Allergy and Immunology Fellowship Program

Dr. Raymond Slavin started the fellowship program in 1970, five years after he 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 more than 47 years. The Allergy and 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).

The 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.

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 Health Saint Louis University Hospital is a quaternary 356-bed academic teaching hospital that is staffed 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 nine Vaccine and Treatment Evaluation Units (VTEU) that form a network sharing 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 Trudy Busch Valentine 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, including 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.

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.

Scheduled weekly specialty conferences include:

• An adult clinical conference every Monday at noon
• 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).

• SSM Health Saint Louis University Hospital
• SSM Health SLUCare Allergy and Immunology Clinic

Pediatric Allergy-Immunology Division:

• SSM Health Cardinal Glennon Children's Hospital
• Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies

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 cost
12. Recreation: Free membership at SLU (Simon) Recreation Center
13. Scholarly and Travel Allowance: fellows have historically received an additional allowance toward 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.