The fellowship program was started in 1970 by Dr. Raymond Slavin, who five years earlier had established the Section of Allergy and Immunology in the Department of Internal Medicine. Since its inception, the fellowship program has been continuously accredited for now more than 47 years. The Allergy & Immunology Residency Review Committee (RRC) of the American College of Graduate Medical Education (ACGME) has commended our fellowship program with no citations. The program has a total of three positions (two positions available in the 2019 NRMP subspecialty match for entry in July 2020).

Well Balanced Case Mix

Fellow case mix is about 45% adults, 55% children. In most diagnostic categories tracked by the RRC, our fellows see patient numbers above the 50th percentile of all programs nationally, with asthma, immune deficiency disorders, food allergy, atopic dermatitis and rhinitis ranking above the 90th percentile.

Academic and Clinical Environment

SLU, founded in 1818 as the first university west of the Mississippi River and the second Jesuit Catholic university in the country, has 8,200 undergraduates and 4,600 graduate students (including 770 medical students). With a slogan, “Higher Purpose, Greater Good”, SLU’s missions are academic excellence, life-changing research, compassionate health care, and a strong commitment to faith and service. Our fellowship program’s two sponsoring hospitals are both on the SLU South/Medical Campus. 1) SSM Saint Louis University Hospital is a quaternary 356-bed academic teaching hospital that is staffed exclusively by the SLUCare Physician Group, the SLU medical faculty group practice. In September 2019, a $550 million construction project will complete construction on a new university hospital pavilion and new outpatient clinic building. 2) SSM Cardinal Glennon Children’s Hospital, a 190-bed inpatient and outpatient academic pediatric medical center provides nationally ranked care and includes a Jeffrey Modell Diagnostic & Research Center for Primary Immunodeficiencies. The immunodeficiency program at Cardinal Glennon is a clinical referral center for both the Jeffrey Modell Foundation (JFM) and the Immunodeficiency Foundation (IDF), and is also a designated center of an NIH sponsored Primary Immunodeficiency Disease Treatment Consortium. The pediatric Division of Allergy and Immunology, headed by Alan Knutsen, M.D., Professor of Pediatrics, works with the Bone Marrow Transplantation Division in transplantation of severe T-cell immunodeficiencies. Other notable services at Cardinal Glennon include the St. Louis Cord Blood Bank - the second largest in the world - and the Missouri Poison Center which provides free statewide service 24/7.

On the Internal Medicine side, the Section of Allergy and Immunology headed by Mark Dykewicz, M.D., Raymond and Alberta Slavin Endowed Professor in Allergy and Immunology, is part of its parent Division of Infectious Diseases, Allergy and Immunology (IDAI), led by Division Director Daniel Hoft, M.D., Ph.D., the Dianna and J. Joseph Adorjan Chair in Infectious Diseases and Immunology. The Division has outstanding new research facilities; has investigators who are conducting translational studies on mechanisms of asthma in murine models; basic research on Th2 and Th9 cells; and operates an internationally recognized Center for Vaccine Development, The Division is funded by the National Institute of Allergic and Infectious Diseases (NIAID) as one of only 9 Vaccine & Treatment Evaluation Units (VTEU) that form a network sharing in nearly $1 billion in NIH research contracts through 2023. SLU was recently designated as one of the VTEU network’s two Omics Core Facilities, and will receive millions in funding for cutting edge research to study transcriptomic, proteomic, lipidomic and metabolomic responses to infection, vaccination and allergic responses. Major research support is also provided by the Bill and Melinda Gates Foundation. This environment offers robust opportunities for basic and translational research for Allergy & Immunology fellows.

Other components of the SLU medical center campus are its School of Nursing and Doisy College of Health Sciences. The SLU College of Public Health and Social Justice, located several blocks from the Medical Center Campus, provides additional opportunities for collaborative health care initiatives and research studies.

Greater St. Louis, with a metropolitan population of 2.9 million, offers world-class higher education, cultural institutions and multiple attractions (e.g. the 79 acre Missouri Botanical Garden with one of the largest Japanese gardens in North America; several major museums including the St. Louis Art Museum in Forest Park, Gateway Arch, St. Louis Symphony (ranked in the top 10 in the U.S.), the country’s largest outdoor musical theater (the Muny), the St. Louis Zoo), St. Louis Cardinals Baseball, St. Louis Blues Hockey, an extensive variety of restaurants, one of the largest urban networks of hiking and bicycle trails in the U.S., and an abundance of parks and outdoor recreation. Widely considered a great place to raise children, the area offers award winning schools, Midwestern friendliness and a cost of living below the national average.

Research and Scholarly Activity

Roua Azmeh (2015-2017)

  • Current project: Survey study ongoing - submitted as abstract for AAAAI 2017 Annual Meeting: “Treatment of pediatric acute severe asthma by pediatric emergency medicine and critical care program directors: 20 year practice trends” (Becker, Dykewicz).
  • Foster KJ, Rodrigues JM, Lee J, Powell S, Azmeh R, Knutsen AP. Periodic fever, aphthous stomatitis, pharyngitis, adenitis syndrome at a single children's hospital. Inter J Allergy Medications (accepted).
  • Dogged Persistence of Childhood Eosinophilic Esophagitis, case report poster at the ACAAI 2015 Annual Meeting, San Antonio.
  • Review article published: Rodrigues J, Caruthers C, Azmeh R, Dykewicz MS, Slavin RG, Knutsen AP. The spectrum of allergic fungal diseases of the upper and lower airways. Expert Rev Clin Immunol. 2016 May;12(5):531-50.
  • Autoimmune polyendocrinopathy candidiasis ectodermal dystrophy (APECED) is an autosomal recessive disease with chronic mucocutaneous candidiasis (CMC) and autoimmune disease; second known patient with chronic autoimmune urticaria as an initial symptom. (ACAAI case report Knutsen/Becker)
  • Azmeh R, Dykewicz MS. Seasonal Allergic Rhinitis. In Bernstein JA. Rhinitis and Upper Related Airway Conditions: A Clinical Guide. Springer International. 2018 pp 1-7. ISBN 978-3-319-75369-0.
  • Co-writing, with Julia Lee and Sara Powell, review article on the diagnosis and management of Eosinophilic Esophagitis the Current Pediatric Reviews Journal (Becker).
  • Quality Improvement project on allergen immunotherapy at SLU and Glennon (Dykewicz).

