Pediatric Allergy & Immunology - UT Southwestern

international food allergy expert. More than 100 attendees heard from Dr. Burks and Dr. Bird. The event was hosted
by Children’s in conjunction with the Food Allergy Initiative in an effort to raise food allergy awareness and research
support.
• FAC nurses addressed several audiences eager to receive more guidance on handling food allergies. The Dallas
Association of Parent Education learned from an FAC Nurse about the basic pathophysiology of a food allergy reaction,
along with a review of the most current food allergy statistics.
• The Food Allergy Center partnered with Whole Foods Market to conduct themed instructional cooking classes for
parents dealing with food allergies. This class is open to the community and provides inspirational ideas on how to
handle different situations such as back-to-school lunches and snacks, holiday time and quick dinner meals all avoiding
the top eight allergens.
• The FAC participated in Children’s Red Balloon Run and Relay, produced in partnership with Passion for Children’s. The
Food Allergy Family Experience Council spearheaded the efforts to include their close family and friends to support the
advocacy of food allergy. More than $3,000 was raised and all profits made from the run will go towards scholarships
for Food Allergy Camp 2012.
• The Food Allergy and Anaphylaxis Network is the world leader in food allergy information, resources and programs.
Dr. Bird was named the Honorary Medical Walk Chair for the Dallas Food Allergy and Anaphylaxis Network Walk.
• A panel discussion was held at Region X for parents with children struggling with food allergies going back to school.
The panel consisted of experts from the FAC informing parents how to keep their children safe at school and providing
guidance for effective communication to school personnel.
Immunology
Clinical Care
• Directed by Dr. Maite de la Morena, the Immunology Outpatient Clinic
at Children’s serves as a referral center for primary immunodeficiency
diseases for North Texas, southern Oklahoma, Arkansas, Louisiana and
New Mexico. Patients with recurrent, persistent or unusual infections are
evaluated for an inherited disorder of immune function. The clinic has
expertise for management of all established primary immunodeficiency
disorders (>155 disorders currently recognized). Referrals for periodic
fever syndromes and evaluations for immunosuppressed states post
transplantations also are seen in clinics.
• Assisted by Erin Orwat, RN, more than 600 patients are seen per year.
The Immunology program currently follows more than 200 patients with
established primary immunodeficiency diseases. Around 50 patients are
receiving infusions of gammaglobulin regularly. Inpatient consultation
services for evaluation of immunodeficiency are available seven days a week.
• In collaboration with the Stem Cell Transplant Program at Children’s,
children with primary immunodeficiency diseases can be transplanted at
our institution. This provides a unique collaboration between transplanters
and immunologists. Diseases that have been transplanted include: SCID,
X-hyper IgM, Wiskott Aldrich syndrome, Chronic Granulomatous Disease,
Interferon Gamma defect, Chediak-Higashi syndrome, and Hemophagocytic Lymphohistiocytosis.
Dr. Maite de la Morena
Director, Immunology Outpatient Clinic
Research
• MicroRNA in PID: We are currently analyzing the microRNA profile of patients with Primary Immunodeficiency
Disease. Despite the known relevance of microRNA for the development and functioning of the immune system, little
is known about changes in their expression in patients with PID. An R21 funded project has allowed for the analysis of
71 patients with established immunodeficiency. This study is performed in collaboration with Dr. Nicolai van Oers at
UTSW. Publications from such analysis are currently submitted for publication.
• Identification of novel genes in patients with primary immunodeficiency diseases through exome sequencing. A total
of six families are participating in the analysis of rare immunodeficiency phenotypes in which a molecular diagnosis
is unknown. This analysis is currently being performed in collaboration with Dr. Ward Wakeland and Dr. Nicolai van
Oers, Associate Professor of Immunology, Microbiology and Pediatrics at UT Southwestern.
• The United States Immunodeficiency Network, (USIDNET) is a National Registry for patient with established
immunodeficiency diseases. USIDNET, a program of the Immune Deficiency Foundation (IDF), is funded in part
by the National Institute of Allergy and Infectious Diseases (NIAID) and the National Institutes of Health (NIH), an
agency of the Department of Health & Human Services.
