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 (around 70–80%) and laboratory duties (around 20–30%). 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.