The Allergy Immunology Training Program is highly integrated with the clinical and research activities of the UNC Department of Medicine’s Division of Rheumatology, Allergy, and Immunology, the UNC Department of Pediatrics, as well as the research activities of the Thurston Arthritis Research Center. This is a three year training program where all fellows participate in a comprehensive clinical program leading to ABAI certification after the first two years and complete a research project by the end of the third year.

In conjunction with the UNC School of Medicine and the Department of Medicine the Division coordinates educational programs for medical students, residents, and subspecialty trainees. Fellowship training is available to well-trained internists who are interested in a superior program with both clinical and bio-medical research training. Our goal is to train outstanding clinicians and research scientists for careers in academic Allergy and Immunology. Successful applicants will be highly motivated individuals with a sincere desire to pursue a career in academic medicine.

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To be eligible for admission into the program, candidates must have (at time of admission) successfully completed an ACGME approved training program in either internal medicine or pediatrics, and be licensed in good standing in the state of North Carolina to function as a resident. Non-US applicants must demonstrate appropriate visa or immigration status which allows them to function in the State of North Carolina and UNC Hospitals as a resident. All applicants must also meet any general requirements for post graduate medical training set forth by the UNC Hospitals Office of Graduate Medical Education.

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During the first year of training, A/I residents will spend 9 months in the core A/I rotation. They will also have 3 months of elective time in the first year. However A/I residents will be required to attend the A/I continuity clinics and the A/I conferences throughout the year.

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During the second year of training, there will be 8 months spent on the core 2nd year rotations and 2 months on clinical electives and 2 months on research electives. However A/I residents will be required to attend the A/I continuity clinics and the A/I conferences throughout the year.

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Although this is not mandatory we strongly urge our fellows to commit to a third year of training. During this year fellows will spend approximately 80% of their time pursuing the line of research that they had begun in years one and two, 10% of their time following their patients in continuity clinic and 10% of their time participating in didactic education.

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The breadth and depth of basic and clinical research at UNC is tremendous. In basic research, AITP faculty have a focus in three areas: Airways Inflammation, Autoimmunity, and Tumor/Transplantation Immunology. While our faculty participate in numerous industry-sponsored clinical trials, the primary clinical research focus of AITP faculty is outcomes research.

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The focus on clinical/outcomes is directed by Dr. Joanne Jordan, the associate director of the Thurston Arthritis Research Center. As one of only five centers in the country to be designated by the National Institutes of Health as a Multidisciplinary Clinical Research Center in Arthritis, the Thurston Arthritis Research Center is able to coordinate a unique array of clinical research projects and to share data and facilities among different research projects within the Center in order to accelerate the advancement of scientific knowledge and new treatments for these diseases. Clinical/outcomes research within TARC is multidisciplinary, associated with the UNC School of Public Health, one of the premier schools of public health in the country. Trainees within this component will be able to obtain a Masters of Public Health (MPH) through the association. Currently, much of the research being conducted in this component is arthritis-related, but with the collaboration between the AITP and CEMALB, more effort is being expended towards allergic and airways diseases. In addition, the TARC staff is establishing an asthma database, a joint effort between the Duke Asthma Center and UNC.

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1. Comparison of population-based quality of life measurements
2. Autoimmune biomarkers collaborative network
3. The Johnston County OA Project: arthritis & disability
4. Bioinformatics Integration Support System – a collaborative project between UNC, Research Triangle Institute, IBM and SAS to build an informatics system to support investigators of the NIAID Division of Allergy, Immunology and Transplantation.
5. Antiphospholipid Syndrome Registry (APSCORE) – a national registry to catalog and store biological samples for antiphospholipid syndrome.
6. Overcoming Racial Health Disparities

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The focus on airways inflammation is directed by Dr. Peden, the director of the UNC Center for Environmental Medicine, Asthma and Lung Biology (CEMALB).

The CEMALB is the primary UNC partner to the Human Studies Division of the National Health and Environmental Effects Research Laboratory of the US Environmental Protection Agency. These agencies are both housed in the EPA Human Studies Facility (HSF) located on the UNC Medical Center Campus and conduct a collaborative research program focused on examination of the effect of air pollutants on human health.

