Dr Rohit Ghurye, ST4 clinical immunology at the Royal London Hospital, discusses clinical immunology, what working and training in the specialty involves, and what it takes to be a successful clinical immunologist.
Introduction to immunology
Immunology is the branch of medicine concerned with the body’s defence system known as the immune system. Clinical immunologists are doctors who specialise in the care of patients with failure of the immune (defence) system (immunodeficiency) and heightened immune reactivity (allergy and autoimmunity) due to infections, allergic reactions, vasculitis and transplants.
Clinical immunologists in the UK undertake a range of clinical and laboratory duties, but their core activities are in the clinical management of patients. Their clinical work is largely outpatient based and involves:
- primary immunodeficiency
- autoimmune rheumatic diseases and systemic vasculitis
- joint paediatric clinics for children with immunodeficiency
- immunoglobulin infusion clinics for patients with antibody deficiency.
Their laboratory work underpins the diagnosis and monitoring of immunological diseases. They have responsibility for clinical liaison, interpretation and validation of results and quality assurance and assay development.
A minority of immunologists (less than ten percent) also provide laboratory support for transplantation, histocompatibility leukocyte antigen (HLA) and tissue typing.
Immunologists provide support for the diagnosis and management of conditions such as:
- autoimmune diseases such as Type-1 diabetes or rheumatoid arthritis or inflammatory bowel disease
- human immunodeficiency virus (HIV)
- other severe/systemic infections
- multiple sclerosis
Dr Richard Herriot, consultant immunologist at Aberdeen Royal Infirmary:
Immunology is a complex and stimulating area of practice in which scientific understanding and clinical progress is constant. There is no opportunity to be bored or complacent. The job brings you into contact with a wide range of professional colleagues across many disciplines and with patient groups who are, for the most part, highly engaged with their place in contributing to good care outcomes.
- Visit the British Society for Immunology website for more information on the specialty.
- Medical Care: Immunology section
- Clinical Medicine articles:
- Bright PD, Smith L, Usher J, et al. False interpretation of diagnostic serology tests for patients treated with pooled human immunoglobulin G infusions: a trap for the unwary. Clin Med 2015;15:125–9.
- Ismail S, Cheng L, Grigoriadou S, Laffan J, Menon M. Lesson of the month 2: The limitations of steroid therapy in bradykinin-mediated angioedema attacks. Clin Med 2015;15:101–3.
- Sharp CA, Bruce IN. Clinical and scientific letters – Efficiency in follow-up immunology testing for patients with connective tissue diseases and vasculitis. Clin Med 2010;10:632–4.
- Johnston S. Designer drugs: the biologic therapies. Clin Med 2006;6:337–43.
- CME clinical immunology articles in Clinical Medicine (2011):
- Ali FR. Does this patient have atopic asthma? Clin Med 2011;11:376–80.
- Huisoon AP, Krishna MT. Does this patient have an immunodeficiency? Clin Med 2011;11:380–4.
- Johnston SL. Does this patient have vasculitis? Clin Med 2011;11:385–90.
- Spickett GP, Stroud C. Does this patient with urticaria/angioedema have anaphylaxis?. Clin Med 2011;11:390–96.
- Savic S, Wood P. Does this patient have periodic fever syndrome? Clin Med 2011:11:396–401.
- Improving Quality in Allergy Services – accreditation scheme publications.