• Long-term outcomes in patients with X-Linked hyper IgM syndrome. (Pending IRB approval)
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Advocacy and Education
• On October 30, 2011 faculty, nursing and administrative staff got together with PID patients and their families to
celebrate the 4 th annual Kids Day event at the Dallas Zoo. Close to 200 people participated in this gathering which is
sponsored by the Jeffrey Modell Foundation.
Education and Training
The Allergy and Immunology division provides the major instruction to pediatric residents in the evaluation and
management of children with allergic diseases, asthma and immunodeficiency diseases. It also provides didactic teaching
for the pediatric residents on the basics of allergy and immunology and directs teaching for the pediatric residents in the
regular departmental clinical conferences and as part of the inpatient consultation service.
Pediatric residents see outpatients in our clinics under the supervision of one of the members of the division faculty. Relevant
articles about specific allergic and immunologic disorders are provided to residents at the beginning of each rotation, and
residents attend clinical conferences offering didactic teaching for fellows.
An Allergy and Immunology elective is available for pediatric residents and fourth-year medical students. The objectives of
the elective are to:
• Develop a working differential diagnosis of allergies, asthma and primary immunodeficiencies;
• Learn how to conduct a complete physical exam, including the upper and lower airways;
• Examine and discuss patients from all major allergy and immunology categories: allergic rhinitis, asthma, urticaria, drug
allergy, food allergy and primary immunodeficiency.
In addition to medical student and resident training, the division has one of only 71 accredited programs for fellowship
training in Allergy and Immunology; Dr. David Khan is the Program Director. The Allergy/Immunology (A&I) fellowship
training program continues to train high-quality A&I specialists. Our view is that successful training in allergy and
immunology should consist of balanced exposure to training experiences involving adults and children, no matter what the
training background or the long-term plans of any particular fellow-in-training. Drs. Rebecca Gruchalla and David Khan,
the program director, oversee the adult teaching clinics at Parkland, while Drs. Maite de la Morena, Indulekha Warrier
and Drew Bird oversee the teaching clinics at Children’s. Further staffing of both adult and pediatric clinics is provided by
our 29 volunteer-clinical faculty members. Approximately 40 percent of A&I fellows have come from pediatric house staff
programs, and approximately half of the outpatient clinics attended by A&I fellows occur at Children’s.
Presentations/Teaching Activities
Rebecca Gruchalla, M.D., Ph.D.
• “Inner-city mold exposure and inner-city asthma, Workshop: Inner-city Allergens as Causes and Exacerbations of
Asthma, American Academy of Allergy, Asthma and Immunology Annual Meeting, San Francisco, March 2011
J. Andrew Bird, M.D.
• “Food Allergies in Children,” Current Trends in Family Medicine CME Conference, UT Health Science Center, Tyler,
TX, February 2011
• “Update on Oral Desensitization and Tolerance,” 13 th Annual Texas Allergy, Asthma and Immunology Society
(TAAIS), Allergy for the Allergist, Houston, TX, May 2011
• “Review of the Diagnostic Guidelines for the Diagnosis and Management of Food Allergy,” Florida Dietetic
Association, Fort Lauderdale, FL, July 2011
• “Diagnosis and Management of Food Allergy,” Pediatric Grand Rounds, UT Southwestern, October 2011
• “Food Allergy, Oral Food Challenges, and Vaccines,” American College of Allergy, Asthma and Immunology Annual
Meeting, Boston, MA, November 2011
M. Teresa (Maite) de la Morena, M.D.
• “Primary Immunodeficiency Diseases,” Dallas Internist Club, Dallas, TX, March 2011
• “Management Strategies and Outcomes for CD40Ligand,” Primary Immune Deficiency Treatment Consortium
(PIDTC) Meeting, San Francisco, CA, April 2011
• “Recurrent Candidiasis: Lessons from Primary Immunodeficiency Diseases,” Allergy/Immunology Grand Rounds,
Presbyterian Hospital, Dallas, TX, May 2011
David A. Khan, M.D.
• “Management of the Drug Allergic Patient: Utilizing Ancient Techniques in the 21 st Century,” Allergy & Immunology
Grand Rounds, National Institute of Health (NIH), Bethesda, MD, February 2011
• “Difficult Drug Allergy Cases,” American Academy of Allergy, Asthma and Immunology Annual Meeting, San
Francisco, CA, March 2011
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