These studies are used by environmental policy makers within EPA and other governmental agencies as well as by the medical community at large. Additionally, laboratories of the intramural branch of the National Institute of Environmental Health Sciences (primarily the Laboratory of Pulmonary Pathobiology) also partner with the CEMALB and EPA to examine genetic risk factors for susceptibility to the effects of air pollutants. CEMALB investigators are also funded by NIH and the pharmaceutical industry. In addition to the collaborations listed above, there are other programmatic collaborations as well. There is a long standing collaboration between the pediatric allergy program and the pediatric pulmonology program. Many of the investigators of the CEMALB are from the pulmonology division and have research interests in CF, asthma and in mechanisms of airway inflammation in general, especially that involved with the innate immune system.

A number of investigators from the adult pulmonology division are also CEMALB investigators, with research interests in airway inflammation and the effect of pollutants on airway inflammation. There is also an airway physiology and particle deposition laboratory which allows for study of the regions of the airway in which particles deposit. In collaboration with CEMALB and the EPA, Dr Patel will establish a proteomics and protein microarray facility in the HSF to expand capabilities in use of proteomics and genomics in determining risk factors for susceptibility to air pollutants.

The approaches employed by CEMALB investigators broadly fall into 3 types; phase I studies of the effect of air pollutants, allergens and irritants employing human challenge studies, epidemiological studies examining the effect of ambient air pollutants on human health and in vitro studies of the effect of pollutants on tissues obtained from human volunteers. The resources available to investigators in the HSF include exposure chambers for challenge studies of human volunteers, in vitro exposure chambers for cells in culture, laboratories for examination of samples, including resources for electron microscopy, histology and cytology, molecular biology and flow cytometry. The HSF also has a fully staffed medical facility devoted entirely to translational research, including 2 bronchoscopy suites. CEMALB investigators also have access to the UNC General Clinical Research Center, including biostatistical support, nutritional support, clinical laboratory support and clinical and nursing support for studies which require overnight hospitalization for observation.

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1. Endotoxin and Bronchial Inflammation in Asthma
2. CD14 and LPS-induced inflammation in chronic bronchitis
3. Effect of Coarse Particles on airway responses in asthma
4. Genetic susceptibility to ozone-induced bronchial airway inflammatory responses in humans.
5. Effect of pollutants on systemic inflammation
6. Pharmacotherapy for pollutant induced and inflammatory lung diseases

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The focus on autoimmunity is directed by Dr. Patel, the director of the Thurston Arthritis Research Center. The Thurston Arthritis Research Center is composed of more than 70 physicians and researchers from 17 departments within the Schools of Medicine, Dentistry, Nursing and Public Health (http://tarc.med.unc.edu/faculty.php). Its research focuses on arthritis and autoimmune disorders such as rheumatoid arthritis, juvenile arthritis, blistering skin diseases, diabetes, inflammatory bowel disease, multiple sclerosis and lupus.

Examples of projects ongoing in the Autoimmunity Focus area are:

1. Autoimmune mechanisms of thrombosis
2. Anti-SM B cell regulation
3. ANCA-associated glomerulonephritis
4. T cell reactivity to GAD65
5. Molecular mechanisms of overcoming tolerance in SLE
6. Regulation of endogenous dendritic cell function by IL-10

During the first year of training, Residents will meet with Dr. Patel to discuss research interests and to inventory strengths, weaknesses and career goals of a specific resident. Each resident will then be matched with a research mentor with an active laboratory with evidence of ongoing funding. The mentor and Resident will identify a research area and specific project for the resident to pursue. The resident will then write a description of the research and plan for its completion, present this to the mentor and, when approved by the mentor, present this to Dr. Patel and Dr. Peden. The A/I resident will be expected to develop the hypothesis and research plan, be able to articulate this plan and present regular progress reports to Dr. Patel and Dr. Peden. It is expected the research developed by the A/I resident will lead to a first author publication or a significant co-authorship role and will be published in a peer reviewed journal Focus on Tumor/Transplantation Immunology

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The focus on tumor immunology is directed by Dr. Patel, the director of the Thurston Arthritis Research Center, in collaboration with the Comprehensive Cancer Center at UNC. The group of investigators that have formed this group have active and collaborative research programs that focus on the host immune response to tumors and defi ning methods to improve the response through immunization or gene therapy. All of the faculty are outstanding mentors with a strong track record of training.

Examples of projects ongoing in the Tumor/Transplantation Immunology Focus area are:

1. Role of CX3CR1 in the anti-tumor effects of NK cells
2. Antiapoptotic mechanisms in prostate cancer
3. Analysis of the thymic microenvironment in SCID
4. Immune mechanisms of transplant rejection
5. MHC in solid organ transplantation

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