Dr Jennifer Lortan
As often happens at social gatherings, one of the first opening questions in
conversation with strangers is "what do you do?"; when I reply, "I am an
Immunologist," there is usually a long silence as they struggle with this,
followed by "ah yes, you immunise people.". Although
Immunology began with Edward
Jenner's work on small pox that eventually lead on to hugely successful
immunisation programmes, I hope to convince you that there is very much more
to the clinical practice of Immunology
than immunising people
Immunology
as a Clinical Specialty
Immunology is one of the
smaller clinical specialties in the United Kingdom. Consultant Immunologists
usually have a dual role, combining both the provision of clinical care and
related laboratory investigation of patients with a wide range of disorders
of the immune system. This encompasses patients with immunodeficiency,
allergy, autoimmune and vasculitic disorders.
Immunology services are often
based in Teaching Hospitals and are lead by Consultant Immunologists working
in teams that include Specialists Registrars,
Immunology Nurse Specialists,
Biomedical and Clinical Scientists and administrative staff.
Patient Care Provided by
Immunology Consultants
This is usually based in outpatient clinics where patients are assessed,
investigated, diagnosed, treated and monitored, often for life-long
disorders. The spectrum of clinical problems that are encountered will
depend on local factors and to some extent the particular area of expertise
of the individual consultant.
Immunodeficiency Clinics
Patients with primary immunodeficiency especially antibody deficiency but
also combined T and B lymphocyte deficiency, complement and phagocytic
defects, are managed. Children with these disorders are usually dealt with
in conjunction with Paediatricians in joint clinics, as most consultant
Immunologists are trained in adult medicine. Occasionally Immunologists are
directly involved in the care of patients with HIV infection and AIDS but
this would be unusual in the United Kingdom.
Consultant Immunologists also participate in Immunoglobulin (IgG) infusion
clinics that are often lead by
Immunology Specialist Nurses. Most of the patients treated in these
clinics receive IgG as replacement therapy for antibody deficiency (both
primary and secondary in origin). Some centres have expanded to use
high-dose IgG as immuno-modulatory therapy for a limited range of other
disorders such as inflammatory neuropathies. Many centres also offer highly
successful home therapy programmes where patients, with the help of a
partner, are trained to administer the treatment to themselves.
Autoimmune and Vasculitis Clinics
Immunologists with a special interest in connective tissue disease often
participate in joint clinics with Rheumatologists where patients with these
disorders are diagnosed and managed.
Allergy Clinics
Immunologists often contribute to the provision of allergy services, and
depending on local circumstances either provide clinics on their own, with
Allergists or jointly with organ-based specialists such as Dermatologists or
Chest Physicians.
Laboratory
Immunology
Consultant Immunologists lead and provide direction for diagnostic
immunology laboratory services,
provide clinical liaison, interpretation and validation of results. Working
with the Laboratory Manager they are also responsible for quality assurance,
assay development and teaching and supervision of Biomedical and Clinical
Scientists as well as Specialist Registrars.
Why is Immunology an Exciting
Specialty?
It is the variety and complexity of clinical problems encountered, in a
field that is ever changing, which provides the greatest intellectual
challenge. There are many immunological disorders that remain undefined and
new therapies emerging that need evaluating, so there are also many
opportunities for clinically related research.
The first requirement is a solid grounding in general internal medicine
(or paediatrics) and the acquisition of MRCP (or equivalent). You would then
need to apply for a specialist registrar training position in
Immunology. These training posts
are usually for five years, during which time you would prepare for the
MRCPath in Immunology, probably
undertake some research and finally be awarded a CCST in
Immunology and your name be
entered onto the specialist register. You would then be eligible to apply
for a position as a Consultant Immunologist, which is when the fun really
begins! Although this is a small speciality, there has been a sustained
expansion in new consultant posts allowing for great optimism for future
prospects.
So do we Immunise People?
Well not very often as it happens and when we do, we use immunisation as
a tool to test the integrity of the immune response.
Out-of-Hours Duties, On-Call or Having a Life
Out-Side Work
If this is something that concerns you, although Immunologists provide
full 24 hours a day, 7 days a week cover, there are truly no "Immunological
Emergencies" that only you can handle on the spot! So being on call for
Immunology usually involves
giving advice over the telephone rather than having to go into the hospital
at 2 o'clock in the morning.
