Pediatric Allergy & Immunology - UT Southwestern

Research Activities
Under Dr. Gruchalla’s direction, the division continues to expand both its clinical and basic science research efforts in
asthma. UT Southwestern was among 11 institutions selected by the National Institutes of Health to receive $56 million
over five years as part of the Inner City Asthma Consortium (ICAC). The ICAC investigates novel treatments and causes
of asthma in urban children. Ongoing studies include a
prospective, longitudinal evaluation of environmental factors
that influence the development of asthma.
The consortium is administered by the University of Wisconsin-
Madison. In addition to UT Southwestern, research is being
conducted at:
• Boston University,
• Children’s Memorial Hospital in Chicago,
• Children’s National Medical Center in Washington, D.C.,
• Henry Ford Health System in Detroit,
• National Jewish Health in Denver,
• Johns Hopkins University in Baltimore,
• Mount Sinai School of Medicine in New York,
• St. Louis Children’s Hospital, and
• University of California, San Francisco.
In addition to three current studies, a very important trial funded by this consortium was published in March 2011 in the
New England Journal of Medicine, co-authored by Dr. Gruchalla. The article, “Impact of the Addition of Omalizumab
to Guidelines Based Therapy of Inner-City Asthma: A Randomized Controlled Trial,” found that a new anti-asthma
medication, omalizumab, improved asthma control in the 419 children and young adults studied, nearly eliminated seasonal
exacerbations of asthma, and reduced the need for controller medication when used in concert with NIH-based treatment
guidelines. The study was a multi-institutional one involving UT Southwestern scientists and eight other academic medical
institutions. In addition to the numerous ICAC clinical studies, ICAC-related basic research collaborations also are ongoing
with UT Southwestern investigators, Drs. Michelle Gill, David Farrar and Nitin Karandikar.
The Primary Immunodeficiency Program is engaged in both clinical and basic research. In collaboration with the Stem
Cell Transplant at Children’s Medical Center, children with primary immunodeficiency diseases can be transplanted at
our institution and are part of the Primary Immunodeficiency National Transplant Consortium (PIDTC). In terms of basic
research, three areas of interest are as follows:
1. To understand the molecular etiologies that may contribute to clinical heterogeneity in patients with primary
immunodeficiency diseases. We are currently collaborating with Dr. Nicolai van Oers, Associate Professor of
Immunology, Microbiology and Pediatrics at UT Southwestern, who has profiled the microRNA expression pattern in
patients with Primary Immunodeficiency Diseases.
2. To understand the long-term natural history of patients with X-linked hyper IgM syndrome. Dr. de la Morena has
received funding through the Jeffrey Modell Foundation for this multinational collaborative study.
3. To identify novel genes in primary immunodeficiency disease through exome sequencing. This project is done in
collaboration with Dr. Ward Wakeland, Professor and Chairman of Immunology at UT Southwestern. The PIDs
continue to provide unique opportunities to further our understanding of the biology of normal human immune
function.
Clinical Activities
Asthma and Allergy
The Asthma and Allergy outpatient clinic is equipped to diagnose and manage the whole spectrum of allergic diseases. There
are nine half day clinics per week to provide care for patients. An average of 200 patients are seen per month for evaluation
and management of various atopic diseases, including, but not limited to, asthma, allergic rhinitis, atopic dermatitis, food
allergy, insect sting allergy and drug allergy. Procedures such as skin prick testing for environmental and food allergens,
hymenoptera venom allergy testing and testing for drug allergies are performed by trained personnel. Other services offered
are immunotherapy - both traditional and rush - and anti-IgE immunoglobulin administration.
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A Pulmonary Function Lab is available for spirometry as well as exhaled nitric oxide studies for the evaluation and
management of patients with asthma. Providers work closely with educators from the Asthma Education and Asthma
Management programs to provide a comprehensive management strategy for patients with severe asthma. Special procedures
such as drug challenges and food challenges are also performed in the outpatient clinic.
A combined Allergy/Immunology and Otolaryngology sinus clinic (CASCADE) has been established to provide
comprehensive care for patients with chronic sinusitis. One half-day clinic per month is offered at both the Dallas and
Legacy campus. To facilitate care, patients who are seen in these clinics have a complete evaluation of allergen sensitization
patterns and immunological system, as well as an otolaryngological evauluation in one setting.
A multidisciplinary High Risk asthma clinic was established in the summer of 2011 to provide comprehensive asthma care
to patients with severe asthma and other co-morbid conditions. Two half-day clinics are offered at the Dallas campus where
patients are evaluated by multiple providers including an allergist, pulmonologist, nutritionist, psychologist and asthma
educators to provide comprehensive asthma care and education.
An active inpatient consult service is available for evaluation of patients with allergic diseases. Consults are usually requested
in cases of suspected drug-allergy, anaphylactic reactions and severe asthma.
Food Allergy
In September of 2010, the Food Allergy Center (FAC) at Children’s, which is directed by Dr. Drew Bird, officially opened its
doors. This multidisciplinary center, in association with UT Southwestern, is the only academically affiliated pediatric food
allergy program in North Texas. As such, the Center provides comprehensive care for patients who have been diagnosed
with food allergies and conducts research that is instrumental in developing treatments, therapies and, ultimately, a cure for
food allergies. Its staff also works tirelessly throughout the region to educate parents, healthcare providers, school personnel
and community stakeholders to help children and families navigate the many challenges associated with this complex
health issue.
In 2011, the FAC continued to expand its influence within North Texas. Highlights from the year include the following:
Clinical Care
• Nearly 1,000 clinic visits were conducted.
• 134 food challenges were performed with assistance from Maria Crain,
PNP. The food challenge process entails giving the child incremental
doses of a particular food over one hour and monitoring the child for an
additional period of time. If the child can tolerate a full serving of the
potentially allergenic food without having an allergic reaction, the food
may be introduced into the child’s diet.
Research
• A total of 12 children are currently enrolled in a peanut oral immunotherapy
trial aimed at understanding how the immune system develops tolerance to
peanut in peanut allergic children receiving therapy.
• Two multi-center trials examining the safety of giving the flu vaccine to a
child with an egg allergy. The influenza vaccine contains a small amount of
egg protein, and, as such, is administered cautiously to children with egg
allergies.
• Investigating changes in the quality of life for families dealing with food
Dr. Drew Bird
Director, Food Allergy Center
allergies who attend instructional cooking classes. This study seeks to better understand how cooking classes offered
through our Center by a registered dietitian improve the quality of life for children affected by food allergies.
• More than 100 families have participated in our interactive nut identification quiz. The goal of this study is to provide
insight into the ability of those with tree nut allergies to accurately identify the nuts to which they are allergic, as well
as those to which they are not.
Advocacy and Education
• One of the first overnight camps specifically for children with food allergies was hosted at Camp Sweeney in Gainesville,
Texas. Thirty-five children attended camp where safe meals were prepared avoiding a cumulative total of more than 30
different allergens.
• The second annual Food Allergy Collaborative hosted Wesley Burks, M.D., Kiser-Arena Professor and Chief of the
Division of Pediatric Allergy and Immunology at Duke University Medical Center in Durham, North Carolina, and an
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