A Career in Immunology
Spurred on by continued advances in cellular and molecular biology, the science of Immunology has become one of the fastest growing areas of research of recent years. Application of the science of Immunology in Medicine is central to the practice of Clinical Immunology.
Virtually every organ system of the body can be damaged by over- or under-activity of the immune system, hence immunologists are likely to be consulted by clinical colleagues practising in a whole range of disciplines. Within the next ten years, the availability of novel therapeutic agents, for example, cytokines or monoclonal antibodies which are capable of enhancing, modifying or inhibiting immune reactions, is likely to have a major impact on the treatment of a whole range of illnesses.
The application of these novel therapies will require accurate diagnosis, which is an area that laboratory practice in Immunology will have a substantial impact. An example of such advances which have occurred in the last few years are: (i) the use of neutrophil cytoplasmic antibodies (ANCA) for the diagnosis of vasculitic disorders; (ii) the use of endomysia I antibodies and TTG antibodies to enable a rapid and convenient detection of coeliac disease and (iii) the application of lymphocyte surface marker analysis in the diagnosis of immunodeficiencies.
Research Training Opportunities
Immunology SpR posts in the UK are exclusively based in academically strong departments, thus providing excellent opportunities to obtain training in research, often leading to higher degrees.
This growth in immunology research is vastly increasing our understanding of many diseases and suggesting new treatments. However this requires doctors with highly specialised knowledge to translate advances in basic immunology into clinical practice.
The Four Principle Areas of Immunology
Doctors specialising in Immunology are involved in the study, diagnosis and management of conditions involving the immune system.
The four principle areas within the scope of Immunology are:
- Immunodeficiency (primary and secondary)
- Heteroimmune disease (allergy, hypersensitivity, transplantation)
- Autoimmunity (organ-specific and systematic diseases)
- Lymphoproliferative disease (myeloma, lymphoma etc.)
There are clearly many areas in which Immunology overlaps with traditional "organ-based" specialties, for example Respiratory Medicine (especially asthma) and Rheumatology (connective tissue diseases).
The Responsibilities of the Immunologist
The immunologist can be directly responsible for the clinical diagnosis and treatment of patients with immunological conditions. The types of patient under his/her care would depend on local needs and the interests of the individual consultant, but would typically include immunodeficiency and allergy. Combined clinics run in conjunction with consultants from other specialties expand the range of patients seen.
The Working Environment
Clinical laboratory forms an important part of the immunologist's remit. Like all sections of the health service, Immunology laboratories must adapt and respond to the requirements of patients and their consultants. Selection of the range of test offered, their interpretation, and ultimate responsibility for the results issued rests with the consultant supervising the diagnostic laboratory service. The immunologist will also identify new needs and might instigate the development of new assays as technology and knowledge of disease mechanisms advance. In this way he or she is a vital link between the patient and the diagnostic history.
In the course of training most immunologists will have opportunity to perform research. As shown earlier, Immunology is one of the most active research areas in medicine, indeed in all of science. Some individuals may choose to pursue research to higher level, probably obtaining PhD before initiating original research in their areas of interest. This could be either basic laboratory research or clinical research or a combination of both. Appropriately trained clinicians have a crucial contribution to make in Immunology research, combining clinical insight with a scientific background to identify areas of mutual importance.
There are no SHO posts in Immunology. For entry into SpR grade, MRCP is essential, thus trainees would have already received training in General Medicine up to this standard. Depending on the particular needs of the individual appointee, attachments will be arranged for spending time in those clinical disciplines with a high quotient of immunologically-mediated disorders. Possible attachments during the training programme include Nephrology, Rheumatology, Dermatology, Infectious Diseases, Respiratory Diseases and Transplantation teams.