Julia Lee (2016-2018)

  • Lee JS, Becker BA, Kirby A, Knutsen AP. Chromosome 1q23.3q31.1 deletion associated with decreased newborn screening of T cell receptor rearrangement circles (TRECs). Ann Allergy Asthma Immunol. 2018 Jul;121(1):125-126.
  • APECED Abstract co-author, op.cit. see Rouah Azmeh. (Knutsen).
  • PFAPA, see Foster et al under Rouah Azmeh. (Knutsen).
  • Eosinophilic esophagitis quality improvement project for the diagnosis and management of patients at Cardinal Glennon, run by a joint committee of Peds GI and Peds Allergy and Immunology (Becker).
  • Co-writing review article on the diagnosis and management of Eosinophilic Esophagitis (Becker), op.cit. for Roua Azmeh.
  • Quality Improvement project: implementation of new patient questionnaire to more systematically capture patient history at SLU (Dykewicz).
  • Quality Improvement project: development of Epic EHR Smart Sets to improve accuracy and efficiency of ordering lab testing (Dykewicz).

Sara Powell (2016-2018)

  • Powell SD, Woelich SK, Caruthers CN, Dykewicz MS. “Successful IV Desensitization to Racemic Leucovorin: An Underappreciated Cause of Anaphylaxis from Cancer Chemotherapy”, poster presentation at ACAAI 2017 Annual Meeting, San Francisco.
  • PFAPA/CAPS retrospective outcomes study, see Roua Azmeh op. cit. above, (Knutsen).
  • Trichodysplasia case report, manuscript in preparation (Knutsen).
  • Powell S, Knutsen A. Very Early Onset Inflammatory Bowel Disease in a 6 Year Old Girl With LRBA Deficiency.
  • Eosinophilic esophagitis QI project co-participant, see Julia Lee above.
  • Co-writing review article on the diagnosis and management of Eosinophilic Esophagitis (Becker) and Roua Azmeh for the Current Pediatric Reviews Journal.

 

Additional research opportunities: For fellows interested in bench research or academic careers, the Internal Medicine Division also offers bench and translational research opportunities on mechanisms of asthma in murine models, and Th2 and Th9 cells.

Representative of this: Peng H, Ning H, Wang Q, Lu W, Chang Y, Wang TT, Lai J, Kolattukudy PE, Hou R, Hoft DF, Dykewicz MS, Liu J. MCPIP1 controls allergic airway inflammation by suppressing IL-5-producing Th2 cells through Notch/Gata3 pathway. J Allergy Clin Immunol 2018 (Aug); 142;582-94.

 
Conferences

Scheduled weekly specialty conferences include:

  • An adult clinical conference every Monday at 12 p.m.
  • A pediatric clinical conference every Tuesday at 8 a.m.
  • Review of Cellular and Molecular Immunology by Abbas
  • Research conferences are also scheduled

In addition, our fellows also attend national conferences and meetings. Traditionally, the first year fellows attend the Annual Meeting of the American College of Allergy, Asthma, and Immunology (ACAAI) and the second year fellows attend the Annual Meeting of the American Academy of Allergy, Asthma, and Immunology (AAAAI).

Benefits
  1.  PGY-4 Salary, current AY 2019, $56,748
  2. Vacation: 15 working days
  3. Sick Leave 30 days per year
  4. Maternity Leave 30 days, Paternity Leave two weeks
  5. Insurance:
    - Health Insurance 100% coverage for you and eligible dependents
    - Dental Insurance Limited dental coverage for you and eligible dependents
    - Vision Insurance Limited vision insurance for you and eligible dependents
    -  Life Insurance Annual stipend is provided at no cost; may increase 4-fold
    - Dependent Life Available at modest cost for spouse and eligible dependents
    - Long-term Disability Insurance is provided
  6. Malpractice- Fellows are fully insured while on duty
  7. 403B Plan Tax deferred contributions available through payroll reduction
  8. Flex Spending Plan Allows payroll reduction for medical and dental expenses
  9. Dependent Care Allows payroll reduction for eligible childcare expenses
  10. Counseling Employee assistance program at no cost
  11. Parking Adjacent to the hospital at no cos
  12. Recreation: Free membership at SLU (Simon) Recreation Center
  13. Scholarly and Travel Allowance: Fellows have historically received an additional allowance towards the purchase of books, expenses while attending conferences, etc. Although an allowance is expected to continue, the monetary amount varies annually.
  14. During fellowship membership is free for the American Academy of Allergy, Asthma and Immunology (AAAAI), American College of Allergy, Asthma and Immunology (ACAAI and Clinical Immunology Society.
  15. An office equipped with personal computers and a library is located in the medical school building.
  16. Access to the Saint Louis University Library.
  17. Electronic Health Records at all training sites.

View full, most up-to-date list of SLU GME Benefits