Description of specialty
Immunology is a relatively new and rapidly evolving specialty. Consultants require both physician and laboratory training in parallel. Consultant time (excluding supporting professional activity time) in immunology is divided between clinical work (80%) and laboratory (20%) duties. Immunology clinical work is mainly outpatient (50% time). Other significant activities consist of day-case work including the delivery of immunotherapies, and ward work including referrals and small numbers of inpatients.
Laboratory duties include:
- complex allergic disease*: investigation of anaphylaxis, drug allergy, challenge testing, desensitisation and immunotherapy
- immunodeficiency and recurrent infection: primary (often genetic) and secondary including cases due to immunosuppression, immunotherapy or biological agents used across the medical specialties
- autoimmunity and vasculitis: including unsuspected cases identified either by immunopathology laboratory diagnostics, or as a paradoxical complication of immunodeficiency. Note that immunodeficiency cases show immune dysregulation and autoimmunity is common (eg primary antibody deficient patients frequently develop immune thrombocytopenic purpura (ITP) or other autoimmune cytopenias)
- transplantation: support both at a laboratory level and bedside to surgeons and physicians managing immunosuppression and other features
- laboratory diagnostics: immunologists play a key role in data interpretation and communication to GP and hospital requestors, especially infectious diseases, rheumatology, renal medicine, respiratory, dermatology and paediatrics.
*Allergy competence can be gained by a separate certificate of completion of specialist training (CCST) in allergy alone or via combined training with GIM, or another mainstream physician specialty, eg immunology, respiratory medicine.
People considering a career in immunology should be aware that:
- membership of both the Royal College of Physicians (MRCP) or Child Health and Paediatrics (MRCPCH) and Pathologists (MRCPath) or equivalent by examination is required
- MRCP or MRCPCH is a mandatory entry requirement, and MRCPath (Immunology – part 2) is effectively an exit examination at consultant level
- the specialty is expanding with approximately 30 numbered training posts across the UK
- co-location of patient facilities with the immunopathology laboratory is key to service provision and is a requirement of both clinical and laboratory accreditation
- much of the clinical workload relates to patients with rare or scientifically complex disorders, with clinicians managing use of expensive, novel immunotherapies, often requiring complex laboratory monitoring in parallel
- ideally specialist facilities for both adult and paediatric immunology services are co-located (same city if not same site)
- at a national level regional centres are networked, to share protocols and expertise particularly with regard to managing rare disorders
- networks based around regional hubs help to develop peripatetic outreach clinics.